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Engagement in HIV Care at CROI
Interventions to Support Engagement in HIV Care From CROI 2025

Released: April 09, 2025

Expiration: April 08, 2026

Marissa Becker
Marissa Becker, MSc, MD, FRCPC (Public Health)
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Key Takeaways
  • Positive interactions between patients and healthcare professionals can improve retention in care.
  • Financial incentives can initiate improvement in care-seeking behavior, but additional support is needed to sustain these changes.
  • Gender-specific support could be a feasible, scalable way to improve retention in care.

Since HIV was first identified, there have been tremendous advancements in the efficacy, ease of use, and tolerability of antiretroviral therapy (ART). Despite this, significant gaps in engagement in care remain. Care interruption is common globally, with drop-out rates ranging from approximately 15% to 50%, depending on region and other contextual factors, such as age. New strategies and approaches are required to support engagement in care for people living with HIV. At the Conference on Retroviruses and Opportunistic Infections (CROI) 2025, investigators presented several impactful studies from across Africa on innovations and interventions to improve retention in care.

Novel Strategies Are Needed to Support Engagement in Care
Odiya and colleagues examined data from the Rakai Community Cohort Study (2021-23) to understand the care status of people with HIV viremia. In this cohort, 10.1% of people were viremic, indicating a high proportion with viral suppression. However, among those with viremia, the vast majority, 82.9%, were not actively engaged in care.

This suggests there is a need for novel outreach strategies to support those who are disengaged from care and to address the factors contributing to disengagement.

Improving Patient–Healthcare Worker Interactions
To understand whether more positive patient–healthcare worker interactions could improve retention in care after a previous treatment interruption, Mody and colleagues employed a multicomponent, person-centered, care intervention (PCCi) targeting healthcare worker behavior, examining its effect on improving patient experience and retention in care for people living with HIV across 24 clinics in Zambia.

Among 128,901 people who were more than 30 days late to scheduled care visits, the PCCi led to an increased rate of reengagement in care at 12 months: 72.3% among people in the intervention group compared to 67.7% among people in the control group. Overall, PCCi increased the proportion of individuals retained in care 12 months after a treatment interruption from 51.5% to 60.1%.

Provision of Financial Incentives
Solis and colleagues investigated whether small, short-term financial incentives could improve care-seeking behaviors among people starting on antiretroviral therapy (ART) in Tanzania.

Although significant reductions in missed appointments and treatment interruptions were seen during the 6 months that financial incentives were offered, no effect was seen once the incentives were discontinued. Investigators concluded that the data suggest additional support is needed to sustain behavioral changes.

Gender-Specific Support for Engagement in Care

In many contexts, men are less likely than women to stay engaged in care. To determine whether male-specific peer counseling could improve engagement in HIV care, Dovel and colleagues conducted a randomized, controlled trial at 13 health facilities among men living with HIV in Malawi who had never been in care. One group received male-specific counseling, performed in community settings by male lay-cadre. Another group received male-specific counseling and home-based ART initiation by trained nurses. The third group received a stepwise intervention that escalated from male-specific counseling to ongoing psychosocial support from mental health professionals, to home-based ART initiation by trained nurses.

Although investigators found no difference between groups in the composite primary outcome of ART initiation within 90 days of trial enrollment and 6-month retention in HIV care, they reported that the group receiving counseling by male lay-cadre demonstrated a slightly better 6-month rate of retention in care, compared to the group receiving home-based ART initiation from nurses.

I think this presents a feasible and potentially scalable option to support engagement in care.

Although these 3 innovative interventions were implemented and evaluated in African contexts, the knowledge generated from these studies present important considerations for people living with HIV in other environments, including in my country, Canada.

It is disappointing, although perhaps not surprising, to see that the impact of financial incentives was not sustained post intervention. I think there is still more to understand as to why male-specific counseling was more effective than ART initiation by nurses, and this would be interesting to explore in other contexts.

Most importantly, the findings from the PCCi study highlight the importance of respectful and safe care. I find that these data illustrate how healthcare workers must play an active role in dispelling stigma and engaging people in care. However, there remains need for additional research on approaches to enhance care outcomes, improve survival of people living with HIV, and reduce onward transmission.

Your Thoughts
How do you promote engagement and retention in HIV care in your practice? Leave a comment to join the discussion!