Challenges in the evaluation of interventions to improve engagement along the HIV care continuum in the United States

Kathryn Risher, Ph.D, M.H.S
London School of Hygiene & Tropical Medicine

ABSTRACT:
In the United States (US), a high proportion of individuals living with HIV remain unlinked to care, disengaged from care, or incompletely adherent to antiretroviral therapy (ART). We conducted a systematic review of interventions to improve linkage to care, retention in care, re-engagement among those disengaged from care, and adherence to ART in the US. We find that the bulk of evidence (117/152 included studies) addresses adherence interventions, while a very small minority address linkage or reengagement interventions (7/152 and 4/152, respectively). There was tremendous heterogeneity in measures used to evaluate interventions. We found that most (59%) of studies report significantly improved outcomes, but the effect size was variable across studies and populations. The presentation will additionally include recommendations to address the challenges identified by the systematic review.