High Rates of Unplanned Care Interruption: Implications for Program Response

Abstract

Unplanned care interruption (UCI) is an important challenge for HIV programs in resource- limited settings (RLS). More than 1 in 3 patients will interrupt care after starting antiretroviral therapy (ART), predisposing them to poor clinical outcomes. As HIV programs in RLS adopt the new World Health Organization (WHO) treatment guidelines recommending ART for all patients, the volume of patients requiring ART, and the number of patients with UCIs will increase. In addition, reduced donor funding may drive changes at the local level that create additional barriers to care. Policy makers and program managers therefore need to adopt innovative care models to enhance retention in care. The integration of patient-centered chronic care models into HIV care delivery may provide a template for addressing these challenges while serving as a model of care for other chronic diseases. Fortunately, many President’s Emergency Fund for AIDS Relief (PEPFAR) supported HIV clinics have already incorporated some important elements of chronic care models. However, strategic efforts are needed to strengthen and develop them into comprehensive approaches to HIV care in this new era of care delivery.