1319. Events of Disengagement from HIV care and Subsequent Reengagement in a Kenyan Pastoralist Community: Frequency, Determinants, and Patient Views

BACKGROUND: Regular follow-up HIV-infected patients on antiretroviral therapy (ART) is vital to ensure viral suppression, thus reducing HIV transmission, and HIV-related morbidity and mortality. However, some patients have been reported to have events of disengagement from care with subsequent re-engagement in care, though knowledge on the magnitude and determinants of this phenomenon, particularly in pastoralist communities is scarce. METHODS: A mixed-methods study was carried out among HIV-infected patients on antiretroviral therapy (ART) follow-up between January 2014 and June 2017 at the Baringo County Referral Hospital, Kabarnet, Kenya. Records on their clinic attendance and laboratory follow-up were extracted, and those noted to have a recent event of disengagement from care who later re-engaged in care, were then purposively sampled for in-depth interviews. RESULTS: 342 patient records were analyzed, of which 48% (166/342) of the patients were noted to be active at the end of the study period, with 63.3% (105/166) of them noted to have one or more events of disengagement from care. Female patients, patients with baseline CD4 counts ≥200 cells/mm3, and patients with a low WHO stage category (I and II) were more likely to return to care after an experience of disengagement from HIV care (P < 0.05). Eight interviewee transcripts showed the following reported reasons for disengagement in care: long distances, stigma, work-related problems, medication side effects, competing priorities, perceived recovery of the health status, medication fatigue, and not being informed of their clinic return dates. Motivators for re-engagement in care included hospital admissions, fear of getting sick like their spouse, and phone reminders. CONCLUSION: A vast majority of patients currently active in care experienced multiple events of disengagement from care. Thus, early identification of those who disengage from care is recommended, before they become lost to follow-up. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.