In the last few years, engagement in medical care among individuals living with HIV has become a major priority among HIV medical providers and public health researchers. Engagement in medical care is an important concept as it involves the process of linking newly diagnosed individuals into medical care and retaining those individuals in care throughout the course of their infection. Although there have been major advances in the management of HIV, like the advent of Highly Active Antiretroviral Therapy, morbidity and mortality due to HIV cannot be fully reduced if the individual does not optimally retain in care. Retention in HIV medical care has become an emerging topic in HIV research, but there still remains a scarce amount of research on how to properly define retention, understand its predictors, and how it impacts HIV outcomes. The purpose of this dissertation was to evaluate retention in HIV medical care among individuals diagnosed with HIV and seeking care at an urban infectious disease clinic in Kentucky. The three specific aims of this dissertation were to: (1) compare methods in measuring retention in HIV medical care; (2) determine the predictors of poor retention in care and assess the effect of non-HIV related comorbidities have on retention over time; and (3) determine the impact early retention to medical care has on time to viral load suppression and rebound among individuals initiating Highly Active Antiretroviral Therapy. A retrospective cohort study was conducted employing a medical chart review, and patients who sought HIV care at the Bluegrass Care Clinic between January 1st 2003 and May 1st 2011 were eligible for the study. There were 1,358 patients included in the study and these individuals were followed until December 31st, 2011. The results suggested that individuals living with HIV should seek care at least once every six months (visit constancy) and that only 48.6% of the study population obtained optimal retention over time. Over time the rate of retention decreased among the study sample and those with optimal retention were more likely to suppress their viral loads compared to poor retainers.

Magister Public Health - MPH / Background: With the improvements in the effectiveness and availability of antiretroviral therapy (ART), perinatally infected children are surviving to adolescence and emerging as a significant sub-population living with HIV/AIDS in Zimbabwe. Adolescents, aged 10-19 years, face unique challenges related to adherence to chronic medication due to this period of vulnerability that is characterised by decreased parental support and supervision, decreased inhibition, increased risk-taking, and immature judgement. It is widely reported that poor adherence to ART leads to viral rebound, disease progression and drug resistance, in addition to increasing the risk of transmitting resistant strains of HIV to others. It is imperative to determine the factors that influence ART adherence among HIV positive adolescents so that effective interventions can be put in place. The current study described the factors that are associated with adherence to ART among HIV positive adolescents in Zimbabwe. Methodology: A cross-sectional survey of 136 randomly selected adolescents (10-19 years) who were receiving ART at two referral hospitals in Masvingo District in 2019 was undertaken. A questionnaire was administered to collect data on socio-demographic characteristics, adherence and factors related to adherence such as person/patient, health system, medication, disease characteristics and social factors. Clinical data were extracted from the Electronic Monitoring Patient System. SPSS v24 was used for descriptive and inferential analysis. Results: More than half of the participants (61%) had combined optimal adherence (dose adherence, schedule adherence and adhered to dietary instructions) in the previous three days. The most frequent reasons reported for missing HIV medications in the previous month was being away from home (50%); forgetfulness (25%); and having too many pills to take (25%). In bivariate analysis, only duration of time since HIV diagnosis was significantly associated with combined adherence to ART in the previous three days. Conclusion: Tailored interventions are recommended to address low adherence amongst adolescents. These interventions should include convenient clinic appointment schedules for adolescents to pick up medication, reminders to take medication, regimen change to a single dose, and peer education and adherence clubs to improve knowledge about HIV and treatment, and curb treatment fatigue.

Magister Public Health - MPH (Public Health) / Approximately 6% of all people living with HIV in 2016 are adolescents aged 10-19 years. It is reported globally that adolescents on antiretroviral therapy (ART) are at increased risk for poor retention in care, adherence and viral load suppression, compared to children and adults.