Adverse childhood experiences and disengagement from HIV care: a case-cohort study in Tanzania

TL;DR

This study in Tanzania found that adverse childhood experiences increase the risk of disengaging from HIV care, highlighting the need for mental health support in HIV treatment.

Contribution

The study demonstrates a dose-response relationship between adverse childhood experiences and disengagement from HIV care in Tanzania.

Findings

Each additional adverse childhood experience significantly increases the risk of disengagement from HIV care.

Experiencing four ACEs increases disengagement risk by 168% compared to no ACEs.

The study emphasizes the need for trauma-informed mental health services in HIV care.

Abstract

Adverse childhood experiences (ACEs) can have lasting, detrimental effects throughout the lifespan and may influence engagement in health care. We conducted a case-cohort study in Tanzania to estimate the association between ACEs and disengagement from HIV care 12 months after initiating antiretroviral therapy (ART) among 217 adults (26 cases and 191 sub-cohort participants). Experiencing one, two, three, and four additional ACEs was significantly associated with 28% (RRa= 1.24; 95% CI: 1.05, 1.44; p-value < 0.01), 64% (RRa=1.64; 95% CI: 1.22, 2.20), 110% (RRa=2.10; 95% CI: 1.35, 3.26), and 168% (RRa=2.68; 95% CI: 1.49, 4.38) increases in the risk of disengagement from HIV care, respectively. These findings call for integrated trauma-informed mental health services within HIV care to end HIV/AIDS as a public health threat.

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