# 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.

## Key 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.