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However, the relationship between facility switching and virologic outcomes, including viral rebound, is poorly understood.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used data from 40 communities (2015\u20132020) in the Rakai Community Cohort Study to estimate incidence of facility switching and viral rebound. Persons aged 15\u201349 years with serologically confirmed HIV who self-reported ART use and contributed \u22651 follow-up visit were included. Facility switching and virologic outcomes were assessed between 2 consecutive study visits (ie, index and follow-up visits, interval of approximately 18 months). Those who reported different HIV treatment facilities between index and follow-up study visits were classified as having switched facilities. Virologic outcomes included viral rebound among individuals initially suppressed (&amp;lt;200\u2005copies\/mL). Multivariable Poisson regression was used to estimate associations between facility switching and viral rebound.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, 2257 persons who self-reported ART use (median age, 35 years; 65% female, 92% initially suppressed) contributed 3335 visit-pairs and 5959 person-years to the analysis. Facility switching was common (4.8 per 100 person-years; 95% confidence interval [CI], 4.2\u20135.5) and most pronounced in persons aged &amp;lt;30 years and fishing community residents. Among persons suppressed at their index visit (n = 2076), incidence of viral rebound was more than twice as high in persons who switched facilities (adjusted incidence rate ratio = 2.27; 95% CI, 1.16\u20134.45).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Facility switching was common and associated with viral rebound among persons initially suppressed. Investments in more agile, person-centered models for mobile clients are needed to address system inefficiencies and bottlenecks that can disrupt HIV care continuity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad773","type":"journal-article","created":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T01:34:19Z","timestamp":1703036059000},"page":"1591-1600","source":"Crossref","is-referenced-by-count":4,"title":["Incidence of Health Facility Switching and Associations With HIV Viral Rebound Among Persons on Antiretroviral Therapy in Uganda: A Population-based Study"],"prefix":"10.1093","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4991-4033","authenticated-orcid":false,"given":"Joseph G","family":"Rosen","sequence":"first","affiliation":[{"name":"Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Ndyanabo","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Entebbe , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadijja","family":"Nakawooya","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Entebbe , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald M","family":"Galiwango","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Entebbe , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Ssekubugu","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Entebbe , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Ssekasanvu","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Entebbe , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungwon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pathology, School of Medicine, Johns Hopkins University , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine B","family":"Rucinski","sequence":"additional","affiliation":[{"name":"Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gertrude","family":"Nakigozi","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Entebbe , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Nalugoda","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Entebbe , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey","family":"Kigozi","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Entebbe , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas C","family":"Quinn","sequence":"additional","affiliation":[{"name":"Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, Maryland , USA"},{"name":"Rakai Health Sciences Program , Entebbe , Uganda"},{"name":"Division of Infectious Diseases, School of Medicine, Johns Hopkins University , Baltimore, Maryland , USA"},{"name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry W","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, Maryland , USA"},{"name":"Rakai Health Sciences Program , Entebbe , Uganda"},{"name":"Division of Infectious Diseases, School of Medicine, Johns Hopkins University , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin E","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, Maryland , USA"},{"name":"Rakai Health Sciences Program , Entebbe , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Entebbe , Uganda"},{"name":"Division of Infectious Diseases, School of Medicine, Johns Hopkins University , Baltimore, Maryland , USA"},{"name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of 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