{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T17:00:16Z","timestamp":1792429216955,"version":"4.5.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T00:00:00Z","timestamp":1700611200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH\/National Institute of Mental Health and Neurosciences","award":["R01MH104132"],"award-info":[{"award-number":["R01MH104132"]}]},{"DOI":"10.13039\/100000061","name":"NIH\/Fogarty International Center","doi-asserted-by":"crossref","award":["D43TW009343"],"award-info":[{"award-number":["D43TW009343"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000060","name":"NIH\/ National Institute of Allergy and Infectious Diseases","doi-asserted-by":"crossref","award":["U01AI150510-02"],"award-info":[{"award-number":["U01AI150510-02"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Antiretroviral therapy (ART) assures major gains in health outcomes among people living with HIV, however, this benefit may not be realized by all due to care interruptions. Mobile populations comprise a subgroup that is likely to have sub-optimal care engagement, resulting in discontinuation of ART. We sought to evaluate the barriers to care engagement among highly mobile individuals living with HIV and explore options aimed at improving engagement in care for this group.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Qualitative in-depth interviews were conducted in 2020 among a purposive sample of twelve persons living with HIV and eight health care providers in western Kenya, within a mixed methods study of mobility in communities participating in the SEARCH trial (NCT01864603). We explored the barriers to care engagement among mobile individuals living with HIV and explored different options aimed at enhancing care engagement. These included options such as a coded card containing treatment details, alternative drug packaging to conceal drug identity, longer refills to cover travel period, wrist bands with data storage capability to enable data transfer and \u201cwarm handoff\u201d by providers to new clinics upon transfer. Data were inductively analyzed to understand the barriers and acceptability of potential interventions to address them.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Stigma and lack of disclosure, rigid work schedules, and unpredictability of travel were major barriers to care engagement for highly mobile individuals living with HIV. Additionally, lack of flexibility in clinic schedules and poor provider attitude were identified as health-system-associated barriers to care engagement. Options that enhance flexibility, convenience and access to care were viewed as the most effective means of addressing the barriers to care by both patients and providers. The most preferred option was a coded card with treatment details followed by alternative drug packaging to conceal drug identity due to stigma and longer refills to cover travel periods.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Highly mobile individuals living with HIV desire responsive, flexible, convenient and patient-centered care delivery models to enhance care engagement. They embraced simple health delivery improvements such as coded cards, alternative drug packaging and longer refills to address challenges of mobility.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0288087","type":"journal-article","created":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T18:36:55Z","timestamp":1700678215000},"page":"e0288087","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Improving care engagement for mobile people living with HIV in rural western Kenya"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0324-4006","authenticated-orcid":true,"given":"James","family":"Ayieko","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin D.","family":"Charlebois","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Maeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3817-4386","authenticated-orcid":true,"given":"Lawrence","family":"Owino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marguerite","family":"Thorp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Bukusi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya L.","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses R.","family":"Kamya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane V.","family":"Havlir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol S.","family":"Camlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,11,22]]},"reference":[{"key":"pone.0288087.ref001","year":"2023","journal-title":"WHO fact sheet report"},{"issue":"2","key":"pone.0288087.ref002","doi-asserted-by":"crossref","first-page":"e0244936","DOI":"10.1371\/journal.pone.0244936","article-title":"Mitigating the impact of COVID-19 on tuberculosis and HIV services: A cross-sectional survey of 669 health professionals in 64 low and middle-income countries.","volume":"16","author":"MS Khan","year":"2021","journal-title":"PLoS One."},{"key":"pone.0288087.ref003","year":"2022","journal-title":"UNAIDS Global HIV &AIDS Statistics- factsheet"},{"issue":"9","key":"pone.0288087.ref004","doi-asserted-by":"crossref","first-page":"e0256540","DOI":"10.1371\/journal.pone.0256540","article-title":"Why do patients interrupt and return to antiretroviral therapy? Retention in HIV care from the patient\u2019s perspective in Johannesburg, South Africa.","volume":"16","author":"MA Bisnauth","year":"2021","journal-title":"PLoS One."},{"key":"pone.0288087.ref005","author":"UNAIDS","year":"2014","journal-title":"An ambitious treatment target to help end the AIDS epidemic"},{"issue":"9657","key":"pone.0288087.ref006","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/S0140-6736(08)61697-9","article-title":"Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model","volume":"373","author":"RM Granich","year":"2009","journal-title":"Lancet"},{"issue":"Suppl 1","key":"pone.0288087.ref007","doi-asserted-by":"crossref","first-page":"S159","DOI":"10.1086\/425270","article-title":"Patterns of movement and risk of HIV infection in rural Zimbabwe","volume":"191","author":"MP Coffee","year":"2005","journal-title":"Journal of Infectious 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