{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:47:08Z","timestamp":1785822428940,"version":"3.56.0"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Adult males presenting with advanced HIV disease (AHD) experience disproportionate morbidity and mortality, yet retention in care patterns among this group remain insufficiently characterized. Most studies rely on single time-point retention measures, limiting understanding of how engagement evolves over time. This study examined 6- to 12-month engagement trajectories among adult males with AHD in Eswatini and explored multilevel influences shaping retention, disengagement, and re-engagement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A mixed-methods retrospective cohort study was conducted across three high-volume HIV treatment facilities. Quantitative data were abstracted from facility AHD registers and routine clinical records for adult males recorded with AHD and documented 6 and 12-month follow-up outcomes and analyzed descriptively to characterize 6- and 12-month engagement transitions. Twelve-month outcomes were classified as active (being alive and receiving antiretroviral therapy (ART) at the study facility at 12\u202fmonths, without a documented interruption exceeding 28\u202fdays) or unfavourable (death, loss to follow-up, or transfer out). Qualitative data were collected between June and September 2025 through in-depth interviews and focus group discussions with patients and healthcare workers. Thematic analysis was conducted using a socioecological framework. Quantitative and qualitative findings were integrated through joint display.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 173 participants with documented 12-month outcomes, 137 (94.5%) of men active at 6 months remained engaged at 12 months. Of the 21 men classified as lost to follow-up at 6 months, 12 (57.1%) had re-engaged by 12 months. Demographic and baseline clinical characteristics were largely not associated with 12-month outcomes. Qualitative findings identified individual (stigma, delayed acceptance), interpersonal (non-disclosure, masculinity norms), and health system factors (confidentiality concerns, tracing limitations) shaping engagement trajectories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adult males with AHD exhibited distinct engagement trajectories across the first year of ART. Six-month engagement was strongly aligned with 12-month continuity, suggesting that the early treatment period may represent an important period for retention support. The observed re-engagement among over half of those classified as LTFU at 6 months indicates that interruption within the first year can be reversible. Formalizing early retention review, strengthening case-level fidelity to the AHD package, and integrating structured psychosocial assessment within routine AHD care represent actionable directions for improving long-term engagement among men.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1819937","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:35:51Z","timestamp":1785821751000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Engagement trajectories and multilevel influences on retention among adult males with advanced HIV disease in Eswatini: a mixed-methods study"],"prefix":"10.3389","volume":"14","author":[{"given":"Fezokuhle Ncedile","family":"Khumalo","sequence":"first","affiliation":[{"name":"Georgetown University- Center for Global Health Practice and Impact","place":["Mbabane, Eswatini"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold","family":"Mafukidze","sequence":"additional","affiliation":[{"name":"Georgetown University- Center for Global Health Practice and Impact","place":["Mbabane, Eswatini"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samson","family":"Haumba","sequence":"additional","affiliation":[{"name":"Georgetown University- Center for Global Health Practice and Impact","place":["Mbabane, Eswatini"]},{"name":"Georgetown University-Center for Global Health Practice and Impact","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref1","volume-title":"WHO guidelines on the management of advanced HIV disease. 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