| Issue/Objective |
Continuity in HIV care is essential for viral load suppression and is a critical component of the UNAIDS 95-95-95 targets, yet people living with HIV in sub-Saharan Africa may change clinics because of mobility, stigma, or fragmented service delivery. Understanding whether clinic change compromises outcomes is important for people-centered and resilient HIV systems, especially with the current decline in global health funding. We estimated the association between clinic change in the past 12 months and viral load suppression among adults in HIV care across seven sub-Saharan African countries. |
| Methodology/Approach |
We pooled nationally representative Population-based HIV Impact Assessment (PHIA) data collected between 2019 and 2023 in Zimbabwe, Lesotho, Tanzania, Mozambique, Malawi, Uganda, and Eswatini. Analyses were restricted to adults living with HIV who were currently in care and had non-missing data on clinic change and viral load suppression (N=14,003). The exposure was self-reported clinic change in the past year. The outcome was viral load suppression, defined as HIV RNA <1,000 copies/mL. We used inverse-probability-of-treatment weighting with survey-weighted models to estimate adjusted risk differences. |
| Results |
Participants had a mean age of 41.6 years (standard deviation: 12.5), and 66.5% were female. Overall, 14.0% reported past-year clinic switching, ranging from 9.8% in Mozambique to 21.6% in Uganda. Participants with higher mobility, depression, and anxiety scores more often reported clinic switching, while married participants reported switching less often. Overall, 92.8% were virally suppressed, and past-year clinic switching was not associated with viral load suppression (RD: 0.6 percentage points [pp], 95% CI: −1.4 to 2.6). In subgroup analyses, urban participants who switched clinics had higher viral load suppression (RD: 3.0 pp, 95% CI: 0.8 to 5.1). Estimates from country-specific and stricter viral load threshold (<200 copies/mL) analyses did not show statistically significant associations. |
| Discussion/Conclusion |
Among adults living with HIV who remained engaged in care, changing clinics within the past year was not associated with lower viral load suppression. These findings suggest that short-term clinic mobility may not inherently compromise virologic outcomes for patients already in care, and that health systems that accommodate mobility across facilities may help sustain equitable HIV care. |
| Presenters and Affiliations |
Ronald Olum Johns Hopkins Bloomberg School of Public Health |
