Patient Perspectives on Leaving, Disengaging, and Returning to HIV Care.

Continuity of care is the cornerstone of all modern HIV disease management guidelines. Interruptions in care due to disengagement or moving between HIV care centers are common occurrences often contributing to poorer health. In order to understand why patients disengage from HIV care we first document movement into and out of our regional population since 2001 and then interview returning patients about their underlying motivations leaving or transferring care. Overall, 47% of all patients either disengaged (i.e., lost-to-follow-up) or moved away from local HIV care; 16% returned. Motivations and underlying reasons stated by patients who moved were different than for patients who disengaged from care. "Feeling well' and 'loss of interest' most often led to dropping out of care, whereas as employment or family issues predicated more formal moves. Reengaging to HIV care was commonly related to health concerns. Understanding patient's motivations underlying discontinuation of care will help provide insight into the reasons that patients themselves find important thus improving outcomes.