{
  "abstract": "Background Loss to follow-up (LTFU) is the most extreme form of non-adherence in people living with HIV (PLWHA) and a critical barrier to achieving UNAIDS 95-95-95 targets. Engage HIV was developed at the Amedeo di Savoia Hospital in Turin, to systematically address retention in care through a proactive, multidisciplinary approach including active tracing and individualized re-engagement interventions.Methods 2161 medical records were reviewed and patients stratified into 3 categories: Optimal Retention (≥90% adherence to visits, labs and ART), Sub-optimal Retention (<90%), and LTFU (no clinical contact ≥18 months). Active tracing used regional and national health databases and registered clinical contacts. Individualized Engagement Plans were implemented for sub-optimal retention patients.Results Of 2161 PLWHA, 1338 (62%) showed optimal retention and 19 (0,8%) sub-optimal retention (Engagement Plan ongoing, with early adherence improvement observed).804 (37,2%) were classified as LTFU154 (19%) were untraceable: mean age 50.3y; 101M (66%), 53F (34%), ita 67 (43.5%), foreigners 87 (56.5%).Of 650 (81%) traceable patients:418 (64%) had died: cause was known in 258 cases (61.7%), of which 53 (20.5%) were HIV/AIDS-related and 205 (79.5%) non-HIV; cause was unknown in 160 cases (38.3%).Of 232 (36%) living patients:active tracing confirmed that 113 (49%) had been absorbed by other care centres over the years — a status that was previously uncertain or unknown for many of them: mean age 52.9y; 93M (82%), 20F (18%), ita 94 (83%), foreigners 19 (17%).21 (9%) patients actively returned to our centre as a direct result of proactive outreach: they were traced, contacted, and re-engaged through individualized care pathways: mean age 49.9y; 11M (52%), 10F (48%), ita 17 (81%), foreigners 4 (19%).22 (9.5%) patients are currently undergoing active re-engagement: mean age 56y; 17M (77%), 5F (23%), 17 ita (77%), 5 foreigners (23%)76 (33%) are under transfer verification: mean age 54y; 59M (77%), 17F (23%), 65 ita (85%), 11 foreigners (15%).Conclusions Engage HIV shows that applying systematic tracing yields real prevalence data rather than estimates, enabling accurate quantification of unmet need. Active outreach re-engaged 21 patients are the most impactful outcome in terms of individual health and prevention of onward transmission.Conversely, the over-representation of younger, non-Italian patients among the untraceable group suggests that current database strategies are less effective for mobile populations with fewer stable administrative ties. The rigorous LTFU definition (≥18 months) combined with three-tier stratification enabled targeted intervention before full disengagement. The multidisciplinary framework proved essential to building sustainable re-engagement pathways. This model is replicable as a structured tool for improving retention in care in PLWHA.",
  "authors": [
    {
      "affiliations": [
        "Tropical and Infectious Diseases Division A, Amedeo di Savoia Hospital, Turin, Italy"
      ],
      "name": "M Guastavigna"
    },
    {
      "affiliations": [
        "Tropical and Infectious Diseases Division A, Amedeo di Savoia Hospital, Turin, Italy"
      ],
      "name": "G Orofino"
    },
    {
      "affiliations": [
        "Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy"
      ],
      "name": "A Ianniello"
    },
    {
      "affiliations": [
        "Medical Science Department, University of Turin, Turin, Italy"
      ],
      "name": "A Montalbano"
    },
    {
      "affiliations": [
        "Medical Science Department, University of Turin, Turin, Italy"
      ],
      "name": "F Onelia"
    },
    {
      "affiliations": [
        "Hospital Pharmacy, Amedeo di Savoia Hospital, Turin, Italy"
      ],
      "name": "R Ranotti"
    },
    {
      "affiliations": [
        "Tropical and Infectious Diseases Division A, Amedeo di Savoia Hospital, Turin, Italy"
      ],
      "name": "S Scrignoli"
    },
    {
      "affiliations": [
        "Tropical and Infectious Diseases Division A, Amedeo di Savoia Hospital, Turin, Italy"
      ],
      "name": "G Calleri"
    }
  ],
  "title": "SC27 Engage HIV: a multidisciplinary model for proactive re-engagement and prevention of loss to follow-up in PLWHA",
  "uid": "79b9adfa-afb2-59b3-bded-47be6e0da08c"
}