Impact of a structured return-to-care support package on loss to follow-up among re-engaged HIV clients in rural Western Kenya

Background Loss to follow-up (LTFU) among People Living with HIV (PLHIV) on antiretroviral therapy (ART) impedes epidemic control. Clients returning to care (RTC) after disengagement remain vulnerable to LTFU. This study assessed LTFU incidence among re-engaged clients, comparing those who received a structured RTC package with those who received standard care. Methods A retrospective cohort study was conducted among randomly selected PLHIV on ART from UMB-supported sites in Kisii and Migori Counties. Clients LTFU between October 2018 and June 2019, who later RTC, were included. Outcomes were compared between those receiving the RTC package and standard care. LTFU was defined as missing a clinical encounter for over 28 days. Data were extracted from clinical forms, EMRs, and missed-appointment registers. Incidence rates were estimated using Poisson regression, and Cox proportional hazard models assessed the RTC package’s impact. Results Of the 796 eligible clients, 584 (68.1%) received the RTC package. Overall, 192 (33%) were LTFU after 4,658.1 PM (incidence 2.2/100 PM; 95% CI: 1.8–2.7). LTFU at 9 months was lower among those who received the RTC package (13% vs. 24%, p<0.001). Clients receiving RTC package were 43% less likely to be LTFU (aHR 0.57; 95% CI: 0.38–0.78). Females had higher LTFU risk (aHR 1.84; 95% CI: 1.15–2.93). These findings suggest that the RTC package substantially improves client retention and could help in maintaining treatment continuity. Conclusions The RTC package reduced subsequent LTFU, supporting scale-up in HIV programs, while targeted approaches are needed for higher-risk female clients.