Adverse childhood experiences and disengagement from HIV care: a case-cohort study in Tanzania

Abstract Adverse childhood experiences (ACEs) can have lasting, detrimental effects throughout the lifespan and may influence engagement in health care. We conducted a case-cohort study in Tanzania to estimate the association between ACEs and disengagement from HIV care 12 months after initiating antiretroviral therapy (ART) among 217 adults (26 cases and 191 sub-cohort participants). Experiencing one, two, three, and four additional ACEs was significantly associated with 28% (RR a = 1.24; 95% CI: 1.05, 1.44; p -value < 0.01), 64% (RR a =1.64; 95% CI: 1.22, 2.20), 110% (RR a =2.10; 95% CI: 1.35, 3.26), and 168% (RR a =2.68; 95% CI: 1.49, 4.38) increases in the risk of disengagement from HIV care, respectively. These findings call for integrated trauma-informed mental health services within HIV care to end HIV/AIDS as a public health threat.