---
title: "Impact of a Person-Centered Care Intervention on HIV Treatment Reengagement in Zambia"
id: "plos-medicine-2-effect-of-a-person-centered-care-intervention-on-return-and-sustained"
canonical_url: "https://medichelpline.com/clinical-feed/plos-medicine-2-effect-of-a-person-centered-care-intervention-on-return-and-sustained"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PLOS Medicine"
source_url: "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052"
published_at: "2026-09-01T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Impact of a Person-Centered Care Intervention on HIV Treatment Reengagement in Zambia
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-medicine-2-effect-of-a-person-centered-care-intervention-on-return-and-sustained
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PLOS Medicine
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052)
- **Published At:** 2026-09-01T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This study analyzed the effect of a **person-centered care (PCC)** intervention on the reengagement of individuals with HIV after treatment interruptions (TIs). - Conducted in Zambia, the **stepped-wedge, cluster randomized trial** evaluated 24 clinics over 26 months. - The intervention included healthcare worker training, feedback on client experiences, and facility-level incentives. - Results showed a **72.3%** return rate after TIs in the PCC group compared to **67.7%** in the control group, an increase of **4.6%**. - Among those who returned, the incidence of repeat TIs was **44.3%** for the intervention versus **55.6%** for control. - Overall, **82.7%** of returners remained engaged in care at 12 months post-return in the intervention group, compared to **73.4%** in control. - The analysis concluded that targeting **healthcare worker behavior** improves client experiences and supports sustained retention in care, addressing barriers to reengagement effectively throughout lower-income healthcare settings.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosmedicine%2Farticle%3Fid%3D10.1371%2Fjournal.pmed.1005052) * * About * Browse * Publish * [](https://journals.plos.org/plosmedicine/ "PLOS Medicine") * Search [advanced search](https://journals.plos.org/plosmedicine/search) * 0 [Save](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005052#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005052#savedHeader) * 0 [Citation](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005052#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005052#citedHeader) * 25 [View](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005052#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005052#viewedHeader) * 0 [Share](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005052#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005052#discussedHeader) Open Access Peer-reviewed Research Article # Effect of a person-centered care intervention on return and sustained reengagement after treatment interruptions from HIV care in Zambia: A post-hoc analysis of a stepped-wedged cluster randomized trial * Aaloke Mody , Roles Conceptualization, Data curation, Formal analysis, Investigation, Project administration, Supervision, Validation, Writing – original draft, Writing – review & editing * E-mail: aaloke.mody@wustl.edu Affiliation Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-3787-365X ](https://orcid.org/0000-0003-3787-365X "ORCID Registry") ⨯ * Kombatende Sikombe, Roles Conceptualization, Investigation, Project administration, Writing – review & editing Affiliations Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-8187-8661 ](https://orcid.org/0000-0002-8187-8661 "ORCID Registry") ⨯ * Sandra Simbeza, Roles Investigation, Project administration, Writing – review & editing Affiliation Centre for Infectious Disease Research in Zambia, Lusaka, Zambia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-0150-3369 ](https://orcid.org/0000-0002-0150-3369 "ORCID Registry") ⨯ * Njekwa Mukamba, Roles Investigation, Project administration, Writing – review & editing Affiliation Centre for Infectious Disease Research in Zambia, Lusaka, Zambia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-5757-6858 ](https://orcid.org/0000-0002-5757-6858 "ORCID Registry") ⨯ * Laura K. Beres, Roles Conceptualization, Project administration, Supervision, Writing – review & editing Affiliation Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-4731-7828 ](https://orcid.org/0000-0002-4731-7828 "ORCID Registry") ⨯ * Jake M. Pry, Roles Data curation, Project administration, Writing – review & editing Affiliations Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, Department of Public Health Sciences, School of Medicine, University of California, Davis, California, United States of America [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-6312-4420 ](https://orcid.org/0000-0001-6312-4420 "ORCID Registry") ⨯ * Anjali Sharma, Roles Conceptualization, Investigation, Project administration, Supervision, Writing – review & editing Affiliation Centre for Infectious Disease Research in Zambia, Lusaka, Zambia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-8189-0732 ](https://orcid.org/0000-0002-8189-0732 "ORCID Registry") ⨯ * Jacob Mutale, Roles Data curation, Investigation, Resources, Software, Writing – review & editing Affiliation Centre for Infectious Disease Research in Zambia, Lusaka, Zambia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-8914-0645 ](https://orcid.org/0000-0002-8914-0645 "ORCID Registry") ⨯ * Alida Zulu Dube, Roles Investigation, Writing – review & editing Affiliation Centre for Infectious Disease Research in Zambia, Lusaka, Zambia ⨯ * Musunge Mulabe, Roles Data curation, Investigation, Writing – review & editing Affiliation Centre for Infectious Disease Research in Zambia, Lusaka, Zambia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0001-9722-4558 ](https://orcid.org/0009-0001-9722-4558 "ORCID Registry") ⨯ * Lloyd Mulenga, Roles Supervision, Writing – review & editing Affiliation Zambian Ministry of Health, Lusaka, Zambia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-1044-4209 ](https://orcid.org/0000-0002-1044-4209 "ORCID Registry") ⨯ * Suilanji Sivile, Roles Supervision, Writing – review & editing Affiliation Zambian Ministry of Health, Lusaka, Zambia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0005-3072-475X ](https://orcid.org/0009-0005-3072-475X "ORCID Registry") ⨯ * April Ratliff, Roles Formal analysis, Visualization, Writing – review & editing Affiliation Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-4473-2951 ](https://orcid.org/0000-0003-4473-2951 "ORCID Registry") ⨯ * Charles W. Goss, Roles Formal analysis, Supervision, Writing – review & editing Affiliation Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-2682-7316 ](https://orcid.org/0000-0003-2682-7316 "ORCID Registry") ⨯ * Charles B. Holmes, Roles Funding acquisition, Supervision, Writing – review & editing Affiliation Center for Innovation in Global Health, Georgetown University, Washington, D.C., United States of America [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-7924-6761 ](https://orcid.org/0000-0002-7924-6761 "ORCID Registry") ⨯ * Carolyn Bolton Moore, Roles Conceptualization, Funding acquisition, Project administration, Supervision, Writing – review & editing Affiliations Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, Division of Infectious Diseases, University of Alabama, Birmingham, Alabama, United States of America [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-9103-7746 ](https://orcid.org/0000-0001-9103-7746 "ORCID Registry") ⨯ * Izukanji Sikazwe, Roles Conceptualization, Funding acquisition, Project administration, Supervision, Writing – review & editing Affiliations Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-3898-2607 ](https://orcid.org/0000-0002-3898-2607 "ORCID Registry") ⨯ * [ ... ], * Elvin H. Geng Roles Conceptualization, Funding acquisition, Project administration, Supervision, Writing – review & editing Affiliation Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-0825-1424 ](https://orcid.org/0000-0002-0825-1424 "ORCID Registry") ⨯ * [ view all ] * [ view less ] # Effect of a person-centered care intervention on return and sustained reengagement after treatment interruptions from HIV care in Zambia: A post-hoc analysis of a stepped-wedged cluster randomized trial * Aaloke Mody, * Kombatende Sikombe, * Sandra Simbeza, * Njekwa Mukamba, * Laura K. Beres, * Jake M. Pry, * Anjali Sharma, * Jacob Mutale, … * Alida Zulu Dube, * Musunge Mulabe ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: September 1, 2026 * * [Article](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052) * [Authors](https://journals.plos.org/plosmedicine/article/authors?id=10.1371/journal.pmed.1005052) * [Metrics](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005052) * [Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005052) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pmed.1005052) * [Abstract](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052#abstract0) * [Author summary](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052#abstract1) * [Introduction](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052#sec004) * [Methods](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052#sec005) * [Results](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052#sec013) * [Discussion](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052#sec014) * [Supporting information](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052#sec015) * [Acknowledgments](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052#ack) * [References](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052#references) * [Reader Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005052) * [Figures](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005052) ## Abstract ### Background Poor client-provider interactions lead to reinforcing cycles of treatment interruptions (TIs) from HIV care and fear of return, undermining sustained retention. We previously demonstrated a multi-component person-centered care intervention (PCC) targeting healthcare worker (HCW) behavior improved client experience and retention in HIV care. To understand mechanisms of improved retention, we evaluated the effect of the PCC intervention on return after TIs and sustained retention after return in a post-hoc analysis, hypothesizing that friendlier HCW attitudes enable successful reengagement into care. ### Methods and findings We implemented the PCC intervention at 24 clinics in Zambia in a stepped-wedge, cluster randomized trial from Aug 2019 to Nov 2021. Clinics were allocated into 4 groups (8 clinics in Groups 1 and 4, and 4 each in Groups 2 and 3) and randomly assigned to crossover from control to intervention every 6 months. Under control, clinics provided routine HIV care without additional support. Afterwards, clinics received the PCC intervention targeting caring aspects of HCW behavior with 1) training and coaching on PCC practices, 2) measurement and feedback of client experience (via exit interviews), and 3) small facility-level incentives. We examined individuals living with HIV who became >30 days late to a scheduled visit (i.e., TI), categorizing intervention exposure based on the last visit prior to TI. We used electronic health records to assess the effect of the PCC intervention on 1) return to HIV care after a TI, and 2) repeat TIs among those who returned. We used multistate analytic methods to estimate crude incidence of return and repeat TIs and prevalence of being in care at 1-year. We used shared frailty Cox proportional hazards and mixed-effects Poisson models to obtain formal comparisons that accounted for the stepped-wedge design. Individuals were censored at intervention crossover or database closure. During the study period, 128,910 clients (_n_ = 69,671 control, _n_ = 59,239 intervention) became >30 days late (64.3% female, median age 38y [IQR 31,45], median years in care 2.5y [IQR 0.6,6.7]). The PCC intervention increased incidence of return after TI at 12-months (72.3% intervention versus 67.7% control, crude risk difference [RD] +4.6% [CI 4.1,5.2], adjusted hazard ratio [aHR] 1.16 [CI 1.12,1.20]; _p_ < 0.001). Among returners, the intervention decreased incidence of repeat TIs (44.3% versus 55.6%, RD −11.4% [CI −12.2,−10.6], aHR 0.50 [CI 0.45,0.55]; _p_ < 0.001) and increased the proportion in care (with or without repeat TIs) (82.7% versus 73.4%, RD +9.3% [CI 8.6,10.0], adjusted risk ratio [aRR] 1.14 [CI 1.05,1.25]; _p_ = 0.002) at 12-months after return. Overall, the PCC intervention increased the proportion in care 12-months after a TI from 51.5% to 60.1% (RD +8.7% [CI 8.0,9.3], aRR 1.19 [CI 1.05,1.35]; _p_ = 0.008). Effect sizes were similar in direction and magnitude in multiple sensitivity analyses with varying precision. Limitations included post-hoc analysis and those associated with stepped-wedge design. ### Conclusions The PCC intervention likely improved rates of return to care after TIs, sustained reengagement after return, and overall retention among individuals with TIs. Strategies targeting caring aspects of HCW behavior and client experience may help lower barriers to and address persistent challenges with reengagement in care. ## Author summary ### Why was this study done? * Treatment interruptions (TIs) remain one of the most enduring challenges to sustained viral suppression in HIV care, and most people who interrupt will go on to have repeat lapses. * Poor, disrespectful client-provider interactions are a key but under-addressed barrier that can foster fear, guilt, and reluctance to return, yet there are still few evidence-based strategies to improve return to care and durable reengagement in this critical population. * We previously showed that a person-centered care (PCC) intervention targeting healthcare worker behavior improved client experience and overall retention, and in this manuscript we sought to understand the mechanism of that improvement—whether it worked by helping people return to care, helping them stay in care after returning, or both. ### What did the researchers do and find? * We implemented the PCC intervention—comprising healthcare worker training and coaching, systematic measurement and feedback of client experience, and a small facility-level incentive—at 24 public HIV facilities in Lusaka, Zambia, in a stepped-wedge, cluster randomized trial, and used electronic health records to study reengagement among 128,910 individuals who experienced a treatment interruption. * The proportion of people who returned to care 1 year after a treatment interruption was greater in the PCC intervention arm (72.3% intervention versus 67.7% control) and, among those who returned, there were fewer repeat TIs (44.3% versus 55.6%) and a higher proportion remaining in care (82.7% versus 73.4%) in the intervention arm. * Overall, the proportion of individuals in care 1 year after a treatment interruption was 60.1% in the PCC intervention arm and 51.5% in control. * These results were robust in multiple sensitivity analyses that varied key design and analytic decisions, although time-to-event estimates restricted to Groups 1 and 4 were less precise and did not meet conventional significance thresholds. ### What do these findings mean? * Targeting the caring aspects of healthcare worker behavior and improving client experience can lay the foundation for easier reengagement, facilitating people both returning to care and staying in care after a treatment interruption. * These improvements were achieved among individuals with TIs—a population that has face persistent challenges with improving outcomes and represents a remaining frontier in achieving population-level viral suppression. * Investing in client-centered care environments may be a feasible, sustainable, and effective public health strategy, with relevance not only for HIV care but for longitudinal primary and chronic disease care across low- and middle-income settings. * Limitations included the post-hoc nature of the analysis, unequal observations times due to stepped-wedge design, and possibility of selection bias as the PCC intervention may have prevented TIs to begin with. ## Figures ![Fig 3](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005052.g003) ![Fig 4](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005052.g004) ![Table 2](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005052.t002) ![Fig 1](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005052.g001) ![Table 1](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005052.t001) ![Fig 2](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005052.g002) ![Fig 3](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005052.g003) ![Fig 4](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005052.g004) ![Table 2](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005052.t002) ![Fig 1](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005052.g001) ![Table 1](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005052.t001) ![Fig 2](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005052.g002) **Citation:** Mody A, Sikombe K, Simbeza S, Mukamba N, Beres LK, Pry JM, et al. (2026) Effect of a person-centered care intervention on return and sustained reengagement after treatment interruptions from HIV care in Zambia: A post-hoc analysis of a stepped-wedged cluster randomized trial. PLoS Med 23(9): e1005052. https://doi.org/10.1371/journal.pmed.1005052 **Academic Editor:** Ruanne V. Barnabas, Mass General Brigham, UNITED STATES OF AMERICA **Received:** March 26, 2026; **Accepted:** July 28, 2026; **Published:** September 1, 2026 **Copyright:** © 2026 Mody et al. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** Data are available upon request. The Government of Zambia allows data sharing when applicable local conditions are satisfied.
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