Adverse Childhood Experiences and Disengagement from HIV Care: A Case-Cohort Study in Tanzania

Adverse childhood experiences (ACEs) affect health 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%, 64%, 110%, and 168% 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.