Characteristics of new and re-initiating antiretroviral therapy clients in Malawi: implications for client counseling in resource-constrained settings.

Authors

Marguerite Thorp, Kelvin Balakasi, Isabella Robson, Colbert Lemani, Sam Phiri, Risa Hoffman, Morna Cornell, Kathryn Dovel

Published in

Global health action. Volume 19. Issue 1. Pages 2740360. Epub Oct 06, 2026.

Abstract

New antiretroviral treatment (ART) initiates and re-initiators (returning after interruption in treatment [IIT], defined as ≥28 days late for refill) are at higher risk of future IIT compared to stable clients. Counseling is a core strategy to increase retention among new initiates, but little is known about whether re-initiators may have different counseling needs. We compared sociodemographic and psychosocial characteristics of new initiates and re-initiators. We enrolled ART clients ≥15 years living in nine facility catchment areas across three regions of Malawi. We conducted a survey with domains on sociodemographics, ART history, mobility, depression (positive screen: ≥8 on WHO Self-Reporting Questionnaire), and alcohol use (hazardous use: ≥4 for men, ≥3 for women on AUDIT-C). We used Wilcoxon rank-sum and chi-squared tests to assess differences between new initiates and re-initiators. Between September 2023 and April 2025 we screened 1,332 and enrolled 840 eligible ART clients (239 new initiates [28%]). Median age was 38 years; 61% were female. New initiates were more likely than re-initiators to be younger (33 vs. 39 years, p < 0.01), pregnant (21% vs. 4%, p < 0.01), unaware of spouse's HIV status (63% vs. 4%, p < 0.01), screened positive for depression (48% vs. 26%, p < 0.01), and reporting high-risk alcohol usage (34% vs. 19%, p = 0.03). New initiates were less likely to be mobile (21% traveled ≥30 nights in last 12 months vs. 60%, p < 0.01). Counseling should address different needs for new vs. re-initiating clients, targeting depression, alcohol use and disclosure among all clients, disclosure and DSD models for new initiates, and mobility for re-initiators.

PMID:
42834876
Bibliographic data and abstract were imported from PubMed on 06 Oct 2026.

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