Factors Associated with Antiretroviral Therapy Re-Engagement Among Men Who Have Sex with Men in South Africa: A Multi-District Analysis

Men who have sex with men (MSM) are among of the key population groups that have been disproportionately affected by the HIV epidemic globally. Hence, MSM living with HIV may experience unique challenges leading to their disengagement from and re-engagement with care. This study aimed to identify factors associated with ART re-engagement among MSM in selected districts of South African provinces. A retrospective observational study design was followed, utilising MSM routine programme data from 1 January 2018 to 31 December 2022. The programme enrolled 3337 MSM aged 16 years or older who resided in the selected provinces/districts. Descriptive statistics characterised participants’ baseline profiles. Binary logistic regression identified factors associated with re-engagement with ART. Data analysis was done using SPSS version 31.0.1.0; p < 0.05 was considered statistically significant. The district was the only statistically significant predictor of re-engagement among MSM, wherein eThekwini district had lower odds of re-engagement (aOR = 0.248, 95% CI: 0.144–0.428, p < 0.001). This represented a 75% reduction in the likelihood of re-engagement compared to the City of Tshwane. There was no association between being re-initiated on ART and HIV testing modality (aOR = 7.299, 95% CI: 0.567–94.037, p = 0.127). Future studies should longitudinally and qualitatively investigate specific programme and contextual factors driving district-level variation in re-engagement, while incorporating individual-level factors.