Chicago study looks at ways of bringing people with HIV back into care

Researchers recruited 100 people with HIV who had fallen out of care to re-engage in HIV care
Nearly half of participants reported housing insecurity and 35% reported food insecurity
At 48 weeks, 66 participants remained in the study and 54 of them were virally suppressed

When initiated and used as directed, HIV treatment (antiretroviral therapy, ART) can reduce levels of HIV in the blood. Over time, with continued adherence, HIV falls to very low levels in the blood. These low levels are commonly called undetectable—meaning that HIV levels are so low that they cannot be detected with routinely used lab tests.

Suppressing HIV helps the immune system repair itself and allows many ART users to have a long and healthy life. Indeed, researchers project that young people who start ART today will live well into their senior years, provided they continue to take treatment and keep HIV suppressed.

Another benefit of viral suppression is that people with HIV who have an undetectable viral load cannot pass on the virus to their sexual partners.

Current situation

In an ideal world, every person with HIV would have access to care and treatment and would be able to achieve and sustain viral suppression. However, estimates from the Public Health Agency of Canada (PHAC) show that the 70,900 people living with HIV in Canada in 2024 were at the following stages of the HIV care cascade:

91% were aware of their diagnosis

86% of people diagnosed with HIV were on ART

96% of people taking ART had a suppressed viral load

While Canada has made significant progress, there is still work to do to meet global 95-95-95 targets for HIV diagnosis, treatment and viral suppression.

The latest PHAC estimates published in July 2026 show that 2,517 new HIV infections occurred in 2024—a 22.8% increase from 2022. Canada also has much work to do to stem the spread of new HIV infections.

In the U.S.

In 2019, the U.S. launched a plan to end HIV as a public health issue in that country. According to data from the U.S. Centers for Disease Control and Prevention (CDC), only about 66% of people with diagnosed HIV were virally suppressed in 2021. If the U.S. is to reduce the spread of HIV and improve health outcomes for people living with HIV, more people will need support to achieve and maintain viral suppression.

A study in Chicago

According to a team of researchers at the Ruth M. Rothstein CORE Center in Chicago, “Cook County in Illinois is 1 of the 48 counties with the highest burden of HIV transmissions in the U.S.” The team stated that helping people “who have been diagnosed with HIV but are not retained in care […] is key to [preventing] new infections.” They noted that the following factors place people with HIV at risk of not engaging in and being retained in care:

poverty

housing insecurity

lapses in [health] insurance or access to primary care

substance use disorders

mental illness

The team at the CORE Center stated that their clinic “has a low-barrier care model with many people with HIV [who seek care by attending the walk-in clinic] without pre-set appointments.”

Researchers sought non-pregnant adult participants for this Chicago study, which attempted to get people to re-engage in HIV care by at least the following means:

advertising in examination rooms

word of mouth

participant referral

The goal of the study was to try to get participants re-engaged in care so they could rapidly resume treatment and achieve better health through viral suppression. People who entered the study were offered immediate resumption of treatment with Biktarvy, a pill containing the following medicines:

bictegravir

TAF (tenofovir alafenamide)

FTC (emtricitabine)

Biktarvy is taken once daily with or without food. It is generally well tolerated and has proven highly effective in clinical trials over the past decade.

Study details

Once recruited, participants underwent detailed interviews, and their medical and HIV histories were reviewed. Researchers also helped participants try to identify factors that might have had an impact on their health and treatment. In addition to checking for the previously listed factors that co

food insecurity

low health literacy

internalized stigma and disclosure concerns

request for mental health services

Participants underwent medical examinations and had blood and urine samples collected for analysis. They also received small amounts of money (between $25 and $50) at visits to the study clinic at different points over the course of the year.

Researchers were able to enroll 100 participants whose average profile was as follows:

age – 37

sex: cisgender males – 68, cisgender females – 24, transgender females – 6, transgender males or non-binary – 2

time off ART – five months

viral load – 11,084 copies/mL

CD4+ count – 310 cells/mm3 (this ranged from as low as 6 to as high as 1,624 cells/mm3)

Participants had high levels of competing priorities, with 46% experiencing housing insecurity and 35% experiencing food insecurity. In addition, 33% of participants disclosed that they had concerns about their ability to take ART daily. A total of 22% of participants disclosed substance use and 23% requested mental health services.

Results

Over time, participants dropped out of the study. Researchers had staff attempt to stay in contact with participants via text messages and phone calls. However, staff found that over the course of the study some participants stopped responding to messages and calls, and some phone numbers were no longer in service.

week 1 – 100%

week 4 – 86%

week 12 – 64%

week 24 – 70%

week 48 – 66%

Biktarvy was well tolerated, and most side effects were rated as either mild or moderate. No one left the study because of side effects related to Biktarvy. Furthermore, none of the participants developed HIV that was resistant to the medicines in Biktarvy.

Researchers found that participants who disclosed concerns about adherence at the start of the study were significantly more likely to have difficulty suppressing HIV.

Success with caveats

Retaining 66% of participants in the study and keeping 54 of them virally suppressed is a significant achievement. People in the study faced many challenges in their lives and to their health. Finding safe housing and enough food to eat every day is time consuming and demoralizing, and it likely took priority over accessing healthcare.

People were enrolled in the Chicago study between September 2020 and the summer of 2021, when the COVID-19 pandemic was still going strong. The pandemic likely presented additional challenges for retaining participants in the study.

Long-acting ART

In recent years, long-acting injectable formulations of ART have become more widely used in the U.S. In the present study, only two participants switched from daily oral ART to long-acting injectable ART. In the future, more people who face challenges with adherence may benefit from long-acting ART. However, long-acting ART cannot by itself address the challenges created by a lack of affordable housing, insufficient access to food, or undiagnosed, untreated or poorly managed mental health issues.

A future CATIE News bulletin will explore the use of long-acting ART in people who have challenges with adherence.

Keeping people in care

If the spread of HIV is to be ended as a public health issue, more resources will need to be invested in HIV clinics and NGOs so they can provide care and support that meets the needs of their patients. Clinics may also need to hire what the researchers call “personal retention specialists” to conduct regular check-ins with patients and help ensure that they remain engaged in care and treatment.

Research into the needs of people with HIV who are at risk of falling out of care, or who have already fallen out of care, is essential. Reaching 100% viral suppression among people taking ART may seem utopian, but without such progress, improving the health of people with HIV and halting the spread of this virus will not be possible.

Huhn GD, Osborn R, Roden L, et al. The COMEBACK Study: Social determinants of health impact on virologic suppression in a 48-week low-barrier-care study of rapid antiretroviral therapy reinitiation among persons with HIV lost to care. Open Forum Infectious Diseases. 2026 Apr 18;13(5): ofag216.

From Canadian AIDS Treatment Information Exchange (CATIE).
This content was originally published by CATIE, Canada’s source for HIV and hepatitis C information.