“Why Patients drift away”: A Qualitative Study to Explore Factors associated with Loss to Follow-up of Patients Living with HIV in the DIMAMO Surveillance Area in Limpopo Province

Loss to follow-up (LTFU) has been reported as a recurrent challenge affecting the success of antiretroviral treatment among HIV-infected patients in low- and middle-income countries. Additionally, loss of follow-up is a significant problem associated with increased treatment failure, which can be presented through clinical, immunological, and virological failure. Lastly, LTFU exacerbates the rates of morbidity, mortality, and drug resistance among people living with HIV.

The study explores factors associated with loss to follow-up among patients living with HIV in selected public clinics under the DIMAMO surveillance area in the Capricorn district of Limpopo province.

A qualitative research approach, particularly Phenomenology, was adopted to explore and understand the experiences of registered nurses and community health workers who work with patients on antiretroviral treatment at the selected public clinics. Twenty-eight (28) participants were purposively selected. Furthermore, data were collected using semi-structured interviews. Lastly, data was analysed using Delve narrative analysis as guided by Delve and Limpaecher.

Following the process of data analysis, the study revealed that patients living with HIV often face diverse internal conflicts and significant barriers leading to loss of follow-up. The following themes emerged: 1.) Patient-related factors identified in a form of denial related to perceptions of HIV, perceptions of being healed or healthy, and lastly, not accepting responsibility for HIV health status. 2.) Significant barriers associated with disengagement from HIV care among patients were identified in the form of non-disclosure of HIV status to significant others, fear of stigmatisation, perceived breach of confidentiality, and lastly, resistance to or non-use of community healthcare interventions.

In summary, the study identified the key challenges affecting HIV care, including internal conflicts, which manifested in the form of denial, and misconceptions about health status as reported by the participants. Thus, the significant barriers to care disengagement included non-disclosure of HIV status, fear of stigma, perceived breaches of confidentiality, and resistance to community healthcare interventions.

Furthermore, these findings highlight the need for targeted interventions to improve patient retention rates. Notably, a comprehensive training program and information guide for healthcare providers can enhance their ability to support antiretroviral patients and improve treatment adherence and health outcomes.