An exploration of clinic based influences that support or hinder the retention of HIV positive clients in pre-art care at a clinic in Johannesburg, South Africa from January 2010 to July 2014

Abstract

Background: Retaining people living with HIV in the continuum of care (CoC) is a major challenge internationally and in South Africa. However, health care providers can play a role in strengthening retention at different points in the continuum. Understanding the perceptions of health care providers regarding barriers to retention of HIV positive pre-antiretroviral therapy (pre-ART) clients can productively inform pre-ART patient retention programmes. Objective To explore health care worker perceptions on factors associated with retention of pre-ART clients at a clinic in the city of Johannesburg, South Africa. Methods: A cross sectional qualitative study was conducted using semi structured interview guides with a total of 11 health care providers who were comprised of the facility manager, six professional nurses and four lay counsellors in the ART programme. The respondents were purposively sampled. One-on-one interviews were conducted and audio recorded. Field notes were collected during the interviews and the recordings were transcribed after the interviews. Thematic content analysis was conducted using MaxQDA software. Results: The major finding of the research was that there is a lack of understanding of the scope and extent of pre-ART care and not all health care providers seem to get adequate preparation for tracing potential LTFU clients or retaining them in care. Informants in the study indicated as particularly problematic the late return for care by pre-ART clients, which usually occurs when clients are already very sick. Other factors that were identified as challenges include fear of disclosure, shortage of designated health care professional for pre-ART clients, lack of work space in the clinic, inadequate record keeping of patient information, concerns of disclosure and negative attitudes from staff. Clients not returning for their CD4 results, in part due to nonavailability of the results or infrequent health care visits, also led to a loss of care even before eligibility for pre-ART or ART could be determined. Conclusions: This study highlights some of the causes of non-engagement or loss to follow up (LTFU) in the HIV CoC among pre-ART individuals based on the health providers’ perceptions. The research thus provides an impetus for future research involving both health care providers and the pre-ART individuals to explore best practices that will enhance retention of pre-ART individuals in the continuum of care to attain optimal public health services.