Understanding why HIV-infected persons disengaged from pre-ART care in Freetown, Sierra Leone: a qualitative study^*

* 8th International Conference of HIV Treatment and Prevention Adherence; Miami, FL, USA; June 2013.

ABSTRACT

In countries that have not implemented universal antiretroviral treatment (ART), loss to follow-up (LTFU) during pre-ART care remains a problem. We conducted semi-structured interviews with 41 HIV-infected persons who were LTFU during pre-ART care from a prospective cohort of persons newly diagnosed with HIV infection in Freetown, Sierra Leone, in 2012–2013. Interviews determined whether the participant disengaged or transferred care and explored the reasons for being LTFU. Of the 41 participants, 34 (83%) disengaged from care. For persons who disengaged from care, socioeconomic barriers emerged as a dominant theme in both ART-eligible and -ineligible groups while psychosocial barriers emerged as a dominant theme in the ART-ineligible group. Structural barriers emerged as a dominant theme for participants who transferred care. Interventions designed to address socioeconomic and psychosocial barriers may help reduce disengagement from pre-ART care.

KEYWORDS:

• HIV/AIDS
• HIV care continuum
• retention
• public health
• barriers to care
• Sierra Leone

Acknowledgments

The authors thank the following people for their contributions to this work: HIV tracer for recruiting the participants, Sahr James for interviewing the participants and transcribing the interviews, and all of the HIV-infected people that participated.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

* 8th International Conference of HIV Treatment and Prevention Adherence; Miami, FL, USA; June 2013.

Additional information

Funding

This study was funded by the Fulbright U.S. Scholars Program (Grant ID 48421297; http://www.cies.org/).