Loss to follow-up on antiretroviral therapy amongst HIV patients on CCMDD program at Makhado Municipality, Limpopo Province, South Africa

Abstract

Background: Loss to Follow-Up among HIV patients receiving Antiretroviral Therapy (ART) remains a significant barrier to achieving optimal HIV care outcomes in South Africa. The Central Chronic Medicine Dispensing and Distribution (CCMDD) Programme was introduced to improve access to treatment; however, retention challenges persist. Purpose: The study aimed to explore factors contributing to high rates of LTFU among HIV patients enrolled in the CCMDD Programme in the Makhado Local Municipality in the Limpopo Province, South Africa. Study setting: The study was conducted in three purposively selected clinics that implemented the CCMDD Programme in the Makhado Local Municipality, in the Limpopo Province. Method: An exploratory, descriptive qualitative research design was employed. A purpose sample of 34 HIV positive patients, aged 18 years and older, who had defaulted ART within the past twelve months but subsequently returned to care, participated in semi-structured, in-depth interviews. Data were analyzed using Braun and Clarke’s six-step thematic analysis. Trustworthiness was ensured through researcher-led data collection and strategies to enhance credibility and dependability. Results: Five major themes emerged from the data: (1) positive factors of the CCMDD Programme; (2) individual factors; (3) interpersonal factors; (4) community factors; and (5) health system-related factors. The positive aspects of the CCMDD Programme included improved patient adherence to treatment and reduced facility congestion. Contributing barriers included a shortage of medication, long waiting periods, poor data recording, communication breakdowns,Limited understanding of the Programme, distance and travel time, challenges with script renewal, side effects, stigma, nondisclosure, and a lack of social support. Conclusion: The findings of the study highlighted that the key drivers contributing to LTFU include stigma, non-disclosure of HIV status, long travel distances to collection points, lack of social support, and limited knowledge of the CCMDD Programme. Strengthening patient education, improving communication systems, and implementing early tracing strategies may enhance retention and adherence among patients enrolled in the CCMDD Programme.