Abstract:
Background: South Africa has world’s highest prevalence of HIV-positive people with
approximately 7.06 million HIV-positive people with 110 000 HIV- related deaths reported by
Statistics South Africa in 2017. South Africa has expanded access to anti-retroviral therapy
services, from urban centers to resource-constrained rural communities. The rate of loss,
however, to follow-up for patients on anti-retroviral treatment continues to increase.
Aim of the Study: The aim of this study was to determine patient and nurse perspectives on loss
to follow up among HIV-positive patients in Sekhukhune District of Limpopo Province, South
Africa. The findings of the study guided the development of a proposed strategy to decrease loss
to follow up among HIV-positive patients.
Method: A qualitative research design was used with non-probability purposive sampling and with
probability systematic sampling. The sample of patients comprised 30 HIV-positive people
classified as lost to follow-up from clinics with high prevalence rates of lost to follow-up patients.
Eight nurses, four from clinics with high rates and four from clinics with low lost to follow-up rates
comprised the sample of nurses. Semi-structured interviews were conducted using the study
research questions as a guide. Eight interviews were conducted with nurse clinic managers and
30 with the patients. Content analysis was used to analyze the data.
Results: The key themes that emerged from the study included patients’ and nurses`
perspectives on factors contributing to loss to follow up among HIV- positive patients; and
Patients’ and nurses’ perspectives on strategies that would address barriers to loss to follow up
among HIV- positive patients. Sub-themes on patients’ and nurses’ perspectives on factors
contributing to loss to follow up among HIV- positive patients included: Lack of understanding of
anti-retroviral treatment; fearful to disclose HIV status; lack of confidentiality; negative side effects;
use of traditional medicine; self-transfer from one clinic to another. Patients’ and nurses’ elicited
the strategies that would assist patients to remain in care and to take antiretroviral treatment
consistently. The strategies included: providing patients with health education; working as a team;
implementing social support group programme; providing nurses with in-service education on
ethics and ethos. Informed by various intervention models in HIV care: Information Motivational
Behavioural model; Health Belief Model; Social Action Theory and Social Cognitive Theory; I
proposed a strategy that may reduce the rate of non-adherence and loss to follow up among
patients with HIV in Limpopo Province.
