Barriers Contributing to Loss to Follow-up among HIV-patients in Limpopo Province, South Africa: Patients’ and Nurses’ Perspectives

Mahlatse Modipane1, *, Lunic B. Khoza2, Karen Ingersoll3
1 Department of Psychology, University of Mpumalanga, South Africa
2 Department of Health Studies, University of South Africa, Health Sciences, University of Venda, South Africa
3 Center for Behavioral Medicine and Technology, University of Virginia, United States



Antiretroviral therapy is a lifelong commitment that requires patients to adhere to their daily medication dose schedules and make frequent visits to health services for their care. People living with HIV can live healthy long lives when retained on antiretroviral therapy. Retention in care has been identified as the benchmark in the HIV Care Continuum, where most people living with HIV fail. Interventions are urgently needed to address this benchmark to achieve the worldwide 95-95-95 goals. Despite the South African government`s efforts to expand access to antiretroviral therapy services from urban centers to resource-constrained rural communities, there were 140,000 HIV- related deaths in 2014 and 85,796 HIV- related deaths in 2021. Patients have become lost to follow-up, putting their health and that of their communities at risk.

Moreover, the loss of follow-up care among HIV-positive people who are on antiretroviral treatment continues to be a significant problem. The study determined barriers contributing to the Loss of follow-up rates among people living with HIV.


A qualitative research study was conducted; Non-probability purposive sampling was used to select eight nurses from clinics with the highest and lowest loss-to-follow-up rates. The probability systematic sampling method was used to select patients from the selected clinics. Data were collected through semi-structured interviews, and content analysis was used to analyse the data.


Patients’ and nurses’ perspectives on barriers contributing to the loss of follow-up among people living with HIV included lack of confidentiality, lack of understanding of antiretroviral treatment, patients’ self-transfer, and feeling better physically.


Understanding the reasons for the Loss of follow-up could inform the development of retention in care interventions for Limpopo province. The study can be most beneficial with HIV education, skills building, and outreach programme strategies; this will, in turn, increase the knowledge needed to better attract and retain HIV-positive patients in healthcare settings.

Keywords: Antiretroviral therapy, Loss to follow-up, PLWH, Nurses, Compliance, Barriers.

Abstract Information

Identifiers and Pagination:

Year: 2023
Volume: 16
DOI: 10.2174/18749445-v16-230717-2023-71

Article History:

Electronic publication date: 17/07/2023
Collection year: 2023

© 2023 Modipane et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Psychology, University of Mpumalanga, South Africa; Tel: +27716823755; E-mail;