Understanding Drivers of Loss to Follow‐Up in HIV Care in Oromia Regional State, Ethiopia: A Qualitative Grounded Theory
8 affiliations
- 1Department of Health Policy and Management Jimma University Ethiopia
- 2Department of Epidemiology Jimma University Ethiopia
- 3Oromia Health Bureau Ethiopia
- 4Haramaya University College of Health and Medical Sciences Ethiopia
- 5Department of Reproductive Health and Population Studies Bahir Dar University Ethiopia
- 6Department of Internal Medicine Jimma University Ethiopia
- 7Department of Health, Behavior and Society Jimma University Ethiopia
- 8Fenot Associates Addis Ababa Ethiopia
Abstract
Background: Despite significant advancements in antiretroviral therapy (ART), loss to follow‐up (LTFU) remains a critical challenge in HIV care, particularly in low‐resource settings like Ethiopia. LTFU contributes to increased morbidity and mortality rates, heightened transmission risks, and treatment failure. While individual and clinical factors have been widely studied, structural drivers of LTFU are less understood. Hence, this study aimed to understand the structural factors driving LTFU in HIV care.
Methods: A qualitative study using grounded theory was conducted. Data were collected through Key Informant Interviews (KIIs) with program staff, Focus Group Discussions (FGDs) with social support groups, and group interviews with program coordinators and regional directors. Thematic analysis was performed using ATLAS. ti. Software version 7.5.18, and findings were reported following the Standards for Reporting Qualitative Research (SRQR).
Results: Four key themes emerged from the analysis: (1) programmatic and service challenges, including drug supply interruptions, inadequate service integration, and human resource shortages; (2) weak transfer, linkage, and tracing systems, marked by gaps in referral networks and untraceable client identifiers; (3) cultural and socio‐behavioral factors, such as stigma, discrimination, and reliance on faith‐based healing practices. Participant quotations highlighted the pervasive impact of stigma and weak referral systems on patient disengagement from HIV care; and (4) integration gaps in social change and stakeholder engagement, including weak counseling services and limited collaboration with non‐governmental organizations and community organizations.
Conclusion: The findings underscore the critical role of structural factors in shaping retention in HIV care in Oromia. Addressing these barriers may benefit from a multi‐faceted approach, including strengthening health systems, improving referral and tracing mechanisms, reducing stigma, and enhancing stakeholder engagement. These insights provide a foundation for targeted interventions to reduce LTFU and improve HIV care outcomes in the region.
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BibTeX
@article{tafese2026understanding,
title = {{Understanding Drivers of Loss to Follow‐Up in HIV Care in Oromia Regional State, Ethiopia: A Qualitative Grounded Theory}},
author = {Fikru Tafese and Matebu Gezahegn and Zeriun Kura and Eshetu Alemayehu and Yadeta Ayana and Chala Bafikadu and Gusha Belako and Tesfaye Zerfu and Birhanu Kenate Sori and Yadeta Dassie and Firaol Bekele and Negash Sime and Tizta Tilahun Degfie and Daniel Yilma and Yohannes Ejigu and Yohannes Kebede and Mirkuzie Woldie},
journal = {Health Science Reports},
year = {2026},
month = oct,
doi = {10.1002/hsr2.73433},
url = {https://doi.org/10.1002/hsr2.73433},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Understanding Drivers of Loss to Follow‐Up in HIV Care in Oromia Regional State, Ethiopia: A Qualitative Grounded Theory
AU - Fikru Tafese
AU - Matebu Gezahegn
AU - Zeriun Kura
AU - Eshetu Alemayehu
AU - Yadeta Ayana
AU - Chala Bafikadu
AU - Gusha Belako
AU - Tesfaye Zerfu
AU - Birhanu Kenate Sori
AU - Yadeta Dassie
AU - Firaol Bekele
AU - Negash Sime
AU - Tizta Tilahun Degfie
AU - Daniel Yilma
AU - Yohannes Ejigu
AU - Yohannes Kebede
AU - Mirkuzie Woldie
PY - 2026
DA - 2026/10/26
JO - Health Science Reports
DO - 10.1002/hsr2.73433
UR - https://doi.org/10.1002/hsr2.73433
AB - Background: Despite significant advancements in antiretroviral therapy (ART), loss to follow‐up (LTFU) remains a critical challenge in HIV care, particularly in low‐resource settings like Ethiopia. LTFU contributes to increased morbidity and mortality rates, heightened transmission risks, and treatment failure. While individual and clinical factors have been widely studied, structural drivers of LTFU are less understood. Hence, this study aimed to understand the structural factors driving LTFU in HIV care. Methods: A qualitative study using grounded theory was conducted. Data were collected through Key Informant Interviews (KIIs) with program staff, Focus Group Discussions (FGDs) with social support groups, and group interviews with program coordinators and regional directors. Thematic analysis was performed using ATLAS. ti. Software version 7.5.18, and findings were reported following the Standards for Reporting Qualitative Research (SRQR). Results: Four key themes emerged from the analysis: (1) programmatic and service challenges, including drug supply interruptions, inadequate service integration, and human resource shortages; (2) weak transfer, linkage, and tracing systems, marked by gaps in referral networks and untraceable client identifiers; (3) cultural and socio‐behavioral factors, such as stigma, discrimination, and reliance on faith‐based healing practices. Participant quotations highlighted the pervasive impact of stigma and weak referral systems on patient disengagement from HIV care; and (4) integration gaps in social change and stakeholder engagement, including weak counseling services and limited collaboration with non‐governmental organizations and community organizations. Conclusion: The findings underscore the critical role of structural factors in shaping retention in HIV care in Oromia. Addressing these barriers may benefit from a multi‐faceted approach, including strengthening health systems, improving referral and tracing mechanisms, reducing stigma, and enhancing stakeholder engagement. These insights provide a foundation for targeted interventions to reduce LTFU and improve HIV care outcomes in the region.
SN - 2398-8835
ER -