Exploring the factors influencing loss to follow up among patients living with HIV& AIDS on antiretroviral therapy in the Northern Region of Ghana: a qualitative study.

BACKGROUND

Loss to follow-up among people living with HIV remains a major challenge to the success of antiretroviral therapy in sub-Saharan Africa. Although antiretroviral therapy has significantly improved survival and quality of life, sustained engagement in care is threatened by complex individual, social, and health system factors. Understanding these factors within specific contexts is essential for developing effective interventions. This study explored the factors influencing Loss to follow-up among people living with HIV on antiretroviral therapy in the Northern Region of Ghana.

METHODS

A qualitative study design using phenomenological approach was employed. In-depth semi-structured interviews were conducted with 38 participants, ( 28 people living with HIV and 10 healthcare providers), purposively selected from antiretroviral therapy clinic of the Tamale Teaching Hospital. Interviews were conducted in English and Dagbani, audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke’s thematic analysis framework. Trustworthiness was ensured through strategies addressing credibility, dependability, confirmability, and transferability.

RESULTS

Three major themes emerged. Individual-level factors influencing loss to follow-up included transportation and financial constraints, marital status, and personal beliefs or misconceptions about HIV. Facility-related factors influencing loss to follow-up comprised drug stock-outs, negative staff attitudes, and structural challenges such as inadequate privacy. Social and community-level factors influencing loss to follow-up included stigma, and cultural and religious beliefs.

CONCLUSION

Loss to follow-up among people living with HIV in Northern Ghana is a multidimensional phenomenon shaped by interconnected socio-economic, cultural, and health system factors. Addressing Loss to follow-up therefore requires integrated, context-sensitive strategies that go beyond biomedical care. Specifically, strengthening antiretroviral therapy supply chains and implementing patient-centred service delivery models, such as reduced waiting times, are critical to improving trust and continuity of care. In addition, structured stigma-reduction initiatives, including training for healthcare workers and active engagement with community, religious, and traditional leaders, are essential to address socio-cultural barriers and misconceptions surrounding HIV. Such approaches are crucial for improving retention in HIV care.