Beyond the Clinic: Community Health Workers’ Perspectives on Tracing HIV and TB Patients in Rural South Africa

Abstract

Introduction Human immunodeficiency viruses and tuberculosis burden continue to cause major public health concerns in South Africa. Patients who are lost to follow-up impede treatment continuity, contributing to an alarming spread of infections. Community health workers are the main drivers in tracing patients who have defaulted appointments and supporting them in returning to care. However, their perspectives in rural areas have not yet been explored. Methods An exploratory study design adopting a qualitative approach was used to explore CHWs’ perceptions, challenges, and successes in tracing HIV and TB patients in the North West Province. Seventeen CHWs with at least one year of tracing experience were purposively selected from five primary healthcare clinics with a high number of LTFU patients. In-depth semi-structured face-to-face interviews were conducted in Setswana, audio-recorded, transcribed verbatim, and thematically analysed. Results The results revealed five comprehensive themes: (1) CHWs’ critical role and economic dissatisfaction; (2) communication and documentation gaps, including poor record-keeping and ineffective down-referrals; (3) social barriers, notably patient non-disclosure and stigma; (4) perceived success in re-engaging patients and associated personal satisfaction; and (5) recommendations for improving patients tracing, During the interview, decentralised medication pick-up points and stronger collaboration with healthcare facilities emerge strongly. Discussions CHWs expressed that financial insecurity, inadequate logistical support, and community stigma undermine their effectiveness. Nevertheless, they reported satisfaction when patients returned to care. Conclusion Addressing identified challenges through structured remuneration policies, enhanced digital record-keeping, and stigma reduction campaigns could strengthen CHWs’ capacity to improve retention in HIV/TB care. These findings have implications for policymakers and programme managers seeking to optimise CHW-led tracing interventions to reduce loss to follow-up and advance progress toward ending HIV/TB by 2030.