article · Frontiers in Health Services
Patient attrition remains a persistent challenge across the HIV care continuum, hindering progress toward national and global health targets. A planned research initiative outlines a four-phase approach to develop tailored strategies for improving linkage to and retention in HIV care within the Msukaligwa Sub-district of Mpumalanga Province. The investigation uses a convergent parallel mixed-methods design. First, a scoping review examines global practices for strengthening HIV care outcomes. Second, quantitative analysis of regional healthcare data from 2020 to 2024 assesses local retention and linkage trends. Third, qualitative interviews with healthcare providers and people living with HIV explore lived experiences, barriers, and facilitators. Finally, these insights will be synthesised to formulate an evidence-based, context-specific strategy to identify system gaps and improve continuous patient engagement.
Ensuring that people diagnosed with HIV stay linked to continuous medical care is vital for achieving viral suppression and curbing transmission. By evaluating health system data alongside patient and provider experiences, this research aims to identify why individuals fall out of care, helping health authorities design practical interventions that keep patients supported and connected to essential treatment services.
This work represents an early-stage research protocol designed to develop a public health operational strategy rather than a commercial product. The direct users would be provincial health departments, healthcare managers, and clinical staff. While distant from commercial application, the resulting retention frameworks could inform public health management protocols, service delivery models, and clinical workflow tools used across regional HIV treatment networks.
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Background Despite significant progress in HIV services, significant patient loss occurs at every stage of the HIV care continuum. While efforts made by the NDoH aim to combat the HIV epidemic and achieve the 95-95-95 targets, these targets cannot be reached unless PLHIV are effectively linked to and retained in care. This study aims to develop targeted strategies to improve linkage to and retention in HIV care among PLHIV in the Msukaligwa Sub-district, Mpumalanga Province. Methods A convergent parallel mixed-methods design will be employed. The study will consist of four phases: (1) a scoping review to identify global strategies for improving HIV care outcomes; (2) a quantitative strand using descriptive cross-sectional and retrospective cohort designs with TIER.Net data (2020–2024) to assess linkage and retention patterns; (3) a qualitative exploratory study using semi-structured interviews with PLHIV and healthcare providers to explore lived experiences, barriers, and facilitators; and (4) development of an evidence-based, context-specific strategy. Quantitative data will be analysed using descriptive and inferential statistics, while qualitative data will undergo thematic analysis guided by the Socio-Ecological Model. Expected results The study is expected to identify key individual, interpersonal, and health system factors influencing poor linkage and retention in HIV care. It will also highlight critical gaps along the HIV care continuum and provide insight into patient and provider perspectives. Conclusion Findings from this study will inform the development of a tailored, evidence-based strategy to strengthen HIV care engagement in the Msukaligwa Sub-district. This may contribute to improved retention, viral suppression, and progress toward national and global HIV targets.
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DOI: 10.3389/frhs.2026.1929158
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