Factors Contributing to Retention in Care and Treatment Adherence Among People Living With HIV Returning to Care in South-Eastern Tanzania: A Qualitative Study.

Background: People living with HIV (PLHIV) with good adherence to antiretroviral therapy (ART) achieve good health outcomes. However, treatment interruptions remain a major challenge, particularly in rural Africa. This study explored factors related to dropout, return, retention in care, and treatment adherence among PLHIV returning to care after missing clinical visits. Methods: We conducted an exploratory study using a phenomenological approach in rural South-eastern Tanzania, from July to October 2023. In-depth interviews (IDIs) were conducted with 21 PLHIV who resumed care after missing visits for three months or more from the last scheduled appointment and who were taking ART less than 60 days within the last three months, and their 13 treatment supporters. Interviews were conducted at St. Francis Regional Referral Hospital and Kibaoni Health Center.Five focus group discussions (FGDs) were conducted with 6-8 healthcare workers from Kibaoni, Mang'ula, Mkamba, Mgeta Health Center, and St. Francis Hospital. Data were analyzed by thematic analysis, with NVivo 12 software. Results: The median age of the 21 PLHIV was 40 years (range 21 to 63); 10 (47.6%) were females. Reasons for dropping out of care reported included fear of disclosure, complacency with improved health, denial of HIV status, work-related absence, and religious beliefs. Reasons for returning included health deterioration, completion of work obligations causing care interruption, family support, and clinic follow up. Factors promoting retention and adherence were improved health through ART, trust in healthcare services, counseling, health education, clinic follow-up, longer drug refill periods, and family support. Conclusion: Our study highlights persisting stigmatization contributing to dropping from care, with strong family and social support improving adherence and clinic attendance. Future interventions should focus on these factors to enhance retention of lifelong treatment adherence. Working obligations remain a challenge, that could be addressed by facilitated access to remote drug pickup.