ArticleBMJ public health2026
Facilitators of and barriers to linkage to HIV care and treatment in Morogoro, Tanzania: a sequentially mixed-methods evaluation.
Article in BMJ public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Linkage to HIV care and treatment following diagnosis is essential for the prompt initiation of antiretroviral therapy and for effective epidemic control. This evaluation assessed the level of linkage to HIV care and treatment among who tested HIV positive and explored contextual factors in Morogoro Region. Methods: A sequential explanatory mixed-methods design was used. Quantitative data of 392 individuals were collected from HIV testing registers containing data for the period of January 2024 to February 2025. Data were analysed descriptively using Microsoft Excel. Qualitative data were collected using audio-recorded in-depth interviews with six purposively selected healthcare providers who provide HIV testing services at various testing points within the facilities. Transcripts underwent inductive coding and theming through interpretative phenomenological analysis managed in ATLAS.ti V.9. Results: Of the newly diagnosed clients, 90% were successfully linked to care and treatment, with 95% of those linked being enrolled on the same day of diagnosis. Key facilitators to linkage were high-quality pretest and posttest counselling, positive provider-client relationships, active phone follow-up, support from expert clients and mentor mothers and weekly departmental meetings. Major barriers included cultural beliefs among Maasai pastoralist communities, religious/spiritual beliefs favouring non-biomedical healing, unavailability of Care and Treatment Clinics services on weekends, stigma and distance to the clinics. Conclusion: Linkage to HIV care in Morogoro was high but below universal targets, with same-day enrolment common. This was strengthened by counselling, follow-up mechanisms and peer support. However, linkage remains hindered by sociocultural beliefs, stigma and structural barriers such as service availability and distance. Authorities and implementers should strengthen extensive counselling and follow-up mechanisms, through the engagement of treatment advocates. These efforts should focus on addressing negative traditional beliefs, self-denial and HIV-related stigma.
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