Understanding why HIV-infected persons disengaged from pre-ART care in Freetown, Sierra Leone: a qualitative study

AIDS Care. 2019 Apr;31(4):494-497. doi: 10.1080/09540121.2018.1515467. Epub 2018 Aug 26.


In countries that have not implemented universal antiretroviral treatment (ART), loss to follow-up (LTFU) during pre-ART care remains a problem. We conducted semi-structured interviews with 41 HIV-infected persons who were LTFU during pre-ART care from a prospective cohort of persons newly diagnosed with HIV infection in Freetown, Sierra Leone, in 2012-2013. Interviews determined whether the participant disengaged or transferred care and explored the reasons for being LTFU. Of the 41 participants, 34 (83%) disengaged from care. For persons who disengaged from care, socioeconomic barriers emerged as a dominant theme in both ART-eligible and -ineligible groups while psychosocial barriers emerged as a dominant theme in the ART-ineligible group. Structural barriers emerged as a dominant theme for participants who transferred care. Interventions designed to address socioeconomic and psychosocial barriers may help reduce disengagement from pre-ART care.

Keywords: HIV care continuum; HIV/AIDS; Sierra Leone; barriers to care; public health; retention.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Anti-Retroviral Agents / therapeutic use*
  • Attitude of Health Personnel
  • Cohort Studies
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology*
  • HIV Infections / psychology
  • HIV Infections / virology
  • Humans
  • Lost to Follow-Up
  • Male
  • Outcome Assessment, Health Care
  • Patient Compliance*
  • Prospective Studies
  • Qualitative Research
  • Sierra Leone / epidemiology


  • Anti-HIV Agents
  • Anti-Retroviral Agents