Factors associated with interfacility transfer and follow up of adult HIV positive clients in South Western Uganda

Abstract Introduction Human immunodeficiency virus (HIV) is still a significant public health problem with a prevalence of 37.7 million worldwide. In Uganda, awareness of HIV status among adults is at 80.9%, 96.1% of People living with HIV are on ART treatment and 92.2% having viral load suppression as of 2021. Proper linkage, follow up and retention in care are key to successful treatment of people living with HIV. Guidelines for Inter-facility transfer of HIV clients stipulate officially documented transfer of clients to ease access to ART and client follow up. These guidelines though existent, translation into practice is unclear with evidence of self-transfers and registration of transferred clients as ‘ART naïve’ in the new facilities. We therefore sought to assess the prevalence of transferred clients, factors associated with the transfer and follow up of transferred HIV clients in Kabale District in South Western Uganda. Methods A concurrent mixed methods study design was employed. Quantitative data was collected among 183 consecutively sampled adult HIV positive clients who had transferred into the selected facilities using a semi-structured questionnaire. Data was analyzed using SPSS 16. A total of 4 counsellors and 2 expert clients that were purposively selected and subjected to in-depth interviews regarding challenges in transferring of clients. The data obtained was thematically analyzed. Results A total 183 transferred in clients were interviewed, 69.9% were documented transfers and 30.1% were self-transfers. Psychosocial factors were significantly associated with being officially transferred (Chi square value 5.471, df- 1, p value − 0.02) while majority of the clients who self-transferred had structural factors as reasons for transfer. Only 32.8% of the transferred clients had been followed up after transfer contributing to a follow up rate of only 17.9%. Mis-identification of the self-transferred clients and poor interfacility communication emerged as the major challenges to follow up. Conclusion The high prevalence of self-transferred clients and lack of follow up create a great challenge in linkage and retention into care of people living with HIV. Therefore rigorous mechanisms for official transfers and follow up of clients at all levels are necessary to improve client retention in care.