Barriers to retention in care as perceived by persons living with HIV in rural Ethiopia: Focus group results and recommended strategies

Alan R. Lifson, Workneh Demissie, Alemayehu Tadesse, Kassu Ketema, Randy May, Bereket Yakob, Meka Metekia, Lucy Slater, Tibebe Shenie

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Inability to retain HIV-infected patients in care undermines the benefits of starting millions in low-income countries on antiretroviral therapy (ART). In a hospital HIV clinic in rural southern Ethiopia, we conducted focus groups of HIV-infected men and women to learn more about experiences with and barriers to attending clinic appointments. Respondents reported multiple barriers, including those that were patient related (eg, misunderstandings about ART, mistaken belief in AIDS cures, and drug/alcohol use), clinic related (eg, negative provider interactions, lack of familiarity with patients' medical situation, and overcrowding), medication related (eg, side effects), social (eg, stigma and discrimination and lack of support), and situational/resource related (eg, distance to clinic, lack of funds, competing domestic/work priorities, and lack of food). Based on the lessons learned from these focus groups, we implemented a community intervention to improve retention, using trained community support workers who provide patient education, counseling, social support, problem-solving assistance, needed referrals, and improved communication/linkage to the patients' HIV clinic.

Original languageEnglish (US)
Pages (from-to)32-38
Number of pages7
JournalJournal of the International Association of Providers of AIDS Care
Issue number1
StatePublished - Feb 2013

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: the World Health Organization’s Country Office for Ethiopia and the University of Minnesota's Office for International Programs.


  • Community support workers
  • HIV
  • Retention
  • Rural health


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