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HIV Infections / Advanced Hiv Disease · Qualitative descriptive study (COM-B framework)
HIV Research & Clinical Practice · July 23, 2026
Early or partial results. Treat as a signal, not a conclusion.
In advanced HIV disease post-discharge care in Uganda, barriers span physical capability (weakness), knowledge gaps, financial/geographic access, and stigma; facilitators include pre-discharge ART initiation, peer support, and disclosure. Findings suggest that system-level interventions (standardised protocols, structured follow-up, expanded peer support) are necessary but require validation through implementation trials.
Qualitative descriptive study (COM-B framework). Adults with advanced HIV disease recently discharged from medical ward at Mbale Regional Referral Hospital, Eastern Uganda (n=20 patients); 10 healthcare workers providing care for these patients.. n = 10.
Patients identified physical weakness, limited knowledge of linkage process, high transport costs and long travel distances, and stigma/non-disclosure as barriers HCWs reported absence of standardised linkage protocols, lack of post-discharge follow-up mechanisms, and missing incentive structures as systemic barriers Pre-discharge ART initiation, peer support, and disclosure to caregivers were reported as patient-level facilitators
Qualitative design; no quantitative outcome data (linkage rates, timing to engagement, mortality) reported
Clinicians and health systems in resource-limited settings should prioritise pre-discharge ART initiation and structured linkage counselling, leverage peer supporters, and address financial barriers to post-discharge engagement. Results suggest multi-level interventions targeting patient knowledge, system protocols, and social support are needed to improve outcomes.
Qualitative study identifying modifiable barriers and facilitators to post-discharge HIV care linkage in a resource-limited setting; provides hypothesis-generating insights for intervention design but lacks quantitative outcome data or generalizability beyond one hospital.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and health systems in resource-limited settings should prioritise pre-discharge ART initiation and structured linkage counselling, leverage peer supporters, and address financial barriers to post-discharge engagement. Results suggest multi-level interventions targeting patient knowledge, system protocols, and social support are needed to improve outcomes.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background. Hospital discharge represents a high-risk transition period for people living with HIV, particularly those with advanced HIV disease. In low-resource settings, substantial gaps persist in linking these individuals to outpatient HIV care following hospitalisation. This study explored barriers and facilitators to post-discharge linkage to care from the perspectives of patients and healthcare workers (HCWs) in Eastern Uganda.Methods. We conducted a descriptive qualitative study at Mbale Regional Referral Hospital between May and October 2025. Guided by the capability, opportunity, motivation, and behaviour (COM-B) model, we conducted 20 in-depth interviews with adults with advanced HIV disease who had recently been discharged from the medical ward (10 who successfully linked to care and 10 who did not), alongside 10 key informant interviews with HCWs involved in their care. Data were analysed using a thematic framework approach aligned with the COM-B constructs.Results. Patient-reported barriers included physical weakness (physical capability), limited knowledge of the linkage process (psychological capability), high transport costs and long travel distances (physical opportunity), and stigma or non-disclosure of HIV status (social opportunity). HCWs identified the absence of standardised linkage protocols, post-discharge follow-up mechanisms, and incentive structures as key systemic barriers (physical opportunity). Facilitators reported by patients included initiation or resumption of antiretroviral therapy (ART) before discharge (physical opportunity), support from peer supporters and disclosure to caregivers (social opportunity), and fear of clinical deterioration (reflective motivation). HCWs identified the existing TB-HIV linkage system (reflective motivation) and the presence of ward-based linkage counsellors (physical opportunity) as enabling factors.Conclusion. People living with advanced HIV disease face multiple, interrelated barriers to linkage with HIV care following hospital discharge, including physical debility, limited knowledge of the linkage process, financial and geographic constraints, and stigma. Conversely, pre-discharge ART initiation, peer support, and disclosure facilitate successful linkage. Strengthening post-discharge care will require standardised linkage protocols, structured follow-up mechanisms, and expanded use of peer supporters within health systems.
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