Barriers and facilitators to linkage to HIV care after hospital discharge among adults living with advanced HIV disease in Uganda: a COM-B-guided qualitative study.

Why it matters. 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.

Expert analysis

From the abstract

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.

Reported figures

Patient interviews (successfully linked to care)

Patient interviews (did not link to care)

Healthcare worker key informant interviews

Study period

May to October 2025

Key findings

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
Existing TB-HIV linkage system and ward-based linkage counsellors were identified as enabling factors by HCWs

Population. 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.

For practice. 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.

Caveats

Qualitative design; no quantitative outcome data (linkage rates, timing to engagement, mortality) reported
Single-facility study in Eastern Uganda; generalisability to other regions or resource settings unclear
Retrospective patient recall of barriers/facilitators; potential recall and social desirability bias
No reported inter-coder reliability, saturation assessment, or validity checks for thematic analysis

Figures are quoted from the source as reported. PeerCurrent never invents numbers; where a figure is absent it is noted as not reported. Confirm against the original before acting.

Evidence assessment

A multidimensional read, graded only from the abstract, not a single opaque score.

Study design

moderate

Descriptive qualitative design with purposive sampling; appropriate for barrier/facilitator exploration.

Directness

strong

Direct exploration of patient and provider perspectives on linkage to care post-discharge.

Consistency

moderate

Dual perspectives (patients and HCWs) provide convergent and divergent viewpoints; no external comparison cohort.

Risk of bias

limited

Small purposive sample; no quantitative outcome validation; selection bias in linked vs. unlinked groups.

Sample adequacy

limited

20 patient interviews (10 linked, 10 unlinked) and 10 HCW interviews from single facility; limited generalisability.

Provenance

Source: EuropePMC
Source type: aggregator
Content analyzed: abstract

Evidence grading reflects the portion of the source actually analyzed. Always confirm against the original before acting.

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