Perceptions and experiences of HIV care retention during the first 12 months at Kanyamazane CHC

Background: Despite South Africa’s progress in expanding access to antiretroviral therapy (ART), retaining people living with HIV (hereafter referred to as patients) in care remains a major challenge. Retention is essential for achieving viral suppression and preventing onward HIV transmission. Objectives: This study aimed to explore the perceptions and experiences of patients and healthcare providers regarding factors influencing retention in care during the first 12 months of ART. Method: A qualitative exploratory design was used at Kanyamazane Community Health Centre (CHC), a primary healthcare facility in Mpumalanga province, South Africa. Semi-structured interviews were conducted with 12 patients and four healthcare providers, purposively sampled to include those consistently retained and those re-engaged after loss to follow-up. Data were transcribed verbatim and analysed thematically using Braun and Clarke’s framework with ATLAS.ti. Trustworthiness was ensured through member-checking and triangulation. Results: Six key themes were identified: (1) social and clinical support, (2) health education and empowerment, (3) motivation, (4) geographical and financial constraints, (5) stigma and disclosure challenges and (6) health system-related barriers. Facilitators of retention included family support, peer groups and differentiated service delivery models. Barriers included long waiting times, staff shortages and inadequate follow-up systems. Participants recommended structured appointment systems and personalised case management. Conclusion: Retention in HIV care is influenced by an interplay of individual, social and health system factors. Holistic, person-centred interventions are needed to promote early and sustained engagement in care. Contribution: This study demonstrates that early retention in HIV care is strengthened by family involvement, peer support, continuous counselling and home-based care, while barriers such as stigma, long clinic waiting times and poor tracing systems persist. It provides actionable strategies including structured booking systems and tailored case management to improve retention.