Barriers and Facilitators to Retention of Adolescents in HIV Care at Kabuyanda Health Center IV, Isingiro district, Uganda

BackgroundAdolescents living with HIV face significant challenges in maintaining continuity of care despite free ART services in Uganda. Retention is essential for achieving positive health outcome and preventing further transmissions of the virus, but loss to follow-up remains high, especially in rural settings like Isingiro District. Despite interventions at Kabuyanda HCIV, such as home drug delivery and reminder calls, one in five adolescents drops out of care. Nationally, gaps persist in adolescent-friendly strategies.This study assessed barriers and facilitators to adolescent HIV care retention at this rural facility. MethodsA qualitative cross-sectional study was conducted at Kabuyanda HCIV and 41 participants (adolescents in care and Lost to Follow up (LTFU), caregivers, and health workers) were selected through random sampling. Data were collected via semi-structured interviews, analysed thematically using NVivo 15, and interpreted using the Socio-Ecological Model (SEM) and Health Belief Model (HBM). Key outcomes included psychosocial, health system, and socioeconomic factors influencing retention.ResultsUnique findings included medication sharing between caregivers and adolescents, and burden of balancing school and care, and rejection of mobile clinics over fears of involuntary HIV disclosure and stigma issues at home which disrupted adherence. A notable facilitator was peer modelling by Young Adults with Positive Status (YAPS), which enhanced trust, motivation, and emotional support. Other enablers were school-based systems, mobile services (when accepted), and flexible livelihood options.Persistent challenges involved stigma, food insecurity, health illiteracy, and stock-outs of supportive medications like Septrin.ConclusionAdolescent retention in HIV care is strengthened through peer-led interventions and contextual flexibility. Strategies must respect adolescents’ privacy while scaling up adolescent-responsive and disclosure-sensitive services.