Table 2.

Recommendations to facilitate ongoing engagement with health services

Recommendations	Details
PLHIV as Partners	Although most healthcare workers In South Africa know about person-centred care, of which the ‘Welcome Back’ strategy is part, our study findings suggest a paternalistic approach to healthcare still exists, where healthcare workers make decisions and, as has been reported elsewhere, the individual needs, values and experiences of PLHIV are overlooked [61, 62]. Patient health engagement models such as the ‘Patients as Partners’ concept have emerged from person-centred care, and gone even further, suggesting PLHIV should be members of their health care team as they are key in aligning healthcare decision-making with their daily activities and long-term plans [63]. If PLHIV are goal directed, this will enhance retention in care and lead to improved health outcomes [63–66].
Counselling	Support at the time of diagnosis: When someone is newly diagnosed with HIV, providing support as they come to terms with their diagnosis will facilitate engagement with the health services and initiation of ART. Ongoing support and counselling: Counselling and peer support can be beneficial in considering HIV status disclosure with family or friends [67]. Ongoing information: Continued, and repeated, information on HIV and ART is necessary to address the limited knowledge and understanding of HIV and disease progression. HIV and TB co-infection: PLHIV who develop TB need information on the interrelationship between HIV and TB, in addition to counselling and support to cope with the pill burden [68]. Information on possible adverse drug events and returning to the clinic for symptom management can contribute to optimal retention in care. Grief counselling: Both HIV and TB involve loss, the loss of personhood, health, partners and family members. In providing person-centred care, identifying PLHIV who are struggling with loss and complicated grief, and providing psychosocial support will enhance retention in care.
Health system factors	Inflexibilities within HIV service delivery need to be addressed including: • the establishment of efficient person-centred transfer systems across facilities, • flexible ART appointment schedules that accommodate unexpected life events [41], • multi-month scripting for ART (3- or 6-months), • gender sensitive HIV services to support the retention of men in care [69], • integrating holistic services across the care continuum and the provision of patient-centred services so that very ill and weak patients discharged post AHD can access services, • the provision of ancilliary support at times when life circumstances/relationships are particularly challenging. This could include food, housing and treatment for other illnesses and substance abuse disorders [70].
Ongoing research	Ongoing research and the development and implementation of new technologies such as long-acting injectable ART could reduce the frequency of ART visits and minimize competing priorities between HIV care and the stresses of daily life outside of the clinic [39].

ART antiretroviral therapy