Retention in care outcome definitions.

For clients on HIV treatment in sub-Saharan Africa, early disengagement from care is a critical obstacle to achieving UNAIDS’s second 95 target. While South Africa’s Differentiated Service Delivery Guideline on Fast Track Initiation and Counseling (FTIC) defines normative procedures, the impact of implementation and drivers of disengagement remain unclear. The PREFER mixed-methods study enrolled a prospective cohort of adult clients initiating ART, returning to care after disengagement, or on ART for ≤6 months at 18 public healthcare facilities in South Africa. A survey collected demographic, clinical, and preference data. Participants were followed for up to 7 months using routinely collected medical records to estimate continuity of care (attendance at all scheduled visits within 28 days). Focus group discussions (FGDs) were conducted 12 months post-enrollment among participants who had expressed concerns about retention. A content analysis was conducted; emergent themes were situated within the Socio-Ecological Model framework. During the study period 7/9/2022–30/6/2023, PREFER-SA enrolled 1,049 participants (72% female, median age 33 years, 24% with CD4