When we found patients in-person, we also asked why they silently transferred to a new clinic or stopped attending HIV care altogether. We categorized these reasons into structural, clinical, and psychosocial categories.

Patients' Reasons for Silently Transferring/Switching Clinics

Structural reasons were the main driver of silently transferring to a new facility, followed by clinical and psychosocial reasons as seen in Figure 2.

Figure 2: Reasons for Patients Silently Transferring/Switching Clinics

Structural reasons included:long distance from home to the clinic, transportation challenges/costs from home to the clinic, and work and family obligations that made it difficult to go to the original clinic.

Clinical reasons included:patients having to spend too long at the health facility, healthcare workers not providing respectful and quality patient-centered care, and a long and complicated process of ART initiation.

Psychosocial reasons included:risk of HIV status disclosure to someone at the clinic; and family obligations made it difficult for patients to go to the original clinic.

These reasons for switching of clinics suggests that the transfer procedures should be made efficient such that patients are given official transfer letters as and when they desire to be transferred to a different ART clinic. This information should immediately be entered into the EMRS to minimize the mis-categorisation of them as "lost" patients.

Patients' Reasons for Stopping HIV Care

Psychosocial reasons were the main driver for stopping HIV care followed closely by structural reasons and clinical reasons as seen in Figure 3.

Figure 3: Reasons for Stopping HIV Care

Psychosocial reasons included:risk of HIV status disclosure to someone at the clinic, patient feeling well and thus believing they were no longer in need of care, high CD4 count, and having no reason to attend to clinic.

Structural reasons included: interference of work demands with collecting ART drugs, expensive transportation costs, and ART services not being available in the new location when a patient moved.

Clinical reasons included: having to spend too much time at the clinic, fear of being scolded by clinic staff for missing a scheduled appointment, lost ART Care Card, long process of ART initiation, and healthcare workers not treating patients with respect.