Background. HIV remains amajor public health challenge in Zambia.Theroll-out of antiretroviral treatment (ART) has engendered\nnew challenges in retention in care. Objective. To conceptualise the factors affecting retention in care of ART patients at three\nprimary healthcare facilities using the ecological framework. Method. Qualitative data were collected through in-depth interviews\nwith 45 ART patients and three focus group discussions with 20 healthcare providers from three primary healthcare facilities in\nKabwe district, Zambia, and subjected to thematic content analysis. Results. Individual level barriers to retention in care included\nside effects, gaining weight, belief in faith healing, and use of herbal remedies and alcohol. Interpersonal barriers such as stigma\nand nondisclosure of HIV status were reported. At the institutional level, inadequate space in the clinic, long waiting times, long\ntravel distances, and shortage of third-line drugs presented barriers to retention in care. Food shortages and patient mobility were\nreported as community barriers to retention in care. Conclusion.The ecological framework conceptualises the complex and dynamic\nfactors affecting retention inART care and highlights the need formultifaceted interventions that combine health education, disease\nmanagement, and opportunities for income generation in a socially responsive and accountable environment.
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