Facilitators and barriers in HIV linkage to care interventions: A qualitative evidence review

Objective: To synthesize qualitative evidence on linkage to care interventions for people living with HIV. Design: Systematic literature review. Methods: We searched 19 databases for studies reporting qualitative evidence on linkage interventions. Data extraction and thematic analysis were used to synthesize findings. Quality was assessed using the Critical Appraisal Skills Programme tool and certainty of evidence was evaluated using the Confidence in the Evidence from Reviews of Qualitative Research approach. Results: Twenty-five studies from 11 countries focused on adults (24 studies), adolescents (eight studies), and pregnant women (four studies). Facilitators included community-level factors (i.e., task shifting, mobile outreach, integrated HIV, and primary services, supportive cessation programs for substance users, active referrals, and dedicated case management teams), and individual-level factors (encouragement of peers/family and positive interactions with healthcare providers in transitioning into care). One key barrier for people living with HIV was perceived inability of providers to ensure confidentiality as part of linkage to care interventions. Providers reported difficulties navigating procedures across disparate facilities and having limited resources for linkage to care interventions. Conclusion: Our findings extend the literature by highlighting the importance of task-shifting, mobile outreach, integrated HIV, and primary care services. Both community and individual-level factors may increase the feasibility and acceptability of HIV linkage to care interventions. These findings may inform policies to increase the reach of HIV services available in communities.