Navigating HIV care in a mobile society: case studies of clinic transfers in South Africa's public health sector

In South Africa, people living with HIV (PWH) often relocate for work and family obligations, which creates unique challenges for continuous HIV care. We explored the experiences of mobile individuals living with HIV navigating clinic transfers without formal letters. A qualitative study was conducted with PWH on antiretroviral therapy (ART) from two clinics in KwaZulu-Natal. Participants, who had not disclosed their HIV treatment history at registration, were interviewed in-depth between March and October 2023. Content and thematic analyses, informed by Andersen's behavioral model and self-management domains, were used. This study presents two case studies of individuals who faced challenges with accessing ART after relocating to new areas: a 37-year-old female worker and a 47-year-old male construction worker. Both faced difficulties accessing ART after relocation. When they presented at new clinics, they were told they could not access care without transfer letters. Unable to return to previous clinics, they sought treatment at a third clinic as treatment-naive, changing their names to avoid detection. To cover ART gaps, they also purchased or borrowed ART from others. These individuals developed strategies to overcome barriers. Educating clinic staff on the challenges faced by migrants could help improve transfers.