Barriers and Enablers to HIV Care access and engagement among Mobile Populations in Sub-Saharan Africa: A Mixed-Methods Systematic Review
1
School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A602
ABSTRACT
BACKGROUND:
Human mobility is increasingly recognised as a critical determinant of HIV care outcomes in sub-Saharan Africa (SSA), a region bearing the highest global HIV burden and extensive internal, circular, and cross-border migration. While mobility is essential for livelihoods, the pathways through which it shapes sustained engagement in HIV care remain insufficiently synthesised.
METHODS:
We conducted a mixed-methods systematic review of peer-reviewed studies published between 2016 and 2025 examining barriers and enablers to HIV care access and engagement among adult mobile populations in SSA. Searches were conducted in PubMed, Scopus, and EBSCOhost. Study selection and quality appraisal followed PRISMA guidelines, and methodological quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). Data were synthesised using a narrative thematic approach guided by the Socio-Ecological Model (SEM), examining influences across individual, interpersonal, community, organisational, and policy levels.
RESULTS:
Twenty-two studies from eight SSA countries were included, comprising qualitative (n=14), quantitative (n=5), and mixed-methods (n=3) designs. Mobility consistently emerged as a driver of HIV care disruption, particularly affecting retention and ART adherence. Key barriers included stigma and fear of disclosure, limited knowledge of ART access points, economic insecurity, disrupted social support networks, rigid clinic systems, negative provider attitudes, and restrictive transfer and documentation requirements. These barriers were exacerbated by frequent or unplanned movement and health systems poorly aligned with mobile livelihoods. Enablers included social and peer support, disclosure, community-based ART delivery, multi-month dispensing, emergency ART refills, mobile clinics, and patient-centred service models. Intervention studies demonstrated improved retention and ART possession when services were adapted to mobility realities.
CONCLUSIONS:
Mobility functions not merely as a sociodemographic characteristic but as a structural exposure shaping HIV care engagement through interacting behavioural, organisational, and policy mechanisms. Integrating mobility-responsive approaches into HIV programme design is essential for sustaining engagement in care and progress toward the UNAIDS 95–95–95 targets.
Human mobility is increasingly recognised as a critical determinant of HIV care outcomes in sub-Saharan Africa (SSA), a region bearing the highest global HIV burden and extensive internal, circular, and cross-border migration. While mobility is essential for livelihoods, the pathways through which it shapes sustained engagement in HIV care remain insufficiently synthesised.
METHODS:
We conducted a mixed-methods systematic review of peer-reviewed studies published between 2016 and 2025 examining barriers and enablers to HIV care access and engagement among adult mobile populations in SSA. Searches were conducted in PubMed, Scopus, and EBSCOhost. Study selection and quality appraisal followed PRISMA guidelines, and methodological quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). Data were synthesised using a narrative thematic approach guided by the Socio-Ecological Model (SEM), examining influences across individual, interpersonal, community, organisational, and policy levels.
RESULTS:
Twenty-two studies from eight SSA countries were included, comprising qualitative (n=14), quantitative (n=5), and mixed-methods (n=3) designs. Mobility consistently emerged as a driver of HIV care disruption, particularly affecting retention and ART adherence. Key barriers included stigma and fear of disclosure, limited knowledge of ART access points, economic insecurity, disrupted social support networks, rigid clinic systems, negative provider attitudes, and restrictive transfer and documentation requirements. These barriers were exacerbated by frequent or unplanned movement and health systems poorly aligned with mobile livelihoods. Enablers included social and peer support, disclosure, community-based ART delivery, multi-month dispensing, emergency ART refills, mobile clinics, and patient-centred service models. Intervention studies demonstrated improved retention and ART possession when services were adapted to mobility realities.
CONCLUSIONS:
Mobility functions not merely as a sociodemographic characteristic but as a structural exposure shaping HIV care engagement through interacting behavioural, organisational, and policy mechanisms. Integrating mobility-responsive approaches into HIV programme design is essential for sustaining engagement in care and progress toward the UNAIDS 95–95–95 targets.
| eISSN: | 2654-1459 |
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