Understanding loss to follow up in HIV care: a sociobehavioral perspective from Oromia, Ethiopia.

Loss to follow-up (LTFU) remains a persistent challenge in HIV care despite advances in antiretroviral therapy. Sociobehavioral factors, including individual beliefs, psychosocial dynamics and social context, strongly influence patient retention. This study explored determinants of LTFU among people living with HIV (PLHIV) in Oromia, Ethiopia. A facility-based case-control study was conducted among 986 randomly selected PLHIV across 19 health facilities. Data were collected using structured questionnaires and analyzed using bivariate and multivariate logistic regression. Several sociobehavioral factors were significantly associated with LTFU. Lower household income, living alone, and lack of transportation during security disruptions emerged as strong predictors. Individuals earning less than 3000 ETB per month had higher odds of disengagement, while living alone increased vulnerability. Older age at ART initiation showed a modest protective effect. Beliefs about HIV and ART also influenced retention: those who believed HIV could be cured by traditional medicine were more likely to disengage, whereas belief in lifelong ART benefits reduced risk. Social disruptions, including extended travel, social ceremonies and workplace changes, further contributed to LTFU. These findings highlight the need for culturally responsive, community-based care models and strengthened peer support to improve retention in HIV care.