Liberia Project

Assessing barriers to retention in HIV care in Monrovia, Liberia

Summer 2017

Led by Beth Barrows, MS, RN, School of Nursing

Students (school affiliation): Molly Crothers (nursing), Geneen Godsey (social work), and Allison Pugay (nursing)

Project goal

The goal of the project was to assess barriers to retention in HIV care at the individual, provider, and organizational level at selected faith-based sites in Monrovia, Liberia. 

Project summary

University of Maryland, Baltimore students from the Schools of Nursing and Social Work traveled to Monrovia, Liberia to learn about the context of HIV care and assess the barriers to retention in HIV care. Prior to departure, the interdisciplinary group collaborated to prepare a comprehensive table of evidence on barriers/facilitators, interventions, and socio-ecological models related to retention in HIV care in developing countries in order to gain a better understanding of the context of HIV care. The team was also invited to participate in the Preparing the Future (PTF) Educational Program offered by the Jacques Initiative at the Institute of Human Virology, School of Medicine. The students worked with faculty to develop a survey questionnaire for individuals living with HIV (PLHIV) and providers caring for PLHIV to guide one-on-one and group discussions. A standardized organization tool was selected to assess sites on visits to acute care settings, along with guided questions for providers.

In Liberia, students along side the interdisciplinary team of the partnering organization participated in a variety of activities such as site visits to acute care and other community-based sites and the National HIV/AIDS Program that serve PLHIV and vulnerable children/orphans affected by HIV. This helped students better understand the infrastructure of care that is in place for PLHIV and observing home visits to PLHIV informed students about the health needs of HIV individuals and their families. Students engaged with and shadowed Liberian nursing and social work staff and students, to have more awareness of their professional roles in HIV care and the HIV health care worker capacity in Liberia. Through focus group discussions, individual interviews, and surveys, students were able to gather information from care providers and patients about their perceptions of barriers and facilitators to retention in care for PLHIV. Students also participated in education activities with PLHIV and high school students.

Project outcomes

Overall, the students obtained a significant understanding of the context of care, barriers to HIV/other care, and the impact of the social determinants on HIV care and treatment in a developing country in West Africa. The students were able to compare and contrast the similarities/differences between Monrovia, Liberia and Baltimore, Maryland USA as it relates to HIV. Lastly students were able to appreciate how the experience might impact their future professional practice in low resourced settings.  


"Honestly, it allowed me to first slow down and then view the experiences in country from the students' eyes and share what I have learned over the years and what I learned from our trip together. I came back more refreshed. It is a privilege to be a part of something that serves our partner’s needs, the students’ needs, and satisfies needs of the instructor (that you may not have been aware of)." -  Beth Barrows, School of Nursing

"This experience has truly redefined the saying, 'meet someone where they are,' and has reminded me to be more cognizant of what my clients may need. In addition, I am reminded that intervention and support often must continue beyond program enrollment limitations. When this is accomplished then I truly believe that individuals and families will be better able to find joy, be renewed and perceptions regarding behaviors can be transformed."  - Geneen Godsey

"Our nursing curriculum definitely covers screening patients’ support systems and housing, but not to the extent that I saw in Liberia. In my career, especially when dealing with HIV patients, I’ll be sure to remember the patients I talked to in Liberia, and just how much effort, bravery, and support it takes to live with HIV. I’ll be sure to screen more thoroughly, asking about family member and sexual partner diagnoses and how frequently these tests are being done, as well as screening for any other home or environment conditions that could also serve as health indicators. I’ll be sure to remember to be patient and encouraging to any future patients with HIV, or any patient who needs help with any sort of status disclosure for that matter, and encourage them to build and seek as much support as they need. Personally, this experience and meditation has only opened more doors for me." - Allison Pugay

Read the 2017 Liberia team presentation from the UMB Global Forum in October.