Barriers and facilitators of adherence to long-term antiretroviral treatment in Kampala, Uganda

Few qualitative studies have evaluated adherence to long-term antiretroviral treatment (ART) in sub-Saharan Africa. We explored adherence barriers and facilitators among PLWH on long-term ART (≥10 years in Kampala)., We conducted 22 in-depth interviews with 16 purposively selected PLWHs on long-term ART and six purposively selected healthcare providers at the Infectious Diseases Institute ART clinic.,. Interviews with PLWH explored their perspectives regarding; comprehension of ART adherence, ART adherence experiences, and adherence barriers and facilitators. Provider interviews covered: perceived ART adherence barriers and facilitators and how to reinforce and support ART adherence. Qualitative data were analyzed using a deductive content analytic approach. The median age of PLWH was 52 years [IQR] 39 - 65). Most (63%) had been on ART for 15-20 years, 50% were male, and 38% had treatment supporters. Both providers and PLWH on long-term ART emphasized the importance of adhering to prescribed medication to suppress HIV. Adherence facilitators: (i) Achieving sustained viral suppression improved overall health and motivated PLWH to maintain long-term adherence. (ii) Spousal treatment partners, financial support from adult children for transportation to clinic appointments, and the desire to fulfill social responsibilities were also adherence motivators. (iii) Policy changes, such as providing multi-month drug refills and community ART delivery, were effective strategies for promoting adherence. Adherence barriers: (i) Financial constraints - lack of money for transportation - often resulting in delayed or missed appointments to the clinic. (ii) Work obligations that conflicted with clinic appointments negatively impacted long-term ART adherence. (iii) Pill fatigue and avoidance of adherence counseling sessions by PLWH with detectable viral load exacerbated non-adherence. Familial support and differentiated ART delivery had a mutually beneficial effect on long-term adherence. Future studies should evaluate the unique adherence needs of this rapidly growing ART-experienced population and identify the most efficient strategies for adherence support.