Barriers and Experiences of Caregivers in Accessing Viral Load Testing and Supporting ART Adherence for Paediatric HIV Patients in Eastern Province, Zambia

Background: Routine HIV viral load (VL) testing is essential for monitoring treatment effectiveness in paediatric patients on antiretroviral therapy (ART). However, in low-resource settings like Zambia, caregivers’ perspectives on barriers to accessing VL testing remain underexplored. This study aimed to explore caregiver-reported challenges in accessing HIV VL testing and supporting ART adherence for children living with HIV in Eastern Province, Zambia. Methods: A qualitative descriptive exploratory design was used, incorporating in-depth interviews, and focus group discussions to gain a deeper understanding of caregiver experiences. A purposive sample of 36 caregivers of HIV-positive children aged 0–10 years receiving ART participated in the study. Interviews were recorded, transcribed, coded, and analysed thematically. Ethical approval was obtained, and informed consent ensured confidentiality and voluntary participation. Results: Thematic analysis revealed several barriers to accessing paediatric VL testing. Long turnaround times for test results, high transportation costs, long distances to health facilities, limited knowledge about VL testing, stigma, frequent stockouts of test kits, and extended waiting times at clinics. Cultural beliefs and religious were also obstacles. Caregivers recognized its importance in monitoring treatment and supporting adherence. Conclusions: Caregivers face in accessing VL testing for children living with HIV, including socioeconomic hardship, healthcare system limitations, and sociocultural factors. Strengthening paediatric HIV care will require decentralizing VL testing services, extending clinic hours, implementing community-based education, reducing stigma, and promoting child-friendly, culturally sensitive practices. These strategies can enhance caregiver engagement, improve adherence, and ensure better treatment outcomes for children on ART. Key words: Viral load testing, paediatric HIV, ART adherence, caregivers, Zambia.