COVID-19–Related Disruptions and Adaptations to HIV Service Delivery in Rakai, Uganda: A Qualitative Study Among Virologically Unsuppressed People Living With HIV and HIV Care Providers
ABSTRACT: COVID-19 pandemic restrictions disrupted HIV services globally, but few studies have explored experiences from rural Africa or experiences of virologically unsuppressed individuals who may experience heightened barriers to care. We sought to explore COVID-19-related disruptions and adaptations to HIV service delivery in rural Rakai, Uganda. We conducted qualitative, in-depth interviews with 38 people living with HIV, all with high-level viremia (≥1,000 copies/ml), and 15 HIV clinicians. We also conducted six focus group discussions with peer health workers. Findings were analyzed thematically using a team-based inductive and deductive approach. Participants described the disruptive impact of COVID-19, precipitating transportation barriers and constraints to facility access, human resource gaps, and anticipated and enacted stigma. HIV services adapted, however, through approaches such as multimonth antiretroviral treatment dispensing, intensified community-based antiretroviral treatment delivery, flexibility in working hours, and changes in service access locations. Findings can inform HIV service delivery responses to future public health emergencies.
Authors
- Neema Nakyanjo (ORCID: https://orcid.org/0000-0002-1908-7957)
- Joseph G. Rosen (ORCID: https://orcid.org/0000-0003-4991-4033)
- Robert Ssekubugu (ORCID: https://orcid.org/0000-0003-1245-4774)
- Charles Ssekyewa (ORCID: https://orcid.org/0000-0003-2240-4105)
- Dauda Isabirye (ORCID: https://orcid.org/0000-0002-1336-4861)
- Caitlin Elizabeth Kennedy (ORCID: https://orcid.org/0000-0001-6820-063X)
- William George Ddaaki (ORCID: https://orcid.org/0000-0002-2395-7003)
- M. Kate Grabowski (ORCID: https://orcid.org/0000-0002-4451-3436)
- Joseph Kagaayi (ORCID: https://orcid.org/0000-0003-4101-3038)
- Gertrude F. Nakigozi (ORCID: https://orcid.org/0000-0001-6193-2790)
- Fred Kakaire Nalugoda (ORCID: https://orcid.org/0000-0001-6119-9293)
- Larry W. Chang (ORCID: https://orcid.org/0000-0001-7985-4567)
- Steven James Reynolds (ORCID: https://orcid.org/0000-0002-5403-2759)
- Tongying Zhao (ORCID: https://orcid.org/0009-0005-3622-3411)
- Godfrey Kigozi (ORCID: https://orcid.org/0009-0008-9142-6870)
Institutions
- National Institutes of Health (US)
- Johns Hopkins University (US)
- Brown University (US)
- Johns Hopkins Medicine (US)
- Rakai Health Sciences Program (UG)
- National Institute of Allergy and Infectious Diseases (US)
Publication Details
- Journal
- Journal of the Association of Nurses in AIDS Care
- Published
- 2026-10-27
- DOI
- https://doi.org/10.1097/jnc.0000000000000693
- Primary Topic
- HIV/AIDS Research and Interventions
- Type
- article
- Field-Weighted Citation Impact
- 0.00