Uptake of antiretroviral therapy among people living with HIV in Addis Ababa, Ethiopia: A qualitative exploratory study
Abstract
Background: Unsuppressed viral load despite antiretroviral therapy (ART) remains a major challenge to effective HIV treatment in Ethiopia. In Addis Ababa, retention in care and adherence remain problematic despite the widespread implementation of differentiated service delivery (DSD) models. Aim: To explore ART uptake among people living with HIV (PLHIV) in Addis Ababa from the perspectives of PLHIV and healthcare providers, using a qualitative exploratory approach. Setting: The study was conducted in eight selected public health centres in Addis Ababa, Ethiopia. Methods: A qualitative exploratory study design was employed, involving in-depth interviews with a purposive sample of 36 participants: 20 people living with HIV and 12 healthcare providers (including ART nurses, pharmacists and HIV programme coordinators). Data were analysed thematically to investigate key barriers and facilitators influencing ART uptake. Results: Six themes emerged: (1) structural and systemic barriers, including drug shortages and transportation challenges; (2) psychosocial-related barriers, such as stigma and fear of disclosure; (3) variable awareness and perceptions of DSD models; (4) adherence motivators, including health preservation and social support; (5) provider–patient relationship dynamics; and (6) recommendations focusing on health-system reforms and community engagement. Limited awareness of DSD options and inconsistent implementation reduced the effectiveness of DSD models. Conclusion: Improving ART delivery in Addis Ababa requires integrated interventions that address structural, economic and psychosocial barriers, strengthen patient–provider communication and enhance community engagement. Contribution: The study provides actionable, context-specific evidence on barriers and facilitators to ART uptake, supporting efforts to improve adherence and retention and to advance progress towards global HIV targets and Sustainable Development Goals 3.3 and 3.8.