Reasons for Missed ART Doses and Health Workers’ Perspectives on ART Adherence Among People Living with HIV in Southwestern Uganda: A Cross-Sectional Mixed-Methods Study.
Abstract
Background: Missed antiretroviral therapy (ART) doses can compromise treatment outcomes among people living with HIV. This study explored reasons for missed ART doses among people living with HIV and health workers’ perspectives on factors influencing ART adherence in southwestern Uganda. Methods: A cross-sectional mixed-methods study was conducted among 386 adults receiving ART at Mbarara City Council Health Centre IV and Bwizibwera Health Centre IV. Quantitative data were collected using a structured interviewer-administered questionnaire and analysed using Stata version 18.0. Qualitative data were collected through nine key informant interviews with healthcare providers involved in HIV care and ART services and analysed thematically using Braun and Clarke’s six-phase approach. Results: Among the 386 participants, 162 (42.0%) missed at least one ART dose since their most recent refill, while 101 (26.2%) missed at least two doses. The median number of missed days was 2 (IQR 1–3). The common reasons for missed doses were travel (38.9%) and forgetfulness (33.3%). Others included lack of medication (9.3%) and domestic conflicts or stress (6.2%). Healthcare providers described ART adherence being shaped by everyday life circumstances; mobility, distance and stigma creating barriers to accessing ART services; social relationships, stigma and beliefs influencing treatment behaviour; health-system organization affecting continuity of care; adherence-support strategies being implemented within resource constraints; and the need for more flexible, decentralized and adequately resourced ART services. Providers particularly described work-related mobility, alcohol use, treatment fatigue, non-disclosure, stigma, transport difficulties, waiting times, and difficulties accessing medication when away from the usual ART facility as challenges. Missed ART doses were common and were mainly related to travel and forgetfulness, within broader individual, social and health-system challenges. ART services should strengthen patient-centred adherence support through flexible refill options, community-based ART delivery, appointment reminders and timely management of treatment-related challenges.