BackgroundPrivate health facilities are increasingly being recognized as the neglected partner in the provision of HIV services. The non-adherence rate in the study sites ranged from 19 to 22%. This study explored the factors associated with non-adherence from antiretroviral therapy (ART) among adult patients accessing ART services at two privately owned urban health facilities in Malawi.MethodsWe conducted a descriptive qualitative approach employing in-depth interviews among adults who either defaulted or were retained in HIV care in two privately owned facilities in Malawi from March to July 2017. We purposively selected participants and interviewed a total of 6 ART providers and 24 ART clients. Data were analyzed manually using a thematic approach.ResultsOverall, participants identified four facilitators for retention in care and four broad categories of barriers namely individual, psychological, drug related and human resource related factors. The factors that facilitated retention in care included follow up visits after missing a visit, adequate information education and counseling, and supportive relationships.ConclusionThe main reason for defaulting from antiretrovirals (ARVs) was fear of disclosing an HIV status to avert potential stigma and discrimination. In implementing ART clinics due consideration and strategies need to be adopted to ensure that privacy and confidentiality is preserved. Although adoption of all the key Malawi Implementing strategies like expert clients and a guardian may optimize retention in care, there is need for prior analysis of how those may lead to unintended disclosure which inadvertently affects adherence. Furthermore, private facilities should orient their clients to the public facilities within the catchment area so that clients have an option for alternative access to HIV care in the event of financial constraints.

A descriptive qualitative study among 12 religious leaders and 10 members from seven different religions using in-depth interviews was conducted to explore the factors that influence HIV testing among religious people in the area of Traditional Authority Chitukula, Lilongwe district. Participants and sites were purposively selected and all interviews were recorded using a digital recorder, then transcribed and translated into English. Data were analyzed using a thematic approach. The study showed that prayer has a prominent role in the management of HIV and AIDS. The barriers to HIV testing include a belief in faith healing, the rules of a specific church, and a perception of a low risk of HIV infection among religious people. Interventions that could promote HIV testing include the implementation of HIV self-testing, mobile and or door-to-door HIV services, church-based HIV testing services, and facility-based services that are integrated with other services to preserve privacy. Religious platforms can be leveraged in the delivery of HIV testing services. The promotion of religious-based prevention interventions needs to consider the foundations and beliefs of each religion and be able to contextualize the methods which can be achieved by continuous dialogue and support from religious leaders.