Social Networks and Barriers to ART Adherence Among Young Adults (18–24 years) Living with HIV at Selected Primary Health Facilities of South-Western Uganda: A Qualitative Study

Abstract

Background: Young adults living with HIV (YALWH) struggle to maintain high levels of adherence to antiretroviral therapy (ART) because of numerous barriers. This study describes the social networks of YALWH (18-24 years), their barriers to ART adherence, and the perceived role of social networks in overcoming those barriers. Methods: This study used a qualitative descriptive research design. Twenty-three (23) YALWH who were on ART for a period of greater than one (1) month and had consented to participate in the study were purposively selected from two primary health care facilities in southwestern Uganda. We held four (4) focus group discussions with the YALWH over 5 weeks between the 24th of July and 7th September 2020. Data were audio recorded, transcribed, and entered in Microsoft word 2010. Using the content analysis techniques, data were inductively coded and categories or themes developed. Results: Most YALWH belonged to bonding (family, friends, and neighbors), followed by bridging (informal groups), and linking (health professionals) social networks, respectively. Most YALWH, irrespective of gender, had close connections with their mothers or elder sisters. The commonest form of bridging networks was informal community groups that provided financial services, whereas the linking ones comprised health professionals' directly involved in HIV patient care such as nurses, counselors, and their affiliates (expert clients or clinic based peer supporters), who occasionally acted as bonding networks. Structural barriers to ART adherence (eg, stigma) were the most cited, followed by medication-(eg, pill burden), and patient-related barriers (eg, non-disclosure of HIV status). Bonding networks were perceived to help overcome patient, medication, and structural barriers to ART adherence. Bridging networks overcame structural and medication-related barriers to ART adherence. Linking networks were perceived to help overcome some health systems and medication-related barriers to ART adherence. Conclusion: Bonding social networks seem to play a prominent role in overcoming numerous barriers to ART adherence compared with bridging and linking social networks.

Barriers and Facilitators to Successful Intensive Adherence Counseling in Rural Northern Uganda: An Exploratory Interview with HIV-Positive Clients Using the COM-B Framework

“…These results are plausible because all these are critical external factors that disturb HIV-positive clients psychologically to appoint where they may become non-adherent to their drugs hence unsuppressed viral load due to forgetfulness, anger, and fear of taking their drugs on an empty stomach. Our studies are similar to the results of previous studies conducted in Uganda, 19,20 Eswatini, 18 and a systematic review on barriers and facilitators to ART adherence in sub-Saharan Africa 21 which showed that stigma and discrimination, shortage of food, delayed viral load results, and heavy workload can lead to non-adherence to ART hence unsuppressed viral load. We encourage HIV service providers to avail viral load results to HIV-positive clients as soon as they are ready so that they may know whether what they are currently doing to remain on treatment is working.…”

HIV virologic response, patterns of drug resistance mutations and correlates among adolescents and young adults: A cross-sectional study in Tanzania

“…Young adolescents (10–15 years) and older adolescents (15–17 years) face adherence challenges due to developmental changes and leading to an inability to undertake the task of their HIV management [ 35 ]. Factors such as dependence on parents, guardians, family settings for medication administration, keeping clinic appointments, disclosure of HIV-positive status, attending school, type and dosing of ARV, and patient-provider relationship may adversely affect their adherence to ART, leading to ART failure and/ or development of drug resistance [ 35 , 36 ]. Determinants of adherence and treatment failure in young adults (18–24 years) include self-stigma, non-disclosure of HIV-positive status to family members and sexual partners, age-related behaviors such as alcoholism, illegal drug abuse and transitioning from adolescence to adult HIV care [ 36 ].…”

“…patient-provider relationship may adversely affect their adherence to ART, leading to ART failure and/ or development of drug resistance [35,36]. Determinants of adherence and treatment failure in young adults (18-24 years) include self-stigma, non-disclosure of HIV-positive status to family members and sexual partners, age-related behaviors such as alcoholism, illegal drug abuse and transitioning from adolescence to adult HIV care [36].…”

Uncovering the forgotten story of the impact of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome on economic growth in Ghana: A gender analysis

“…This implies that losing or having a male breadwinner suffering from HIV/AIDs can result in a significant loss of income and time for men, which can negatively impact their ability to grow and thrive compared to women. A study by Ajuna et al 51 in Uganda found that households with HIV‐positive women had lower income and expenditure levels compared to households with HIV‐negative women. However, the study also found that households with HIV‐positive men had higher income and expenditure levels compared to households with HIV‐negative men.…”