Antiretroviral treatment sharing among highly mobile Ugandan fisherfolk living with HIV: a qualitative study

ABSTRACT

Antiretroviral treatment (ART) diversion from prescribed to non-prescribed users (i.e., sharing or selling) is an understudied dimension of HIV treatment adherence. We sought to explore ART diversion patterns in high-prevalence fishing communities on Lake Victoria, Uganda. We implemented a qualitative study in two fishing communities on Lake Victoria in south-central Uganda to identify facilitators of and pathways to ART diversion. We conducted 25 semi-structured interviews with HIV-positive fishermen (n = 25) and female sex workers (n = 10) covering personal and community experiences with ART selling/sharing, reasons for medication diversion, and potential solutions to reduce diversion. Data were analyzed using an adapted framework analysis approach. Participants reported frequent ART sharing within occupational networks, but no selling. Mobility was the principal driver of ART sharing and was associated with other barriers to treatment access including stigma, fear of negative health provider interactions, and transportation. ART sharing appears to emerge in response to short-term treatment interruptions in this setting. Future studies should explore characteristics and drivers of ART diversion in other high-burden settings and identify how these practices are correlated with key health outcomes like virologic failure and drug resistance.

KEYWORDS:

• ARV misuse
• adherence
• fisherfolk
• female sex workers
• HIV treatment
• mobile populations
• Uganda

Acknowledgements

We would like to acknowledge the contributions of the Rakai Health Sciences Program, Social and Behavioral Sciences Department, for collecting data presented in this manuscript. We would also like to recognize fishing community residents for their generous participation and thoughtful contributions.

Authors’ contributions

JGR, NN, MJW, FN, SJR, GN, MKG, and CEK designed the study and prepared data collection instruments. NN and DI oversaw data collection and translation of study materials. JGR and DI conducted data analysis. JGR prepared the first draft of the manuscript. All authors read, edited, and approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institute of Mental Health (NIMH) [grant R01MH105313]; the Johns Hopkins University Center for AIDS Research, an NIH funded program [grant number P30AI094189], which is supported by the following National Institutes of Health (NIH) Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR; and in part (SJR) by the Division of Intramural Research, NIAID. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Study supporters played no role in the conduct or reporting of this study.