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

Figures & data

Table 1 Selection Criteria, Demographic and Clinical Characteristics of Study Participants

Characteristic	n
Selection criteria
# Invited to participate	42
# Assessed for eligibility	31 (n=05, were on ART for <4 weeks)
# Eligible	26 (n=02, could not local languages, n=01, were sick)
# Consented & participated in FGDs	23
Gender
Male	07
Female	16
Residence
Urban	09
Rural	14
Marital Status
Single	15
Married/cohabiting	08
School status
In school	03
Out of school	20
Religion
Christian	20
Others	03
HIV acquisition
Behaviorally	21
Perinatally	02
Drugs
ART only	13
ART & Septrin	10
Average period on ART (median years)	1.8 (3 months–2 years)

Abbreviation: ART, Antiretroviral therapy.

Table 2 Major Themes, Categories, and Codes Derived from Data About Barriers to ART Adherence

Themes	Categories	Subcategories/Codes
Patient related barriers	Non-disclosure of HIV status	Non-disclosure to non-close networks Non-disclosure was because of perceived and anticipated stigma Non-disclosure raised suspicions
	Forgetfulness	Sleep and a busy work schedule Lack of colleagues to remind them
	Change in daily routine	Abrupt change in daily routines Never carried ART
Medication-related barriers	Pill burden	The daily intake of ART Treatment fatigue Drug holidays
	Bigger pill size	Size of the pill Perceived difficulty in swallowing the tablets Improved community understanding of HIV treatment
	Noisy pill packages	Noisy on opening pill packages Noisy during transportation/movement Noise raises suspicions
	ART side effects	Side effects, such as dizziness, general malaise, headache, in somnolence etc. Lack of heavy drinks and food worsened the side effects
Structural-related barriers	Stigma	Persistent enacted stigma Stigma follows actual or accidental HIV status disclosure Lack of privacy and fear of being frequently discussed by others
	Financial constraints	Limited finances to buy medicine Limited finances to buy food
	Health system-related barriers subcategories
	Drug stock-outs	Receive fewer drugs Fewer drugs attracted frequent ART clinic visits Additional transport costs Frequent ART clinic visits raised suspicions among employers Occasional requests for permission to pick ART Picked ART from a secondary site
	Long queues and waiting times	Long waiting times and queues Hunger Early Booking Delegating a colleague to pick ART Skipping the long queues
	Undifferentiated health care services in the adult HIV clinic	Open waiting spaces Easier recognition as a patient with HIV Proximity and the limited time spent with a health worker Poor communication from the health care workers
	Delay in health facility transfers	Lack of smoothness in the transfer Back and forth movement

Table 3 Major Themes, Categories, and Codes Derived from Data About the Perceived Role of Social Networks

Themes	Categories	Subcategories/Codes
The perceived role of bonding networks	Provision of instrumental support	Provide funds to purchase food Provide funds to cover transport costs to ART clinic Provide funds to purchase HIV-related medications Provide food stuff Pick herbs to manage ART side effects Support during pregnancy Job linkage
	Provision of informational and emotional support	Counseling/advice Concern/love and care Encouragement
	Provision of ART intake reminders	Frequently inquire about ART intake Remind YALWH
	Peer to peer support among YALWH	Reciprocity Collaborated to reduce transport costs
	Protection from stigma	Acceptance of their HIV status Non-disclosure of their HIV status to others Hide away ART for them Provide secretive moral (counseling) Provide secretive financial support
The perceived role of bridging networks	Provision of instrumental support, such as financial loans.	Food loans Loan to cover transport costs Loans to cover hospital bills or pay for HIV-related medications School fees loans Enterprise loans
	Peer-to-peer financial assistance among group members to pick ART	Group members to set up teams to pick ART for their colleagues Raise finances for transport to and from ART reception centers
	Provision of informational support.	Advice from the group Invite health workers or expert clients for group support
The perceived role of linking networks	Provision of informational and emotional support	Support beyond working hours or official mandate Encouragement Visiting (love and Care) Counseling/Advice Promptly provided ART during illness
	Provision of ART intake reminders	ART intake reminders Reminders to pick ART
	Keeping or reserving ART for their clients	Keeping ART aside for YALWH Sending ART to YALWH