Barriers and Facilitators to Successful Intensive Adherence Counseling in Rural Northern Uganda: An Exploratory Interview with HIV-Positive Clients Using the COM-B Framework
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
HIV/AIDS-Research and Palliative Care
Abstract
Purpose: Intensive adherence counseling (IAC) was introduced as a strategy to enhance adherence to antiretroviral therapy (ART)
among HIV clients with non-suppressed viral loads. There has been sub-optimal viral load suppression among HIV clients in Uganda
enrolled in IAC. However, there is a scarcity of literature on the barriers and facilitators of successful IAC. We aim to explore the
barriers and facilitators to successful IAC among HIV-positive clients seeking care in public health facilities in rural northern
Uganda.
Patients and Methods: This was an exploratory qualitative study conducted among 15 purposively sampled HIV-positive clients
enrolled in IAC in public health facilities offering ART services in northern Uganda. We conducted in-depth interviews using semistructured
interview guides based on the capability, opportunity, motivation, and behavior (COM-B) framework for behaviour change.
Data were analyzed using the deductive thematic approach of Braun and Clarke following the COM-B framework.
Results: The majority of the participants were females (60%), married (53%), and attained primary education (47%). Barriers to
successful IAC were Capability – alcoholism and promiscuity, Opportunity – stigma and discrimination, delayed viral load result,
shortage of food, and heavy workload; and Motivation – deteriorating health and lack of incentives. Facilitators to successful IAC were
Capability – good knowledge of ART, good memory, and reminder alerts; Opportunity – availability of ART, social support,
availability of ART, prolonged ART refill, and good counseling; and Motivation – desire to live longer and healthy and the desire
to fulfill dreams and goals.
Conclusion: Successful implementation of IAC needs to consider the context of the person in care thus the need to strengthen
individualized IAC sessions. HIV care providers can adopt the COM-B framework to perform individualized IACs and use the
information to strengthen the counseling sessions
Description
Keywords
barriers, facilitators, HIV, intensive adherence counseling
Citation
Beja, H., Daisy, N., Edek, M. T., Kobusinge, V., Akaki, O., Owachgiu, I. O., & Udho, S. (2022). Barriers and Facilitators to Successful Intensive Adherence Counseling in Rural Northern Uganda: An Exploratory Interview with HIV-Positive Clients Using the COM-B Framework. HIV/AIDS-Research and Palliative Care, 14, 553-563.