Reasons for Missed ART Doses and Health Workers’ Perspectives on ART Adherence Among People Living with HIV in Southwestern Uganda: A Cross-Sectional Mixed-Methods Study.

Authors

  • Elizabeth Ninsiima Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda , Department of Public Health, Bishop Stuart University, Mbarara City, Uganda
  • Daniel Atwine Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda
  • Caroline Birungi Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda
  • Joanna Teta Ikiriza Department of Clinical Research, SRF research and Training Centres, Mbarara City, Uganda
  • Bernard Ahimbisibwe Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda
  • Elna Owembabazi Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda
  • Nighty Sunday Atwine Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda
  • Rachael Kanyana Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda
  • Alex Rutebwa Department of Community Health, Mbarara University of Science and Technology.
  • Jackson Selwano Musiime Department of Public Health, Bishop Stuart University, Mbarara City, Uganda
  • Jordan Amanyire Mutambi Department of Public Health, Bishop Stuart University, Mbarara City, Uganda

DOI:

https://doi.org/10.51168/j87hfw42

Keywords:

HIV, antiretroviral therapy, ART adherence, missed doses, PLHIV, Health workers

Abstract

Background: Missed antiretroviral therapy (ART) doses can compromise treatment outcomes among people living with HIV. This study explored reasons for missed ART doses among people living with HIV and health workers’ perspectives on factors influencing ART adherence in southwestern Uganda.

Methods: A cross-sectional mixed-methods study was conducted among 386 adults receiving ART at Mbarara City Council Health Centre IV and Bwizibwera Health Centre IV. Quantitative data were collected using a structured interviewer-administered questionnaire and analysed using Stata version 18.0. Qualitative data were collected through nine key informant interviews with healthcare providers involved in HIV care and ART services and analysed thematically using Braun and Clarke’s six-phase approach.

Results: The common reasons for missed doses were travel (38.9%) and forgetfulness (33.3%). Others included lack of  medication (9.3%) and domestic conflicts or stress (6.2%). Healthcare providers described ART adherence being shaped by everyday life circumstances; mobility, distance and stigma creating barriers to accessing ART services; social relationships, stigma and beliefs influencing treatment behaviour; health-system organization affecting continuity of care; adherence-support strategies being implemented within resource constraints; and the need for more flexible, decentralized and adequately resourced ART services. Providers particularly described work-related mobility, alcohol use, treatment fatigue, non-disclosure, stigma, transport difficulties, waiting times, and difficulties accessing medication when away from the usual ART facility as challenges.

Missed ART doses were mainly related to travel and forgetfulness, within broader individual, social and health-system challenges. ART services should strengthen patient-centred adherence support through flexible refill options, community-based ART delivery, appointment reminders and timely management of treatment-related challenges.

Author Biographies

  • Elizabeth Ninsiima, Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda , Department of Public Health, Bishop Stuart University, Mbarara City, Uganda

    is a Research and Community Engagement Officer at Soar Research Foundation and SRF Research and Training Centres in Mbarara, Uganda. She holds a Bachelor of Environmental Science from Makerere University and is pursuing a Master of Public Health at Bishop Stuart University. Her work focuses on community engagement in health research, development of community engagement strategies, coordination of Community Advisory Boards, stakeholder engagement, research ethics, and qualitative and quantitative research. Her research interests include HIV, sexual and reproductive health, vulnerable populations, and community-engaged research.

  • Daniel Atwine, Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda

    is the Executive Director of SRF Research and Training Centres and Soar Research Foundation in Mbarara, Uganda. He is a medical doctor, epidemiologist, and research consultant with a PhD in Epidemiology, an MPhil in Science and Technology Studies, an Advanced Master in Public Health Methodology, and an MBChB. He has extensive experience in clinical and public health research, research ethics, clinical trials, teaching, and postgraduate research supervision. His research experience spans tuberculosis, HIV, malaria, maternal and child health, diagnostics, eye health, nutrition, and health systems research.

  • Caroline Birungi, Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda

    is a Research Regulatory Manager and Research Training Coordinator at SRF Research and Training Centres and Soar Research Foundation in Mbarara, Uganda. She holds a Bachelor of Science with Education and is pursuing a Master of Public Health specialising in Research Ethics. She also holds a Postgraduate Diploma in Clinical Trials. Her professional experience includes research ethics and regulatory compliance, quantitative and mixed-methods research, data quality assurance, research coordination, staff supervision, and research training.

  • Joanna Teta Ikiriza, Department of Clinical Research, SRF research and Training Centres, Mbarara City, Uganda

    is a Programs and Systems Coordinator and Data Manager at Soar Research Foundation in Mbarara, Uganda. She holds qualifications in Information Technology and Software Engineering and has professional experience in data management, information technology, database systems, and research data management. Her work includes development and implementation of data management procedures, management of research databases, data quality assurance, staff training, and technical support for research data systems. She has experience using REDCap, Kobo Collect, Epi Info, and other research data platforms.

  • Bernard Ahimbisibwe, Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda

    is a Production and Digital Learning Manager at Soar Research Foundation and SRF Research and Training Centres in Mbarara, Uganda. He holds a Bachelor of Science with Education from Mbarara University of Science and Technology. His professional experience includes research production, data management, translation, transcription, digital learning, and development of research communication and dissemination materials. He has additional training in Good Clinical Practice, research ethics, and cybersecurity and supports the development of digital and research-related materials at SRF.

  • Elna Owembabazi, Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda

    is a Senior Research Associate at SRF Research and Training Centres and a Senior Lecturer in Human Anatomy at Kampala International University. She holds a PhD in Anatomical Sciences from the University of the Witwatersrand, a Master of Science in Human Anatomy, and a Bachelor of Medical Laboratory Science. Her research interests include anatomical sciences, reproductive biology, non-communicable diseases, addiction, and interdisciplinary biomedical research. She has experience in university teaching, postgraduate research supervision, research coordination, and interdisciplinary research.

  • Nighty Sunday Atwine, Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda

    is a public health specialist and Program Coordinator with the USAID-supported Mbarara Regional Referral Hospital Strengthening Activity in Uganda. She holds a Master of Public Health and a Bachelor of Medicine and Bachelor of Surgery. She has more than eight years of experience in health programme coordination and implementation, including previous work with Amref Health Africa and USAID-supported health programmes. Her professional experience includes HIV, tuberculosis, malaria, nutrition, reproductive, maternal, child and adolescent health, monitoring and evaluation, stakeholder coordination, and health-system strengthening.

  • Rachael Kanyana, Department of Clinical Research, SRF Research and Training Centres, Mbarara City, Uganda , Department of Clinical Research, Soar Research Foundation, Mbarara City, Uganda

    is a Language Translation and Transcription Officer at SRF Research and Training Centres in Mbarara, Uganda. She holds a Diploma in Commercial Art and Design from Ndejje University and a Certificate in Ophthalmic Theatre Nursing from Ruharo Eye Centre. She has professional experience in healthcare, ophthalmic services, translation, transcription, and client service. At SRF Research and Training Centres, she supports research through translation and transcription of research materials and data, contributing to data collection, processing, and dissemination. She also has training in Good Clinical Practice and basic ophthalmology.

  • Alex Rutebwa, Department of Community Health, Mbarara University of Science and Technology.

    is a medical doctor and public health professional with experience in clinical practice, public health, health systems strengthening, and clinical research. He holds a Bachelor of Medicine and Bachelor of Surgery (MBChB) from Makerere University and a Master of Public Health (MPH) from Mbarara University of Science and Technology (MUST). He has served in health-system leadership and public health roles and is currently the Medical Director at Kabwohe Clinical Research Centre in Sheema District, Uganda. His professional interests include public health, clinical research, health systems strengthening, and improving the quality and delivery of healthcare services in Uganda.

  • Jackson Selwano Musiime, Department of Public Health, Bishop Stuart University, Mbarara City, Uganda

    is a Public Health Specialist, Assistant Lecturer at Bishop Stuart University, and Medical Director at Musmush Medical Centre in Mbarara, Uganda. His research interests include public health, health service delivery, quality improvement, and healthcare access. His research has focused on patient flow and quality of care among older adults in outpatient settings in southwestern Uganda and on mobile telehealth systems and information accessibility. He has also conducted qualitative research on the experiences and support needs of doctoral students in southwestern Uganda.

  • Jordan Amanyire Mutambi, Department of Public Health, Bishop Stuart University, Mbarara City, Uganda

    is a lecturer in the Department of Public Health and Biomedical Sciences, Faculty of Nursing and Health Sciences, at Bishop Stuart University, Mbarara, Uganda. He is a public health specialist, counsellor, and nursing professional with extensive experience in HIV/AIDS programme implementation and health services. He has worked with TASO and Mbarara District Local Government and has research experience in HIV/AIDS, mental health, non-communicable diseases, counselling, and psychosocial challenges among older adults living with HIV/AIDS.

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Published

2026-09-30

Issue

Vol. 7 No. 3 (2026): September 2026 issue

Section

Section of Health Services Research

License

Copyright (c) 2026 Elizabeth Ninsiima, Daniel Atwine, Caroline Birungi, Joanna Teta Ikiriza, Bernerd Ahimbisibwe, Elna Owembabazi, Nighty Sunday Atwine, Recheal Kanyana, Jackson Selwano Musiime, Jordan Amanyire Mutambi

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

How to Cite

Ninsiima, E., Daniel, Caroline, Joanna, Bernard, Elna, Nighty, Rachael, Rutebwa, A., Jackson, & Jordan. (2026). Reasons for Missed ART Doses and Health Workers’ Perspectives on ART Adherence Among People Living with HIV in Southwestern Uganda: A Cross-Sectional Mixed-Methods Study. Student’s Journal of Health Research Africa, 7(3), 14. https://doi.org/10.51168/j87hfw42

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