Exploring Barriers and Enablers to Antiretroviral Therapy Adherence Among Children and Adolescents in Rural South Africa: A Qualitative Study in the KSD Sub-District

Authors:
Open Access
Publisher website
Google Scholar
Abstract
Background Antiretroviral therapy (ART) has transformed HIV into a manageable chronic condition, yet adherence among children and adolescents remains a persistent challenge, particularly in resource-constrained settings. Understanding the ecological determinants of adherence is critical for sustaining treatment outcomes. Methods A qualitative phenomenological design was employed to explore barriers and enablers of ART adherence among HIV-positive children and adolescents below 18 years in the King Sabata Dalindyebo (KSD) Sub-District, Eastern Cape, South Africa. In-depth, semi-structured interviews were conducted with caregivers and adolescents, transcribed, translated, and analyzed using inductive thematic content analysis in Nvivo software. Trustworthiness was ensured through credibility, transferability, dependability, and confirmability strategies. Results From the data analyzed, nine themes were identified and grouped into three overarching categories: (1) household and psychosocial barriers (forgetfulness, stigma, and cultural beliefs), (2) structural and treatment-related challenges (socio-economic constraints and side effects), and (3) supportive enablers (caregiver commitment, reminder systems, positive health service support, and personal motivation). Findings revealed that adherence failures were often linked to caregiver burden, stigma, and treatment tolerability, while enablers such as family support, structured routines, and acceptance of HIV status strengthened adherence. Conclusion ART adherence among children and adolescents is shaped by interconnected household, psychosocial, structural, and health system factors. Tailored interventions that strengthen caregiver support, reduce stigma, improve child-friendly formulations, and promote adolescent self-efficacy are essential for sustaining treatment outcomes. These insights contribute to the design of contextually responsive pediatric HIV programs in South Africa and similar resource-constrained settings.

This publication has 33 references indexed in Scilit: