Acceptability of Suubi+Adherence intervention to improve ART adherence in Southern Uganda: A qualitative analysis
PLOS One
Authors: Josephine Nabayinda, Ozge Sensoy Bahar, Phionah Namatovu, Proscovia Nabunya, Samuel Kizito, Anita Kabarambi, April Thames & Fred M. Ssewamala.
This study examined the acceptability of the Suubi+Adherence intervention, a multifaceted approach designed to improve antiretroviral therapy (ART) adherence among adolescents and young adults living with HIV in southern Uganda. Although ART is highly effective at improving health outcomes and preventing HIV transmission, young people often experience greater challenges with medication adherence than adults. The Suubi+Adherence intervention sought to address both economic and behavioral barriers to consistent ART use by combining matched savings accounts, mentorship, financial management education, business development training, and an electronic medication-monitoring device.
The researchers conducted semi-structured, in-depth interviews with 36 young people who had participated in the intervention. The qualitative analysis was guided by the Theoretical Framework of Acceptability and examined participants’ motivations for joining the program, experiences with intervention components, and factors that facilitated or hindered participation. The study represents qualitative analysis from the broader Suubi+Adherence-Round 2 research program, which evaluated interventions addressing ART adherence among youth in Uganda.
Participants identified economic empowerment opportunities as a major motivation for participation. In particular, they valued learning how to save money and develop income-generating activities. Participants also reported that the Wisepill electronic monitoring device was useful because it provided reminders to take their medications. The relevance and practical application of the intervention content further contributed to its acceptability.
Several factors supported continued participation, including transportation reimbursements, family support, and intervention content that reflected participants’ everyday experiences and needs. However, participants also described barriers, including long distances and transportation costs, conflicts between intervention sessions and household responsibilities, and competing personal obligations. These findings demonstrate that even well-designed adherence interventions may face implementation challenges when participation requires substantial time or travel.
Overall, the study suggests that combining economic empowerment with behavioral adherence support may be an acceptable strategy for addressing the complex social and economic factors influencing ART adherence among young people living with HIV. The findings highlight the importance of designing youth-focused HIV programs around participants’ practical needs while reducing logistical barriers to engagement. Such approaches may help strengthen long-term ART adherence and support improved health outcomes among adolescents and young adults living with HIV.