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The Women's Health CoOp (WHC), a brief, woman\u2010focused, behavioural, evidence\u2010based intervention, has been shown to be effective in reducing heavy drinking and improving HIV\u2010related outcomes among this key population. However, these women face other broader socioecological barriers to antiretroviral therapy (ART) adherence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The WHC was implemented in a modified, stepped\u2010wedge implementation science trial in public health clinics and substance use treatment programmes in Cape Town, South Africa. A qualitative substudy was conducted to explore barriers to HIV treatment adherence among women enrolled in this trial. Eight focus group discussions were conducted with 69 participants 6 months after completion of the WHC workshops. Focus groups were audio\u2010recorded (with consent), transcribed verbatim\u00a0and analysed using a thematic approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean age of the participants was 33 years and the mean self\u2010reported number of drinks per day was 13. The main contextual factors influencing participants\u2019 ART adherence were intrapersonal\u2010level factors (substance use, financial constraints, food insecurity; community\u2010level factors (anticipated and enacted stigma, community violence) and institutional\u2010level factors (patient\u2013provider relationships, health facility barriers, environmental stigma).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Comprehensive interventions addressing the contextual barriers and unique challenges faced by women who misuse alcohol in low\u2010resource settings that intersect with HIV treatment nonadherence should be implemented in tandem with successful biobehavioural HIV interventions for long\u2010term effectiveness and sustainability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patient or Public Contribution<\/jats:title><jats:p>Our South African community collaborative board has been involved throughout this study; participants and clinic staff voices have been essential in our interpretation of these findings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hex.13422","type":"journal-article","created":{"date-parts":[[2022,1,21]],"date-time":"2022-01-21T08:38:05Z","timestamp":1642754285000},"page":"754-763","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["\u2018We have goals but [it is difficult]\u2019. Barriers to antiretroviral therapy adherence among women using alcohol and other drugs living with HIV in South Africa"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8346-7359","authenticated-orcid":false,"given":"Jacqueline W.","family":"Ndirangu","sequence":"first","affiliation":[{"name":"Substance Use, Gender, and Applied Research Program, RTI International  Research Triangle Park North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret W.","family":"Gichane","sequence":"additional","affiliation":[{"name":"Substance Use, Gender, and Applied Research Program, RTI International  Research Triangle Park North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felicia A.","family":"Browne","sequence":"additional","affiliation":[{"name":"Substance Use, Gender, and Applied Research Program, RTI International  Research Triangle Park North Carolina USA"},{"name":"Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Courtney P.","family":"Bonner","sequence":"additional","affiliation":[{"name":"Substance Use, Gender, and Applied Research Program, RTI International  Research Triangle Park North Carolina USA"},{"name":"Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William A.","family":"Zule","sequence":"additional","affiliation":[{"name":"Substance Use, Gender, and Applied Research Program, RTI International  Research Triangle Park North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin N.","family":"Cox","sequence":"additional","affiliation":[{"name":"Substance Use, Gender, and Applied Research Program, RTI International  Research Triangle Park North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin M.","family":"Smith","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tara","family":"Carney","sequence":"additional","affiliation":[{"name":"Alcohol, Tobacco and Other Drug Research Unit South African Medical Research Council  Tygerberg South Africa"},{"name":"Department of Psychiatry and Mental Health University of Cape Town  Rondebosch Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5146-6463","authenticated-orcid":false,"given":"Wendee M.","family":"Wechsberg","sequence":"additional","affiliation":[{"name":"Substance Use, Gender, and Applied Research Program, RTI International  Research Triangle Park North Carolina USA"},{"name":"Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Department of Psychology North Carolina State University  Raleigh North Carolina USA"},{"name":"Psychiatry and Behavioral Sciences Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,1,21]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"UNAIDS. 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