{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:15:09Z","timestamp":1791220509800,"version":"4.1.0"},"reference-count":112,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>In Ghana, poor treatment adherence among persons living with HIV (PLHIV) affects the effective treatment and management of HIV\/AIDS. A key limitation in addressing the antiretroviral therapy (ART) adherence challenge is the skewed nature of the existing literature on the topic, as much of the research on ART adherence has focused on patient-reported experiences, failing to capture the perspectives of healthcare providers involved in ART delivery.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>We ascertained healthcare providers\u2019 perspectives on ART adherence among PLHIV and their proffered recommendations for improved ART retention in the Volta Region of Ghana.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A total of eighteen healthcare providers offering ART services to PLHIV in the Volta Region of Ghana were purposefully recruited from five HIV sentinel sites and interviewed. The data was thematically analyzed using ATLAS.ti.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>The health workers\u2019 experiences were categorized under seven thematic areas. These included difficulties in accessing healthcare providers, improvements in adherence to treatment, people who have interrupted treatment often being new clients, general improvements in health outcomes, financial challenges, persistent stigmatization, and varied levels of family awareness about clients\u2019 status. The reasons for treatment interruption were categorized into fifteen areas. These factors included appointment intervals, healthcare workers, medication shortages, long waiting times, clients\u2019 distance from the facility, forgetfulness, drug characteristics, financial challenges, stigmatization, drug side effects, lack of donor support, alternative treatment choices, misconceptions about HIV cures, and the location of the ART clinic within the health facility. Participants recommended making health facilities\/ART sites accessible to communities, increased advocacy on HIV by PLHIV, extended appointment intervals, continuous availability of antiretroviral drugs (ARVs), community support in the treatment of HIV, improved counseling, public education on HIV to reduce stigmatization, government support, home dispensing of ARVs, regulating the activities of traditional herbalists and faith-based healers, and the encouragement of religious bodies in ART adherence education for improved ART uptake. The ART-related challenges identified by the healthcare providers should be addressed by both the Ghana Health Service and the Ghana AIDS Commission to improve ART uptake and adherence in the Volta Region and across the country if Ghana is to end the HIV pandemic by 2030, as set by UNAIDS.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0333695","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T17:29:47Z","timestamp":1759512587000},"page":"e0333695","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Healthcare providers\u2019 experiences and recommendations for antiretroviral therapy adherence in Ghana: A facility-based phenomenological study"],"prefix":"10.1371","volume":"20","author":[{"given":"Elvis Enowbeyang","family":"Tarkang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2724-3649","authenticated-orcid":true,"given":"Emmanuel","family":"Manu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fortres Yayra","family":"Aku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Komesuor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Charles-Unadike","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelisiwe","family":"Khuzwayo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3951-4573","authenticated-orcid":true,"given":"Judith","family":"Anaman-Torgbor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"pone.0333695.ref001","volume-title":"Key populations and Sub-Saharan Africa\u2019s HIV response","author":"M Mhango","year":"n.d"},{"key":"pone.0333695.ref002","volume-title":"Fact sheet 2024 - Latest global and regional HIV statistics on the status of the AIDS epidemic","author":"UNAIDS","year":"2024"},{"key":"pone.0333695.ref003","unstructured":"World Health Organization. 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Okeke","year":"2014","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"1","key":"pone.0333695.ref044","doi-asserted-by":"crossref","first-page":"28","DOI":"10.3390\/children11010028","article-title":"Qualitative study on the voices of adolescents living with perinatally acquired HIV in selected clinics in the Limpopo province of South Africa","volume":"11","author":"RA Mabasa","year":"2023","journal-title":"Children"},{"issue":"4","key":"pone.0333695.ref045","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1080\/09540121.2012.720362","article-title":"Internalized stigma and HIV status disclosure among HIV-positive black men who have sex with men","volume":"25","author":"NM Overstreet","year":"2013","journal-title":"AIDS Care"},{"issue":"1","key":"pone.0333695.ref046","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s12981-022-00452-5","article-title":"Patient experiences and preferences for antiretroviral therapy service provision: implications for differentiated 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Panahi","year":"2022","journal-title":"J Patient Exp"},{"issue":"9","key":"pone.0333695.ref056","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1080\/09540121.2012.699669","article-title":"Factors associated with pregnant women\u2019s anticipations and experiences of HIV-related stigma in rural Kenya","volume":"24","author":"YP Cuca","year":"2012","journal-title":"AIDS Care"},{"issue":"1","key":"pone.0333695.ref057","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0211298","article-title":"Reducing HIV-related stigma and discrimination in healthcare settings: A systematic review of quantitative evidence","volume":"14","author":"GT Feyissa","year":"2019","journal-title":"PLoS One"},{"key":"pone.0333695.ref058","doi-asserted-by":"crossref","first-page":"18640","DOI":"10.7448\/IAS.16.3.18640","article-title":"Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis","volume":"16","author":"IT Katz","year":"2013","journal-title":"J Int 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Nachega","year":"2012","journal-title":"AIDS"},{"key":"pone.0333695.ref073","article-title":"Patients\u2019 perceptions of nurses\u2019 behavior influence patient participation in nursing care: a critical incident study","volume":"2011","author":"IE Dapaah","year":"2011","journal-title":"Nursing Research and Practice"},{"issue":"3","key":"pone.0333695.ref074","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1097\/QAI.0b013e318295b86a","article-title":"Higher quality communication and relationships are associated with improved patient engagement in HIV care","volume":"63","author":"TE Flickinger","year":"2013","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0333695.ref075","volume-title":"Consolidated guidelines on HIV testing services: 5Cs: consent, confidentiality, counseling, correct results, and connection","author":"World Health 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Okoronkwo","year":"2013","journal-title":"International Scholarly Research Notices"},{"issue":"5","key":"pone.0333695.ref079","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25492","article-title":"Stigma and quality of co-located care for HIV-positive people in addiction treatment in Ukraine: a cross-sectional study","volume":"23","author":"Y Sereda","year":"2020","journal-title":"J Int AIDS Soc"},{"issue":"4","key":"pone.0333695.ref080","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.jiph.2015.06.010","article-title":"Eliminating mother-to-child transmission of the human immunodeficiency virus in sub-Saharan Africa: The journey so far and what remains to be done","volume":"9","author":"OO Adetokunboh","year":"2016","journal-title":"J Infect Public Health"},{"issue":"3","key":"pone.0333695.ref081","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1093\/heapol\/czx187","article-title":"The role of community health workers in improving HIV treatment outcomes in children: lessons learned from the ZENITH trial in Zimbabwe","volume":"33","author":"J Busza","year":"2018","journal-title":"Health Policy Plan"},{"issue":"1","key":"pone.0333695.ref082","doi-asserted-by":"crossref","DOI":"10.4102\/phcfm.v9i1.1343","article-title":"Factors contributing to antiretroviral drug adherence among adults living with HIV or AIDS in a Kenyan rural community","volume":"9","author":"MT Kioko","year":"2017","journal-title":"Afr J Prim Health Care Fam Med"},{"key":"pone.0333695.ref083","article-title":"Retention in care and adherence to ART are critical elements of HIV care interventions","author":"SM Stricker","year":"2014","journal-title":"AIDS Behav"},{"issue":"10","key":"pone.0333695.ref084","doi-asserted-by":"crossref","first-page":"5424","DOI":"10.3390\/ijerph18105424","article-title":"Stigma and Discrimination towards People Living with HIV in the Context of Families, Communities, and Healthcare Settings: A Qualitative Study in Indonesia","volume":"18","author":"NK Fauk","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0333695.ref085","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10461-016-1453-3","article-title":"HIV Disclosure Anxiety: A Systematic Review and Theoretical Synthesis","volume":"21","author":"M Evangeli","year":"2017","journal-title":"AIDS Behav"},{"issue":"8","key":"pone.0333695.ref086","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0104961","article-title":"Multi-level factors affecting entry into and engagement in the HIV continuum of care in Iringa, Tanzania","volume":"9","author":"EH Layer","year":"2014","journal-title":"PLoS One"},{"issue":"1","key":"pone.0333695.ref087","doi-asserted-by":"crossref","DOI":"10.1097\/QAI.0b013e31829b567d","article-title":"High HIV testing uptake and linkage to care in a novel program of home-based HIV counseling and testing with facilitated referral in KwaZulu-Natal, South 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Non-adherence to antiretroviral therapy among HIV infected adults in Mon state of Myanmar. n.d."},{"issue":"1","key":"pone.0333695.ref091","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1186\/s12889-019-6691-7","article-title":"Understanding factors influencing linkage to HIV care in a rural setting, Mbeya, Tanzania: qualitative findings of a mixed methods study","volume":"19","author":"ES Sanga","year":"2019","journal-title":"BMC Public Health"},{"issue":"11","key":"pone.0333695.ref092","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002183","article-title":"Patient-Reported Barriers to Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis","volume":"13","author":"Z Shubber","year":"2016","journal-title":"PLoS Med"},{"key":"pone.0333695.ref093","first-page":"503","article-title":"Factors Contributing to Loss to Follow-Up from HIV Care Among Men Living with HIV\/AIDS in Kibaha District, Tanzania","volume":"14","author":"MB Mandawa","year":"2022","journal-title":"HIV AIDS (Auckl)"},{"issue":"7","key":"pone.0333695.ref094","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.socscimed.2011.12.022","article-title":"Because he has bought for her, he wants to sleep with her: Alcohol as a currency for sexual exchange in South African drinking venues","volume":"74","author":"MH Watt","year":"2012","journal-title":"Social Science & Medicine"},{"key":"pone.0333695.ref095","doi-asserted-by":"crossref","DOI":"10.1186\/1748-7161-10-S1-P5","article-title":"How \u2018idiopathic\u2019 is adolescent idiopathic scoliosis? A systematic review on associated abnormalities","volume":"10","author":"TP Schl\u00f6sser","year":"2015","journal-title":"Scoliosis"},{"issue":"1","key":"pone.0333695.ref096","article-title":"Role and outcomes of community health workers in HIV care in sub\u2010Saharan Africa: a systematic review","volume":"16","author":"GW Mwai","year":"2013","journal-title":"African Journal of Reproduction and Gynaecological Endoscopy"},{"key":"pone.0333695.ref097","doi-asserted-by":"crossref","first-page":"23259582211000525","DOI":"10.1177\/23259582211000525","article-title":"\u201cThose People Motivate and Inspire Me to Take My Treatment.\u201d Peer Support for Adolescents Living With HIV in Cape Town, South Africa","volume":"20","author":"CA Rencken","year":"2021","journal-title":"J Int Assoc Provid AIDS Care"},{"key":"pone.0333695.ref098","article-title":"Adverse reactions to antiretroviral therapy: a prevalent concern","volume":"41","author":"CM de P\u00e1dua","year":"2018","journal-title":"Revista Panamericana de Salud P\u00fablica"},{"key":"pone.0333695.ref099","volume-title":"Antiretroviral HIV Drugs: Side Effects and Adherence","author":"S Watson","year":"2020"},{"issue":"3","key":"pone.0333695.ref100","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1080\/17290376.2008.9724912","article-title":"Barriers and facilitators to patients\u2019 adherence to antiretroviral treatment in Zambia: a qualitative study","volume":"5","author":"N Sanjobo","year":"2008","journal-title":"SAHARA J"},{"issue":"1","key":"pone.0333695.ref101","doi-asserted-by":"crossref","first-page":"28","DOI":"10.24875\/AIDSRev.19000037","article-title":"HIV Treatment Adherence - A Shared Burden for Patients, Health-Care Providers, and Other Stakeholders","volume":"21","author":"SA Abdulrahman","year":"2019","journal-title":"AIDS Rev"},{"issue":"12","key":"pone.0333695.ref102","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1016\/S1473-3099(11)70181-5","article-title":"Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies","volume":"11","author":"T B\u00e4rnighausen","year":"2011","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"pone.0333695.ref103","article-title":"The tale of two epidemics: HIV\/AIDS in Ghana and Namibia","volume":"15","author":"YA Halasa-Rappel","year":"2021","journal-title":"The Open AIDS Journal"},{"issue":"4","key":"pone.0333695.ref104","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1007\/s10461-009-9533-2","article-title":"Transportation costs impede sustained adherence and access to HAART in a clinic population in southwestern Uganda: a qualitative study","volume":"14","author":"DM Tuller","year":"2010","journal-title":"AIDS Behav"},{"key":"pone.0333695.ref105","doi-asserted-by":"crossref","DOI":"10.1136\/sextrans-2016-052974","article-title":"Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV\/AIDS in Eastern and Southern Africa","volume":"93","author":"M Moshabela","year":"2017","journal-title":"Sex Transm Infect"},{"issue":"7","key":"pone.0333695.ref106","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1007\/s10461-014-0729-8","article-title":"Impact of geographic and transportation-related barriers on HIV outcomes in sub-Saharan Africa: a systematic review","volume":"18","author":"AJ Lankowski","year":"2014","journal-title":"AIDS Behav"},{"issue":"2","key":"pone.0333695.ref107","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s10461-014-0865-1","article-title":"The impact of community support initiatives on the stigma experienced by people living with HIV\/AIDS in South Africa","volume":"19","author":"C Masquillier","year":"2015","journal-title":"AIDS Behav"},{"key":"pone.0333695.ref108","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s12906-016-1101-5","article-title":"Traditional, complementary and alternative medicine use by HIV patients a decade after public sector antiretroviral therapy roll out in South Africa: a cross sectional study","volume":"16","author":"M Nlooto","year":"2016","journal-title":"BMC Complement Altern Med"},{"key":"pone.0333695.ref109","doi-asserted-by":"crossref","first-page":"115","DOI":"10.3389\/fpubh.2017.00115","article-title":"Use of Non-Prescription Remedies by Ghanaian Human Immunodeficiency Virus-Positive Persons on Antiretroviral Therapy","volume":"5","author":"AK Laar","year":"2017","journal-title":"Front Public Health"},{"key":"pone.0333695.ref110","unstructured":"Caiara A. 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