{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T09:32:19Z","timestamp":1793093539665,"version":"4.5.0"},"reference-count":39,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T00:00:00Z","timestamp":1714348800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Transgender women bear a huge burden of human immunodeficiency virus (HIV) in South Africa. However, they are not fully engaged in healthcare across the HIV continuum of care. In addition, transgender women face multiple facets of stigma and discrimination as well as socio-economic inequalities, which all have a negative impact on antiretroviral therapy (ART) adherence.\n\nObjective:\u00a0The study aimed at exploring and describing the experiences of ART adherence of transgender women living with HIV in the Buffalo City Metro Municipality.\n\nMethods:\u00a0The study employed an interpretative phenomenological analysis (IPA) design. Twelve participants were enrolled using a snowballing sampling technique. Data were collected using semi-structured interviews and analysed using an IPA framework.\n\nResults:\u00a0While exploring determinants to ART adherence among transgender women living with HIV in Buffalo City Metro, two superordinate themes emerged: enablers to ART adherence and psychosocial factors promoting adherence. The study found that factors such as differentiated ART service delivery, ARV medicines-related factors, motivators for taking treatment and support systems facilitated ART adherence.\n\nConclusion:\u00a0Emerging from this study is the need to scale up differentiated, person-centred ART service deliveries that will enhance access and adherence to treatment for transgender women.\n\nContribution:\u00a0This study provides unique insights on factors enhancing ART adherence among transgender women. There is a paucity of literature on access to HIV care services for key and vulnerable populations, and these findings will be shared in the country and in the region.<\/jats:p>","DOI":"10.4102\/safp.v66i1.5869","type":"journal-article","created":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T18:07:36Z","timestamp":1714414056000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Determinants of antiretroviral therapy adherence among transgender women in South Africa"],"prefix":"10.4102","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4502-6143","authenticated-orcid":false,"given":"Leonashia Leigh-Ann","family":"van der Merwe","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/048cwvf49","id-type":"ROR","asserted-by":"publisher"}],"name":"University of South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6122-8151","authenticated-orcid":false,"given":"Idah","family":"Moyo","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/048cwvf49","id-type":"ROR","asserted-by":"publisher"}],"name":"University of South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6916-8472","authenticated-orcid":false,"given":"Azwihangwisi H.","family":"Mavhandu-Mudzusi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/048cwvf49","id-type":"ROR","asserted-by":"publisher"}],"name":"University of South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2024,4,29]]},"reference":[{"key":"ref0","unstructured":"Joint United Nations Programme on HIV\/AIDS. UNAIDS 2022 data. Geneva: UNAIDS; 2023."},{"key":"ref1","unstructured":"World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: Recommendations for a public health approach. Geneva: World Health Organization; 2021."},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Mitchell E, Lazuardi E, Rowe E, et al. Barriers and enablers to HIV care among Waria (transgender women) in Indonesia: A qualitative study. AIDS Educ Prev. 2019;31(6):538\u2013552. https:\/\/doi.org\/10.1521\/aeap.2019.31.6.538","DOI":"10.1521\/aeap.2019.31.6.538"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Moyo I, Macherera M. The experiences of sex workers accessing HIV care services in Bulawayo, Zimbabwe. Afr Health Sci. 2021;21(2):593\u2013602. https:\/\/doi.org\/10.4314\/ahs.v21i2.14","DOI":"10.4314\/ahs.v21i2.14"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Sevelius J, Murray LR, Martinez Fernandes N, Veras MA, Grinsztejn B, Lippman SA. Optimising HIV programming for transgender women in Brazil. Cult Health Sex. 2019;21(5):543\u2013558. https:\/\/doi.org\/10.1080\/13691058.2018.1496277","DOI":"10.1080\/13691058.2018.1496277"},{"key":"ref5","unstructured":"Scheibe A, Van der Merwe LL, Cloete A, Grasso MA. Transgender women outreach workers and their role in South Africa\u2019s HIV response. S Afr Health Rev. 2018;2018(1):69\u201376."},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Jimmy B, Jose J. Patient medication adherence: Measures in daily practice. Oman Med J. 2011;26(3):155. https:\/\/doi.org\/10.5001\/omj.2011.38","DOI":"10.5001\/omj.2011.38"},{"key":"ref7","unstructured":"Cloete A, Wabiri N, Savva H, Van der Merwe L, Simbayi L. The Botshelo Ba Trans study: Results of the first HIV prevalence survey conducted amongst transgender women (TGW) in South Africa. 2019. Paper presented at the 9th South Africa AIDS Conference, Durban ICC, KwaZulu-Natal, 11\u201314 June [cited 2022 Jul 16]. Available from: http:\/\/hdl.handle.net\/20.500.11910\/14780"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Bockting W, MacCrate C, Israel H, Mantell JE, Remien RH. Engagement and retention in HIV care for transgender women: Perspectives of medical and social service providers in New York City. AIDS Patient Care STDs. 2020;34(1):16\u201326. https:\/\/doi.org\/10.1089\/apc.2019.0067","DOI":"10.1089\/apc.2019.0067"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Luvuno ZP, Mchunu G, Ngidi H, Ncama B, Mashamba-Thompson T. Evidence of interventions for improving healthcare access for lesbian, gay, bisexual and transgender people in South Africa: A scoping review. Afr J Prim Health Care Fam Med. 2019;11(1):e1\u2013e10. https:\/\/doi.org\/10.4102\/phcfm.v11i1.1367","DOI":"10.4102\/phcfm.v11i1.1367"},{"key":"ref10","unstructured":"Wolton AJ. Trans: Mission A community-led HIV testing initiative for trans people and their partners at a London sex-on-premises venue. HIV Nurs. 2018;18(2): 24\u201329."},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Sandfort TG, Dominguez K, Kayange N, et al. HIV testing and the HIV care continuum among sub-Saharan African men who have sex with men and transgender women screened for participation in HPTN 075. PLoS One. 2019;14(5):e0217501. https:\/\/doi.org\/10.1371\/journal.pone.0217501","DOI":"10.1371\/journal.pone.0217501"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Braun HM, Candelario J, Hanlon CL, et al. Transgender women living with HIV frequently take antiretroviral therapy and\/or feminizing hormone therapy differently than prescribed due to drug\u2013drug interaction concerns. LGBT Health. 2017;4(5):371\u2013375. https:\/\/doi.org\/10.1089\/lgbt.2017.0057","DOI":"10.1089\/lgbt.2017.0057"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Frola CE, Aristegui I, Figueroa MI, et al. Retention among transgender women treated with dolutegravir associated with tenofovir\/lamivudine or emtricitabine in Argentina: TransViiV study. PLoS One. 2023;18(1):e0279996. https:\/\/doi.org\/10.1371\/journal.pone.0279996","DOI":"10.1371\/journal.pone.0279996"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Alase A. The interpretative phenomenological analysis (IPA): A guide to a good qualitative research approach. Int J Educ Literacy Stud. 2017;5(2):9\u201319. https:\/\/doi.org\/10.7575\/aiac.ijels.v.5n.2p.9","DOI":"10.7575\/aiac.ijels.v.5n.2p.9"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Smith JA, Osborn M. Interpretative phenomenological analysis as a useful methodology for research on the lived experience of pain. Br J Pain. 2015;9(1): 41\u201342. https:\/\/doi.org\/10.1177\/2049463714541642","DOI":"10.1177\/2049463714541642"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Noon EJ. Interpretive phenomenological analysis: An appropriate methodology for educational research. J Perspect Appl Acad Pract. 2018;6(1):75\u201383. https:\/\/doi.org\/10.14297\/jpaap.v6i1.304","DOI":"10.14297\/jpaap.v6i1.304"},{"key":"ref17","unstructured":"ECSECC. 2017. Buffalo City Metro Municipality socio economic review and outlook [homepage on the Internet]. Buffalo City [cited 2023 Jun 23]. Available from: http:\/\/www.ecsecc.org\/documentrepository\/informationcentre\/buffalo-city-metro-municipality_44557.pdf"},{"key":"ref18","unstructured":"BCMM. 2020. Integrated development plan review of Buffalo City Metropolitan Municipality [homepage on the Internet]. [cited 2023 Sep 16]. Available from: https:\/\/buffalocity.gov.za\/CM\/uploads\/documents\/202030060615935135241.2"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. Eur J Gen Pract. 2018;24(1):9\u201318. https:\/\/doi.org\/10.1080\/13814788.2017.1375091","DOI":"10.1080\/13814788.2017.1375091"},{"key":"ref20","unstructured":"Creswell JW, Creswell JD. Research design: Qualitative, quantitative, and mixed methods approaches. Newbury Park: Sage; 2017."},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Maher C, Hadfield M, Hutchings M, De Eyto A. Ensuring rigor in qualitative data analysis: A design research approach to coding combining NVivo with traditional material methods. Int J Qual Methods. 2018;17(1):1609406918786362. https:\/\/doi.org\/10.1177\/1609406918786362","DOI":"10.1177\/1609406918786362"},{"key":"ref22","unstructured":"Shosha GA. Employment of Colaizzi\u2019s strategy in descriptive phenomenology: A reflection of a researcher. Eur Sci J. 2012;8(27):31\u201343."},{"key":"ref23","unstructured":"Lincoln YS, Guba EG, Pilotta JJ. Naturalistic inquiry. Beverly Hills, CA: Sage, 1985; 416 pp., $25.00 (Cloth)."},{"key":"ref24","unstructured":"Beck CT. Introduction to phenomenology: Focus on methodology. London: Sage; 2019."},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Macdonald V, Verster A, Baggaley R. A call for differentiated approaches to delivering HIV services to key populations. J Int AIDS Soc. 2017;20:21658. https:\/\/doi.org\/10.7448\/IAS.20.5.21658","DOI":"10.7448\/IAS.20.5.21658"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Daniels J, Struthers H, Maleke K, Lane T, McIntyre J, Coates T. \u2018My Tablets are on Top of the Fridge\u2019: The roles of relationship desire and medical mistrust in ART adherence for HIV-positive MSM and transgender women living in rural South Africa. AIDS Behav. 2019;23:2849\u20132858. https:\/\/doi.org\/10.1007\/s10461-019-02628-z","DOI":"10.1007\/s10461-019-02628-z"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Parker RG, Perez-Brumer A, Garcia J, et al. Prevention literacy: Community-based advocacy for access and ownership of the HIV prevention toolkit. J Int AIDS Soc. 2016;19(1):21092. https:\/\/doi.org\/10.7448\/IAS.19.1.21092","DOI":"10.7448\/IAS.19.1.21092"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Madiba S, Josiah U. Perceived stigma and fear of unintended disclosure are barriers in medication adherence in adolescents with perinatal HIV in Botswana: A qualitative study. BioMed Res Int. 2019;2019:9623159. https:\/\/doi.org\/10.1155\/2019\/9623159","DOI":"10.1155\/2019\/9623159"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Lyimo RA, De Bruin M, Van den Boogaard J, Hospers HJ, Van der Ven A, Mushi D. Determinants of antiretroviral therapy adherence in northern Tanzania: A comprehensive picture from the patient perspective. BMC Public Health. 2012;12(1):1\u20138. https:\/\/doi.org\/10.1186\/1471-2458-12-716","DOI":"10.1186\/1471-2458-12-716"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Heestermans T, Browne JL, Aitken SC, Vervoort SC, Klipstein-Grobusch K. Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: A systematic review. BMJ Global Health. 2016;1(4):e000125. https:\/\/doi.org\/10.1136\/bmjgh-2016-000125","DOI":"10.1136\/bmjgh-2016-000125"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Logie CH, Lacombe-Duncan A, Brien N, et al. Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: A qualitative study. J Int AIDS Soc. 2017;20(1):21385. https:\/\/doi.org\/10.7448\/IAS.20.1.21385","DOI":"10.7448\/IAS.20.1.21385"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Baguso GN, Gay CL, Lee KA. Medication adherence among transgender women living with HIV. AIDS Care. 2016;28(8):976\u2013981. https:\/\/doi.org\/10.1080\/09540121.2016.1146401","DOI":"10.1080\/09540121.2016.1146401"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Nugroho A, Erasmus V, Coulter RW, et al. Driving factors of retention in care among HIV-positive MSM and transwomen in Indonesia: A cross-sectional study. PLoS one. 2018;13(1):e0191255. https:\/\/doi.org\/10.1371\/journal.pone.0191255","DOI":"10.1371\/journal.pone.0191255"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Fauk NK, Merry MS, Ambarwati A, Sigilipoe MA, Mwanri L. A qualitative inquiry of adherence to antiretroviral therapy and its associated factors: A study with transgender women living with HIV in Indonesia. Indian J Public Health. 2020;64(2):116\u2013123. https:\/\/doi.org\/10.4103\/ijph.IJPH_338_19","DOI":"10.4103\/ijph.IJPH_338_19"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Barrington C, Knudston K, Bailey OA, Aguilar JM, Loya-Montiel MI, Morales-Miranda S. HIV diagnosis, linkage to care, and retention among men who have sex with men and transgender women in Guatemala City. J Health Care Poor Underserved. 2016;27(4):1745. https:\/\/doi.org\/10.1353\/hpu.2016.0160","DOI":"10.1353\/hpu.2016.0160"},{"key":"ref36","unstructured":"World Health Organization. WHO recommends dolutegravir as preferred HIV treatment option in all populations. Geneva: World Health Organization; 2019."},{"key":"ref37","unstructured":"Health Systems Trust. 2019. The CCMDD story [homepage on the Internet]. [cited 2020 Apr 09]. Available from: http:\/\/www.hst.org.za\/projects\/Projects%20Details\/The%20CCMDD%20Story%20Jan%202019_HC23Jan19_JK23Jan19%20(1).docx"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Kreslake JM, Elkins A, Thomas CN, Gates S, Lehman T. Peer reviewed: Use of mass communication by public health programs in nonmetropolitan regions. Prev Chronic Dis. 2019;16:E96. https:\/\/doi.org\/10.5888\/pcd16.190014","DOI":"10.5888\/pcd16.190014"}],"container-title":["South African Family Practice"],"original-title":[],"link":[{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/viewFile\/5869\/8700","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/viewFile\/5869\/8701","content-type":"application\/epub+zip","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/viewFile\/5869\/8702","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/viewFile\/5869\/8703","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/view\/5869\/8703","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T07:13:08Z","timestamp":1774941188000},"score":1,"resource":{"primary":{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/view\/5869"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,29]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,29]]}},"URL":"https:\/\/doi.org\/10.4102\/safp.v66i1.5869","relation":{},"ISSN":["2078-6190","2078-6204"],"issn-type":[{"value":"2078-6190","type":"print"},{"value":"2078-6204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,29]]},"article-number":"a5869"}}