| Summary: | Humphrey Beja,1 Nakayiwa Daisy,2 Micheal Tonny Edek,1 Veronic Kobusinge,1 Oscar Akaki,3 Innocent Ocitti Owachgiu,1 Samson Udho1 1Department of Midwifery, Faculty of Nursing & Midwifery, Lira University, Lira, Uganda; 2Department of Psychiatry, Faculty of Medicine, Lira University, Lira, Uganda; 3Department of Environmental Health & Disease Control, Faculty of Public Health, Lira University, Lira, UgandaCorrespondence: Samson Udho, Department of Midwifery, Faculty of Nursing & Midwifery, Lira University, P.O Box 1035, Lira, Uganda, Tel +256 785 588 257, Email sudho@lirauni.ac.ugPurpose: Intensive adherence counseling (IAC) was introduced as a strategy to enhance adherence to antiretroviral therapy (ART) among HIV clients with non-suppressed viral loads. There has been sub-optimal viral load suppression among HIV clients in Uganda enrolled in IAC. However, there is a scarcity of literature on the barriers and facilitators of successful IAC. We aim to explore the barriers and facilitators to successful IAC among HIV-positive clients seeking care in public health facilities in rural northern Uganda.Patients and Methods: This was an exploratory qualitative study conducted among 15 purposively sampled HIV-positive clients enrolled in IAC in public health facilities offering ART services in northern Uganda. We conducted in-depth interviews using semi-structured interview guides based on the capability, opportunity, motivation, and behavior (COM-B) framework for behaviour change. Data were analyzed using the deductive thematic approach of Braun and Clarke following the COM-B framework.Results: The majority of the participants were females (60%), married (53%), and attained primary education (47%). Barriers to successful IAC were Capability – alcoholism and promiscuity, Opportunity – stigma and discrimination, delayed viral load result, shortage of food, and heavy workload; and Motivation – deteriorating health and lack of incentives. Facilitators to successful IAC were Capability – good knowledge of ART, good memory, and reminder alerts; Opportunity – availability of ART, social support, availability of ART, prolonged ART refill, and good counseling; and Motivation – desire to live longer and healthy and the desire to fulfill dreams and goals.Conclusion: Successful implementation of IAC needs to consider the context of the person in care thus the need to strengthen individualized IAC sessions. HIV care providers can adopt the COM-B framework to perform individualized IACs and use the information to strengthen the counseling sessions.Keywords: barriers, facilitators, HIV, intensive adherence counseling
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