What went wrong? A qualitative exploration of the determinants of poor adherence to antiretroviral therapy and retention in care among pregnant and postpartum women in the Uganda WiseMama trial.

Abstract

Pregnant and postpartum women living with HIV face several challenges to antiretroviral therapy adherence and retention in care. Our WiseMama trial in Uganda assessed the effectiveness of real-time wireless pill containers that delivered text message reminders when ART doses were missed and provided data-informed counselling for women with low levels of adherence. The trial found overall poor adherence and retention and no differences between intervention and control arms. To better understand these findings, we collected qualitative data at the conclusion of the trial. Twenty women participated in in-depth interviews, and 36 women participated in focus group discussions that explored the barriers and facilitators to ART adherence and retention in HIV care. Barriers included lack of disclosure to male partners and lack of autonomy and financial independence to afford transportation to the clinic, food to be able to take their medication, and effectively use the wireless pill container. The main facilitators included desire for a healthy baby, disclosure to male partners, supportive clinic staff, and use of the wireless pill container. While WiseMama focused on individual-level determinants of adherence and retention in care, it did not address the critical interpersonal and structural barriers faced by pregnant and postpartum women in Uganda.