Exploring the influence of psychosocial support on ART adherence among adolescents living with HIV at Reach Out Mbuya, Kampala, uganda.

Abstract

Background: Adolescents living with HIV (ALHIV) face unique challenges in adhering to ART, including stigma, mental health difficulties, and inconsistent psychosocial support. Psychosocial interventions are increasingly recognized as critical for improving adherence and overall well-being, yet gaps remain in how this support is perceived and accessed in Uganda. This study explored how psychosocial support influences ART adherence among adolescents receiving care at Reach Out Mbuya Community Health Initiative. Methods: A phenomenological qualitative design was employed, drawing primarily on in-depth interviews with 19 adolescents aged 12–19 years living with HIV, complemented with 11 key informant interviews with caregivers, peer supporters, counsellors, and health workers to provide contextual insights. Participants were purposively sampled to capture a diverse range of experiences. Data were transcribed, translated, and thematically analyzed to identify patterns related to adolescents’ lived experiences, psychosocial support, stigma, mental health challenges, and gaps in care. Results: Findings revealed that adolescents valued psychosocial support through peer groups, counselling, and recreational programs, which fostered openness, reduced loneliness, and motivated adherence. Stigma, particularly fear of disclosure in schools and communities, remained a barrier, often leading to concealment or avoidance of medication. Mental health challenges such as loneliness, sadness, and stress were reported to directly disrupt adherence, though coping mechanisms like music, trusted friendships, and supportive caregivers provided resilience. Caregivers and peers played an active role by reminding or supervising ART use, while health worker counselling was key in regaining adherence after lapses. Gaps were noted in emotional support from some providers, breaches of confidentiality in school settings, and limited livelihood opportunities, which compounded adherence difficulties. Conclusion: Psychosocial support significantly influenced ART adherence among ALHIV, with peer and caregiver support, counselling, and recreational activities serving as key facilitators. However, stigma, mental health challenges, and inconsistent provider support hinder adherence. Strengthening adolescent-friendly psychosocial interventions, ensuring confidentiality in schools, and expanding livelihood opportunities are essential to improve the ART adherence outcome.