Factors shaping bypassing of primary anti-retroviral therapy (ART) facilities and adherence to anti-retroviral therapy medications and treatment

Bypassing primary health centres for anti-retroviral therapy (ART) centres in low-middle-income countries reflects a complex interaction of structural, social and health system factors. Although ART services have been decentralized and expanded to primary health facilities, many clients continue to bypass their primary ART facility to another distant facility for treatment and refilling thereby missing appointment and the overall adherence to medication regimens and treatment. Using Bandura’s self-regulation model, this study explored the factors that influence People Living with the Human Immunodeficiency Virus (PLHIV) to bypass their designated primary ART centres, and their adherence to antiretroviral (ARV) treatment. We employed exploratory case study design and used purposive and convenient sampling methods to select a total of 52 participants, including persons living with HIV (n=37) and healthcare providers (n=15) in four district health facilities in the Upper East Region in Ghana. We found that factors such as stigma, transport challenges, wrong influences and misinformation, coupled with PLHIV difficulty accessing essential HIV care influenced the bypassing behaviours of ART clients. This negatively affected adherence to medication and treatment. Community education on the effectiveness of ART to normalize HIV and ARV use, peer support groups for people living with HIV to share experiences and encourage facility use, and the enaction of laws and measures to discourage HIV-related stigma and discrimination.