Exploring barriers to hypertension medication adherence among people living with HIV enrolled in the iHEART-SA trial: a theoretical domains framework qualitative study

BACKGROUND: Hypertension significantly increases the risk of cardiovascular complications, posing a dual burden for people living with HIV (PLHIV) in Sub-Saharan Africa. This study explores the barriers and enablers of hypertension medication adherence among PLHIV attending three primary healthcare (PHC) facilities in Johannesburg, South Africa. METHODS: A qualitative study design was employed, guided by the Theoretical Domains Framework (TDF). Data were collected through interviews and focus group discussions with a purposive sample of PLHIV and healthcare providers. Sessions were recorded, transcribed, de-identified, and analysed using inductive thematic analysis, with themes categorized using the TDF. RESULTS: Nineteen participants (healthcare providers, n = 6; PLHIV, n = 13) identified four key themes influencing hypertension medication adherence: (1) delays in seeking hypertension care (2), gaps in hypertension-related knowledge among patients (3), the role of social support in encouraging adherence, and (4) limited integration of hypertension care services into HIV programs. Barriers included reliance on traditional medicine, high pill burden, socio-economic challenges, and long waiting times. Social support and targeted educational interventions were identified as facilitators to improve adherence. CONCLUSION: Addressing barriers to hypertension medication adherence among PLHIV requires a multifaceted approach. Interventions focusing on improving health literacy, fostering social support, and integrating hypertension care into routine HIV services are essential for optimizing health outcomes.