COVID-19–Related Disruptions and Adaptations to HIV Service Delivery in Rakai, Uganda: A Qualitative Study Among Virologically Unsuppressed People Living With HIV and HIV Care Providers

COVID-19 pandemic restrictions disrupted HIV services globally, but few studies have explored experiences from rural Africa or experiences of virologically unsuppressed individuals who may experience heightened barriers to care. We sought to explore COVID-19-related disruptions and adaptations to HIV service delivery in rural Rakai, Uganda. We conducted qualitative, in-depth interviews with 38 people living with HIV, all with high-level viremia (≥1,000 copies/ml), and 15 HIV clinicians. We also conducted six focus group discussions with peer health workers. Findings were analyzed thematically using a team-based inductive and deductive approach. Participants described the disruptive impact of COVID-19, precipitating transportation barriers and constraints to facility access, human resource gaps, and anticipated and enacted stigma. HIV services adapted, however, through approaches such as multimonth antiretroviral treatment dispensing, intensified community-based antiretroviral treatment delivery, flexibility in working hours, and changes in service access locations. Findings can inform HIV service delivery responses to future public health emergencies.