Healthcare providers’ perspectives on multilevel barriers to antiretroviral therapy adherence among adolescents and young adults living with HIV in Ghana: a qualitative study

Optimal ART adherence is vital for viral suppression and quality of life, yet Adolescents and Young Adults living with HIV (AYALHIV) in sub-Saharan Africa (SSA) face persistent adherence challenges. Healthcare providers are uniquely positioned to identify adherence barriers and facilitators. This study explored provider perspectives on ART adherence among AYALHIV at a tertiary HIV centre in Ghana. An exploratory qualitative study was conducted (June–September 2021) at Korle-Bu Teaching Hospital. Twenty-six purposively selected providers, including HIV counsellors, pharmacists, doctors, nurses, a psychologist, and peer advocates, participated in in-depth interviews exploring barriers and facilitators across individual, medication, social, and health-system levels. Data were analysed using thematic analysis with deductive and inductive coding. Healthcare providers (median of 12(IQR: 6–15.5) years of experience) identified interrelated adherence factors. Individual barriers included pill fatigue, financial constraints, competing routines, inadequate caregiver supervision, and delayed disclosure. Medication challenges involved adverse effects, pill size, and palatability. Health-system barriers comprised frequent regimen changes due to supply issues and insufficient counselling. Social influences included stigma, parent–child conflict, orphanhood, and limited family support. Proposed strategies included peer-support programmes, caregiver engagement, disclosure support, adolescent-focused provider training, mental health integration, and decentralised youth-friendly services. Health care providers perceive ART non-adherence among AYALHIV as a multifaceted issue shaped by interacting individual, social, medication-related, and health-system factors. Healthcare providers identified peer support, caregiver engagement, developmentally appropriate disclosure, provider training, mental health support, and adolescent-friendly service delivery as potential strategies for addressing these challenges. These provider-informed recommendations warrant further evaluation with AYALHIV and caregivers to establish their acceptability, feasibility, and effectiveness in improving adherence and treatment outcomes.