EXPLORING THE CHALLENGES OF SUBOPTIMAL ADHERENCE TO ANTIRETROVIRAL THERAPY (ART) ON VIRAL LOAD SUPPRESSION: A CASE STUDY OF AREA 25 HEALTH CENTRE, LILONGWE, MALAWI

Adherence to antiretroviral therapy (ART) is a fundamental determinant of viral load suppression and long-term treatment success among people living with HIV. Despite the widespread availability of ART services, suboptimal adherence remains a persistent challenge in sub-Saharan Africa and is associated with virological failure, drug resistance, disease progression, and increased risk of HIV transmission. This study explored the challenges of suboptimal ART adherence and examined the role of Enhanced Adherence Counselling (EAC) in improving viral load suppression among HIV-positive clients at Area 25 Health Centre in Lilongwe, Malawi.

A cross-sectional mixed-methods design was employed. Quantitative data were obtained from secondary sources, including ART registers and electronic medical records, to assess adherence patterns and viral load outcomes. Qualitative data were collected through semi-structured interviews with purposively selected ART clients to capture lived experiences and challenges related to adherence. Quantitative data were analysed descriptively, while qualitative data were analysed thematically.

The findings indicate that ART adherence is influenced by a complex interaction of individual, psychosocial, socioeconomic, and health system factors. Common barriers included forgetfulness, medication side effects, treatment fatigue, stigma, fear of disclosure, transport costs, and long waiting times at health facilities. Clients who demonstrated consistent adherence were more likely to achieve viral load suppression. Enhanced Adherence Counselling emerged as a critical facilitator of adherence, with participants reporting improved treatment literacy, increased motivation, and strengthened coping strategies following counselling sessions.

The study concludes that strengthening Enhanced Adherence Counselling and addressing broader structural and psychosocial barriers are essential for improving ART adherence and sustaining viral load suppression among HIV-positive clients in urban Malawian settings.