How Do I Open Up?: Exploring Factors Associated With Completion of Intensive Adherence Counselling Sessions Among Hiv Patients With High Viral Load in Neno, Malawi

Abstract Background Globally, countries are working tirelessly to achieve the UNAIDS 95-95-95 treatment targets by 2030. Despite making great strides in improving HIV viral load (VL) testing capacity for treatment monitoring in the past decade, a limited number of people living with HIV ( PLHIV) with high VL complete intensive adherence counselling (IAC) sessions which delays follow-up VL testing, consequently, delaying clinical decision-making. This study explored factors associated with the completion of IAC sessions in resource-limited settings. Methods We conducted a mixed-method study utilizing the explanatory sequential design. The quantitative data were collected from patient records from the period between 1 March 2020 to 30 June 2021 in Neno district, while qualitative data were collected from purposively selected PLHIV with high VL and healthcare workers, through focus group discussions (FGDs) and in-depth interviews respectively. 371 patient records were analyzed, while 6 heterogeneous FGDs of patients with high VL were conducted. 15 healthcare workers were also interviewed. STATA software was used to analyze quantitative data while thematic analysis approach was used for qualitative data analysis. Results The median age of the participants at the most recent VL was 39 years (IQR 31–47 years). The median age of respondents in FGDs was 41 years ( IQR 20–57). We found that having community health worker support (ARR = 0.62; 95% CI = 0.39–0.99) and longer duration on ART (ARR = 1.76; 95% CI = 1.09–2.83) were significant predictors of IAC completion. Provider’s unprofessionalism, poor partner support, and lack of private rooms for conducting IAC sessions dissuaded clients to come for subsequent IAC sessions. Conclusion Clients with high VL encounter multiple challenges that affect IAC attendance. Although personal factors play a greater role in fulfilling IAC attendance, health system factors are equally important. ART Clinics need to devise deliberate and careful approaches that target and motivate at-risk clients to complete IAC sessions and improve overall adherence. There’s an urgent need for ART clinics to designate private rooms for IAC sessions and adequately train expert clients on professionalism.