Barriers and facilitators to Antiretroviral therapy adherence among adult HIV positive patients in Hawassa, Southern Ethiopia: a qualitative grounded theory study


  • Habtamu Wondiye Department of Clinical Nursing, Arba Minch College of Health Sciences, Arba Minch, Ethiopia
  • Netsanet Fentahun Department of Health Education and Behavioral science, Jimma University, Ethiopia
  • Rupali J. Limaye Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Maryland, USA
  • Mesfin Kote Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
  • Eshetu Girma School of Public Health, Addis Ababa University


Background: Antiretroviral therapy (ART) not only prevents AIDS-related illness and death: it also has the potential to significantly reduce the risk of HIV transmission and the spread of tuberculosis. Patient’s adherence is crucial to get the best out of ART. As ART is scaled up in Ethiopia, there is a need for better understanding of the factors that influence patients’ adherence to ART which is used to develop culturally appropriate and effective interventions which are in turn more likely lead to successful and sustainable programs for patients with HIV/AIDS. This study aims to explore patients’ and health care professionals’ views about factors that facilitate and constrain optimal adherence to ART among adult HIV patients. Methods: At two health facilities that serve a large number of HIV-positive individuals in Hawassa town, Southern Ethiopia, a qualitative study using non-participant observation; and in-depth interview with 23 ARV user and 5 health professionals were carried out from February to April 2014. Simultaneous data collection and analysis was used and taped data and note were transcribed into Amharic then translated into English. The grounded theory approach was used for analyzing the data as a whole. The analysis began by using the constant comparison approach. The coding process was preceded by open coding, axial and selective coding. All of the codes used were inductive. To manage the overall coding process, Atlas.ti (v.7) software was used. To assure the quality of the research findings different set of criteria were used focusing on the credibility, dependability, transferability and confirmability of the study. Result: The most frequently emerged barriers to adherence included economic constraints, substance misuse, simply forgetting and being busy, fear of stigma and discrimination, pill burden and medication side effects. The most frequently emerged facilitators to adherence included disclosure of HIV status, using an adherence aid, prospects of living longer, social support, experiencing better health and trusting health workers. Conclusion: Overall, these findings were similar to the barriers and facilitators experienced by individuals on ART in other resource constrained setting. Policy-makers and concerned bodies should identify and develop appropriate social policy to promote adherence among ART-prescribed patients whilst Health professionals should aware and address some of the pragmatic and cultural issues around ART. Keywords: Grounded theory, ART, HIV/AIDS, qualitative research

Author Biographies

Habtamu Wondiye, Department of Clinical Nursing, Arba Minch College of Health Sciences, Arba Minch, Ethiopia


Netsanet Fentahun, Department of Health Education and Behavioral science, Jimma University, Ethiopia


Rupali J. Limaye, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Maryland, USA



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How to Cite

Wondiye, H., Fentahun, N., Limaye, R. J., Kote, M., & Girma, E. (2020). Barriers and facilitators to Antiretroviral therapy adherence among adult HIV positive patients in Hawassa, Southern Ethiopia: a qualitative grounded theory study. The Ethiopian Journal of Health Development, 28(1). Retrieved from

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