Managing HIV care in daily life: A qualitative study of ART adherence and retention barriers and facilitators among people attending two urban ART clinics in Panama.

BACKGROUND: Optimal antiretroviral therapy (ART) adherence and retention in HIV care are important for viral suppression among people living with HIV (PLHIV). Although ART is free in Panamanian public clinics, ART adherence and care continuity remain challenges. Prior studies in Panama have described quantitative correlates of adherence in urban clinics and barriers in a rural Indigenous region but less is known about how urban clinic attendees in Panama City and Colón experience adherence and retention in everyday contexts. OBJECTIVES: To describe the barriers and facilitators to ART adherence and retention, and how PLHIV manage HIV care in everyday life among PLHIV attending two urban clinics using the socioecological framework. DESIGN: Qualitative study using semi-structured interviews organized and interpreted using the socioecological framework. METHODS: Between August-November 2024, 20 semi-structured interviews were conducted among PLHIV attending two urban ART clinics (Hospital Santo Tomás and Colón Regional Clinic) in Panama. Participants were purposively selected. Interviews were 30-60 minutes long, audio-recorded, transcribed, inductively coded and then organized thematically across socioecological levels. RESULTS: Twenty participants were included (11 identified as men, 8 cisgender women and one transgender woman); median age was 38.5 years. ART Adherence was supported by medication routines, phone alarms, alternative pill containers, family and partner reminders, supportive health personnel and clinic-delivered education. Retention in care was supported by prioritizing appointments, planning around work and transportation, supportive health personnel, clinic education, transportation availability and advance scheduling. ART adherence and retention were disrupted by emotional distress, demotivation, side effects, forgetfulness, limited family support, stigma and disclosure concerns, rumors and harassment, poor communication with health personnel, pharmacy stockouts, food insecurity, transport costs and time or financial barriers. CONCLUSION: ART adherence and retention are interconnected parts of daily HIV disease management and are influenced by individual, interpersonal, organizational and structural factors. Urban HIV services could benefit from patient-centered adherence support, confidentiality protections, responsive side-effect management, treatment literacy and support for transport, food insecurity and ART access.