Health System Barriers to ART Adherence: Insights from Wassa Amenfi West Municipality, Ghana
DOI:
https://doi.org/10.64261/pajhps.v1n2.008Keywords:
Antiretroviral therapy, adherence, health system barriers, rural health services, HIVAbstract
Background: Achieving optimal adherence to antiretroviral therapy (ART) is essential for viral suppression, reduction of HIV transmission, and attainment of the UNAIDS 95-95-95 targets. While individual and socio-cultural influences have been widely documented, less attention has been paid to the role of health system barriers in sustaining ART adherence in rural Ghana.
Objective: This study examined the association between health system factors and ART adherence among people living with HIV (PLHIV) in Wassa Amenfi West Municipality, Ghana.
Methods: A cross-sectional study was conducted among 602 PLHIV receiving ART at designated treatment centres. Structured questionnaires captured socio-demographic characteristics and health system variables, including distance to facility, staffing adequacy, patient–provider relationship, waiting time, drug availability, and counselling services. Adherence status was self-reported and verified against clinic refill records. Data were analysed using descriptive statistics and chi-square tests to assess associations at a significance level of p < 0.05.
Results: Adherence rates were significantly higher among respondents living within 5 km of the facility (85.4%) compared to those residing more than 10 km away (65.3%). Perceived staff shortages were associated with reduced adherence (68.5% vs. 88.6%). Positive patient–provider relationships corresponded with higher adherence (85.9% vs. 60.2%), while prolonged waiting times (>60 minutes) were linked to lower adherence (59.7%). Drug stock-outs and inadequate counselling services were both strongly associated with reduced adherence.
Conclusion: Health system barriers substantially influence ART adherence in rural Ghana. Interventions to reduce geographical and logistical constraints, strengthen the health workforce, ensure uninterrupted drug supply, optimise patient flow, and enhance counselling services are critical for sustaining ART use. Policymakers should integrate these strategies into decentralised HIV care models to improve retention and treatment outcomes.
Keywords: Antiretroviral therapy, adherence, health system barriers, HIV, Ghana, rural health services
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