Table 1 Examples of meaning units, codes, categories and themes from qualitative content analysis of interviews about experiences of providing IAC at KHCIV

“We have to be very sure that the adherence is above 95% or the adherence is good so we continue our adherence counseling, the reason why I told you we give an allowance of three to six months to conduct IAC. For adults, we do the 3 sessions, one month apart. Then at the third session if the adherence is good, we give them a one-month appointment to come back for a repeat VL test”

Ensuring good ART adherence

IAC is done to ensure good adherence

IAC is the recommended strategy for PLHIV with unsuppressed VL

“then we are having this category of men and women having disclosure issues, maybe a son or daughter fears to tell the father or mother and they keep dodging around; today he or she takes [drugs], tomorrow he/she doesn’t take; so generally, adherence has those dynamics”

Non-disclosure hinders ART adherence

Factors that hinder ART adherence during IAC

Patient related factors affecting ART adherence during IAC

“At the facility level I can say long time waiting for example; some clients come knowing he/she is going to leave early but takes a whole day at the facility”

Long waiting time at the facility

Issues at the facility affecting client adherence to ART and clinic appointments

Health care system related factors affecting ART adherence during IAC

“So, if we engage these peers, give them the training and mentorship, they can do the counseling very well; so that is what is missing here.”

Peer Educators administering IAC

Reducing the workload of HCW

Facilitating provision of IAC