Acceptability of an online peer support group as a strategy to improve antiretroviral therapy adherence among young people in Kampala district, Uganda: qualitative findings

Abstract

Introduction Peer support groups may contribute to adherence and play a role in decreasing the stigma of antiretroviral therapy (ART) adherence among young people living with HIV (YPLHIV). However, peer support activities usually occur face-to-face in Uganda and elsewhere in Sub-Saharan Africa and thus have structural limitations and may not be readily available when young people need them. Online peer support has the potential to help YPLHIV access regular psychosocial support without significant effort or cost. We assessed the acceptability of a WhatsApp peer support group as a strategy to improve ART adherence among Ugandan YPLHIV. Methods We conducted a formative qualitative study in three health facilities in Kampala, Uganda, between July and August 2022. We held four focus group discussions with twenty-six YPLHIV seeking services at the study facilities. We also conducted six key informant interviews with health providers attached to adolescent HIV care clinics. Data was analyzed using thematic analysis guided by Sekhon’s theoretical framework of acceptability (2017), which conceptualizes acceptability through multiple constructs, including affective attitudes, burden, intervention coherence, and perceived effectiveness. Our analysis examined these dimensions in the context of WhatsApp-based peer support groups for HIV care. Results Overall, WhatsApp peer support groups were acceptable for use among YPLHIV. The young people regarded it as convenient because it would save time and would be more cost-effective compared to the transport costs of in-person meetings. Health providers revealed that the WhatsApp peer support group could reduce the stigma associated with community follow-up and empower YPLHIV to overcome stigma. Both young people and health providers suggested that online peer support could enhance emotional support, psychosocial well-being, and ART adherence. However, participants raised concerns about privacy and the cost of internet bundles and smartphones, especially for younger adolescents. Conclusion Online peer support groups are acceptable to Ugandan YPLHIV and hold promise in enhancing psychosocial support and improving treatment adherence in this sub-population. In implementing online support groups, due consideration should be given to software tools with high privacy standards and zero-rated data use for new apps. Research is needed to evaluate the feasibility and effectiveness of this peer support model in Uganda.