Household-level factors and ART adherence among people living with HIV in Cape Town, South Africa: a qualitative study

South Africa has the largest ART programme in the world. ART is provided within the context of the universal test and treat strategy. Sustained high levels of ART adherence are required to ensure viral suppression and prevent ART-drug resistance. However, poor ART adherence remains a challenge in South Africa. While much research has focused on individual - and community-level factors influencing adherence, household-level factors remain under-researched. This study sought to qualitatively examine the role of household-related factors in ART adherence among 15 newly initiated people living with HIV (PLWH) in Cape Town, South Africa. The information-motivation and behavioural skills model and the concept of the HIV competent household provided the conceptual frameworks for the study. Emotional and instrumental support from household members and in particular mothers facilitated adherence. Open HIV dialogue fostered positive health behaviours and ART adherence. Household food insecurity, multimorbidity and busy work schedules both in the absence of household social support hindered ART adherence. Given the significant role of household support, particularly from mothers, in facilitating ART adherence, health facility programmes should aim to involve household members in the treatment of PLWH. This could be facilitated through training community health workers to foster and support HIV competent households.