VISIBLE CONSEQUENCES: THE IMPACT OF MATERNAL SUBOPTIMAL ART ADHERENCE ON MOTHER-TO-CHILD HIV TRANSMISSION IN SELECTED CLINICS OF CAPRICORN DISTRICT, LIMPOPO PROVINCE

Background Sustained maternal adherence to antiretroviral therapy is critical for preventing mother-to-child transmission of HIV. Despite widespread ART availability, maternal non-adherence remains a challenge in high-burden districts of South Africa. While biomedical outcomes are well documented, less is known about how non-adherence affects mothers, children, healthcare providers, and service delivery systems. Objective To describe the impact of maternal non-adherence to ART on MTCT in the Capricorn District within Limpopo Province. Methods A qualitative study using Interpretative Phenomenological Analysis was conducted in selected primary healthcare clinics. Data were collected using unstructured, in-depth interviews with HIV-positive mothers with a history of ART non-adherence and healthcare professionals, including nurses and mentor mothers. Purposive sampling was used to recruit participants with direct PMTCT experience. Data was analysed through iterative coding and theme development consistent with IPA principles. Results Maternal non-adherence was associated with interconnected impacts across multiple levels. At the maternal level, participants described declining health, poor viral suppression, and psychological strain linked to treatment fatigue and stigma. At the child level, non-adherence was linked to increased risk of MTCT, delayed infant testing, missed immunisations, and early developmental concerns. Family relationships were strained by illness-related role disruption and non-disclosure. Healthcare providers reported moral distress, professional frustration, and emotional exhaustion when managing recurrent defaulting. At the system level, non-adherence contributed to repeated treatment re-initiation, clinic congestion, and inefficient use of limited resources. Conclusion Maternal ART non-adherence in selected primary healthcare clinics of the Capricorn District represents a complex, multilevel challenge with biomedical, psychosocial, and health-system implications. It undermines maternal viral suppression, increases MTCT risk, adversely affects early child health outcomes, and contributes to provider strain and inefficiencies in PMTCT service delivery. These findings demonstrate that maternal non-adherence disrupts the PMTCT cascade and poses a significant barrier to sustained MTCT reduction in high-burden settings.