Published in PLOS One on 2026-09-03, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Jason Johnson-Peretz, James Ayieko, Lawrence Owino, Cecilia Akatukwasa, Anjeline Onyango, Fred Atwine, Titus O. Arunga, Colette Aoko, Laura B. Balzer, Moses R. Kamya, Edwin Charlesbois, Jane Kabami, Maya L. Petersen, Gabriel Chamie, Diane V. Havlir, Elijah Kakande, Carol S. Camlin
Source: PLOS One • DOI 10.1371/journal.pone.0356605
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Mobile populations experience difficulties maintaining antiretroviral therapy (ART) adherence and HIV care engagement. We sought to explore participant perceptions of a patient-centred model aimed at enhancing care engagement through ‘dynamic choice’ treatment services for mobile individuals.
We conducted 23 qualitative interviews with participants (N = 18) and healthcare providers (N = 5) from eight communities in southwest Uganda and western Kenya enrolled in a dynamic choice intervention that provided six-month and community ART refills; a “travel pack” with a travel checklist, discreetly packed ART, and an emergency supply of ART; phone access to a mobility coordinator; and facilitated transfers to distal clinics. Interviews explored participant life and mobility contexts, intervention experiences and preferences (as recipient or provider), and patient-provider relations. We employed a framework analysis of selected codes to identify emergent themes around intervention components and recommendations for improvement.
Participants liked all options, the travel pack being most preferred. Longer times between refills allowed participants to concentrate on ART adherence, rather than on managing clinic appointments in the context of uncertain mobility. Viral load counselling was appreciated for explaining the relationship between medication adherence, viral load, and opportunistic infections. Poverty and food insecurity remain obstacles to ideal ART adherence.
Participants suggested scaling up these support services to the whole community, incorporating services to treat additional diseases, and food or employment support to help improve overall health outcomes. Care providers also recommended strengthening supply chains and deploying electronic medical records country-wide to facilitate care for mobile individuals.
Background
To end the HIV epidemic, addressing the needs of people living with HIV who struggle to engage in HIV care and treatment is crucial. In health systems designed for stable residence, mobile individuals face unique challenges to care engagement and antiretroviral therapy (ART) adherence [1–5]. Studies have shown that travel and lack of contact with providers are common reasons for dropping out of HIV care [5–7]. While some mobile people with HIV (PWHIV) engage in care, most experience challenges to adherence and to remaining virally suppressed [8,9]. In a prior trial, we showed that patient-centred care through choice of treatment support options tailored for mobile populations improved retention in care and ART possession over 48 weeks [8]. Since the needs of mobile PWHIV can change over time, we described this as a dynamic choice treatment model of delivery.
In low- and middle-income countries (LMICs), the term ‘mobile individuals’ encompasses people who migrate to change their residence within or across national boundaries, either temporarily or permanently, for economic opportunity or as a result of economic shocks or other drivers (such as civil unrest). The category also includes those who do not change residences but spend periods of time away from home to travel for work or to seek employment, or for reasons such as caregiving, care-seeking, or education [10–12]. This mobility can involve both predictable travel and unplanned trips over which individuals have little control. Men’s and women’s differing labour market opportunities and social role expectations drive differences in their patterns of movement, types of destinations, and consequences of their mobility, which in turn influence HIV risks and outcomes [7,13–16]. For example, while both men and women often travel to look for work, men travel for longer distances and time periods, whereas women return more frequently to their primary residences [12,17,18]. Women’s more limited formal sector labour opportunities mean that many supplement their earnings with commercial and transactional sex work [19,20].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Jason Johnson-Peretz, James Ayieko, Lawrence Owino, Cecilia Akatukwasa, Anjeline Onyango, Fred Atwine, Titus O. Arunga, Colette Aoko, Laura B. Balzer, Moses R. Kamya, Edwin Charlesbois, Jane Kabami, Maya L. Petersen, Gabriel Chamie, Diane V. Havlir, Elijah Kakande, Carol S. Camlin. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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