Healthcare Facility and Provider Factors Affecting Antiretroviral Therapy Adherence: Identifying Critical Intervention Points in Ghana's HIV Treatment Cascade

Despite significant improvements in antiretroviral therapy (ART) availability, suboptimal adherence remains a critical barrier to effective HIV treatment outcomes in sub-Saharan Africa. This study investigated healthcare facility and provider factors influencing ART adherence among HIV/AIDS patients in Ghana's Ashanti Region. Using a convergent parallel mixed-methods design, we collected data from 2000 patients through structured questionnaires and conducted in-depth interviews with 10 patients and 10 healthcare providers. Multiple linear regression analysis demonstrated that provider communication quality (β=0.280, p<0.001) and access to on-site pharmacies with trained pharmacists (β=0.193, p<0.001) significantly increased adherence, while inadequate confidentiality provisions (β=-0.426, p<0.001), segregated hospital admission blocks (β=-0.218, p<0.001), and referral requirements (β=-0.197, p<0.001) negatively impacted treatment engagement. The findings suggest that healthcare systems can significantly improve ART adherence by implementing integrated pharmaceutical care, enhancing provider communication skills, redesigning service delivery to minimize inadvertent status disclosure, and improving facility efficiency.