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СпутникиРНSpaceXРоскосмосNASABackground Polypharmacy is increasingly common among people living with HIV as survival improves and chronic comorbidities require additional medicines. The resulting treatment burden may undermine adherence, particularly in resource-constrained settings. This study explored how polypharmacy influenced medication adherence among adults living with HIV at a primary healthcare facility in Mthatha, South Africa. Methods An exploratory qualitative study used purposive sampling to recruit 16 adults aged 18 years or older who were receiving antiretroviral therapy together with medicines for at least one chronic condition. Semi-structured, face-to-face interviews were conducted in English or isiXhosa, audio-recorded, transcribed verbatim and translated where necessary. Data were analysed using Braun and Clarke’s six-phase thematic analysis. Results Seven themes were identified. Barriers comprised structural and socioeconomic constraints, psychological burden and emotional fatigue, treatment-related challenges and adverse effects, and stigma and non-disclosure. Transport costs, unemployment, long clinic queues, regimen burden and unpleasant symptoms disrupted medicine collection or use. Adherence was supported by family caregiving, phone alarms, established routines, acceptance of chronic illness and other behavioural adaptations. Participants recommended home delivery of medicines, mobile clinics, shorter queues, additional healthcare workers, counselling and financial support. Conclusions Adherence in the context of HIV-related polypharmacy was shaped by interacting treatment, psychosocial, socioeconomic and health-system factors. Integrated, person-centred care should combine regular medication review and counselling with psychosocial support, stigma reduction and differentiated community-based medicine delivery. These findings provide context-specific evidence for strengthening adherence support in under-resourced primary healthcare settings.
Since the widespread availability of effective antiretroviral therapy (ART), the life expectancy of people living with HIV (PLWH) has improved substantially, transforming HIV from a fatal disease into a manageable chronic condition (UNAIDS, 2024; World Health Organization, 2024). As survival has increased, however, so has the burden of multimorbidity, requiring the use of multiple concomitant medications to manage both HIV and other chronic conditions. Consequently, polypharmacy has become increasingly prevalent among PLWH, particularly among older adults and individuals with multiple comorbidities (Demirbas et al., 2025; Coker et al., 2025; Linfield et al., 2024). Although ART has markedly improved health outcomes, the increasing complexity of medication regimens presents new challenges for long-term care.
Managing HIV alongside multiple chronic conditions requires a holistic, person-centred approach rather than one focused on a single disease. A disease-specific approach may limit healthcare providers’ ability to deliver individualised care that addresses the complex needs of people with multimorbidity. Health outcomes are influenced not only by medical care but also by social, economic, environmental, and behavioural factors. While access to effective medical treatment is essential, social determinants of health including income, education, housing, social support, and living conditions also have a profound impact on overall health and well-being (World Health Organization, 2023). Furthermore, adherence to disease-specific treatment guidelines for multiple conditions may inadvertently promote polypharmacy, increasing the risk of adverse drug events, drug–drug interactions, and treatment burden (Masnoon et al., 2017).
Polypharmacy has become an increasing global concern, particularly among older people living with HIV (PLWH), where prolonged antiretroviral therapy (ART) and the growing prevalence of multimorbidity necessitate the concurrent use of multiple medications. Although there is no universally accepted definition of polypharmacy, it is most defined as the concurrent use of five or more medications (Danjuma et al., 2020). In the context of HIV, polypharmacy generally refers to the use of ART alongside non-HIV medications prescribed to manage chronic comorbidities such as hypertension, diabetes, and cardiovascular disease (Back & Marzolini, 2020). However, the concept extends beyond the number of medications used. Polypharmacy also encompasses the appropriateness of prescribing, therapeutic complexity, potential drug–drug interactions, cumulative toxicity, medication adherence, and the overall impact of medication use on clinical outcomes and quality of life (Masnoon et al., 2017; Back & Marzolini, 2020; Duerden et al., 2021).
Polypharmacy places a considerable treatment burden on PLWH by increasing regimen complexity and the risk of drug–drug interactions, adverse drug events, and hospitalisation (El Moussaoui et al., 2020). Evidence suggests that complex treatment regimens (Manzano-García et al., 2018), high pill burden (Yager et al., 2017), and negative medication-related experiences (Krentz & Gill, 2016) are associated with poorer medication adherence. In addition, polypharmacy often coexists with multiple chronic conditions, which may worsen disease burden, contribute to psychological distress, and further compromise adherence (Manzano-García et al., 2018; Gervasoni et al., 2019). Most previous studies have examined adherence to ART and non-ART medications separately among PLWH receiving multiple medications, providing limited insight into overall adherence across the entire medication regimen. A study conducted in the United States reported that only 50% of PLWH achieved at least 85% adherence across all prescribed medications (Zelnick et al., 2021). Suboptimal adherence to either ART or non-ART medications can adversely affect treatment outcomes, increasing the risk of hospitalisation, disease progression, and mortality (Altice et al., 2019).
Most research on medication adherence among people living with HIV (PLWH) has, over the past three decades, focused primarily on adherence to antiretroviral therapy (ART), with comparatively little attention given to adherence in the context of concurrent ART and non-ART medication use, despite the increasing prevalence of polypharmacy (Paramesha & Chacko, 2021). Although several studies have explored barriers and facilitators to medication adherence among individuals receiving multiple medications, they have generally examined isolated aspects of adherence and reported inconsistent findings (Adejumo et al., 2020; Ware et al., 2018; Lacey et al., 2021; Greene et al., 2023). Furthermore, there is a paucity of qualitative evidence, particularly from resource-constrained primary healthcare settings in South Africa, examining how polypharmacy influences medication adherence and how structural, psychosocial, and treatment-related factors shape adherence behaviours among PLWH.
Addressing this evidence gap is important for informing patient-centred interventions and integrated chronic disease management strategies that support optimal medication adherence. Therefore, this study aimed to explore the impact of polypharmacy on medication adherence among people living with HIV attending a primary healthcare facility in Mthatha, Eastern Cape. Specifically, the study sought to examine how polypharmacy influences adherence behaviours, identify the barriers and facilitators to adherence across multiple medications, and generate evidence to inform contextually appropriate strategies for improving medication adherence among PLWH.
A qualitative study was conducted to explore the impact of polypharmacy on treatment adherence among people living with HIV attending Mthatha Gateway Clinic in the Eastern Cape Province of South Africa. A qualitative approach was considered appropriate as it facilitated an in-depth exploration of participants’ lived experiences, perceptions, and challenges associated with managing multiple medications, while providing rich insights into the contextual factors influencing treatment adherence.
The study was conducted at Mthatha Gateway Clinic, a public primary healthcare facility located in Mthatha, Eastern Cape, South Africa. The clinic provides a comprehensive range of primary healthcare services, including HIV testing, antiretroviral therapy (ART), chronic disease management, tuberculosis care, and family planning. It serves a predominantly rural and peri-urban population with a high burden of HIV and chronic comorbidities, making it a suitable setting for exploring the impact of polypharmacy on treatment adherence among people living with HIV (PLWH).
The study population comprised adults aged 18 years and older living with HIV who were receiving antiretroviral therapy (ART) alongside medication for one or more chronic conditions. Participants were recruited using purposive sampling to ensure the inclusion of individuals with direct experience of polypharmacy. Recruitment continued until data saturation was achieved, whereby no new themes or insights emerged from subsequent interviews. A total of 16 participants were included in the study. Eligibility required concurrent use of ART and medication for at least one chronic condition; people unable to provide informed consent were excluded.
Data were collected between 5 March and 20 March 2026 through semi-structured, face-to-face interviews conducted in either English or isiXhosa, according to participants’ preferences. An interview guide was used to explore participants’ experiences of managing multiple medications, barriers and facilitators to treatment adherence, treatment-related challenges, social support, stigma, and recommendations for improving adherence. All interviews were audio-recorded with participants’ informed consent and supplemented with field notes to capture contextual information and non-verbal observations.
Audio-recorded interviews were transcribed verbatim and translated into English where necessary. The data were analysed using Braun and Clarke's (2006) six-phase thematic analysis approach. The researcher first familiarised herself with the data through repeated reading of the transcripts before generating initial codes. Similar codes were grouped into categories and organised into potential themes, which were subsequently reviewed, refined, defined, and named. The analysis focused on identifying patterns and meanings related to treatment adherence among people living with HIV (PLWH) managing polypharmacy. Data collection and analysis occurred concurrently, allowing emerging insights to inform subsequent interviews and ensuring that data saturation was achieved. Coding was conducted manually; no specialist qualitative-analysis software was required.
Trustworthiness was addressed through credibility, dependability, confirmability and transferability (Lincoln & Guba, 1985). Credibility was supported by engagement during interviews and the use of verbatim quotations. The same semi-structured guide was used consistently, recordings were checked against transcripts, and an audit trail of recordings, field notes, transcripts and analytic decisions was maintained. Rich descriptions of the setting, participants and procedures support judgements about transferability.
This study was conducted by a multidisciplinary team of South African researchers, including a clinician and a social sciences scholar with a background in Psychology. The lead author (UP) recognised that her clinical training and professional experiences could influence data interpretation. To enhance reflexivity and minimise potential bias, the research team included participants with diverse experiences and ensured that multiple perspectives were considered throughout the analysis. Transcripts were independently reviewed, coding decisions were discussed collectively, and emerging themes were critically examined through dialogues between UP and NN. Differences in interpretation were discussed and resolved collaboratively to ensure that the findings reflected participants’ experiences rather than the researchers’ assumptions.
Ethical approval was obtained from the Walter Sisulu University Research Ethics Committee (WSU HREC 292/2025), and permission to conduct the study was granted by the Eastern Cape Department of Health (EC 202510 006). Written informed consent was obtained from all participants prior to data collection. Participants were informed about the purpose of the study, the procedures involved, the voluntary nature of participation, and their right to withdraw at any stage without negative consequences or any impact on the healthcare services they received. Confidentiality and anonymity were ensured through the use of unique participant codes, and all study records were securely stored and managed.
Sixteen participants took part. Eleven (68.7%) were women, ten (62.5%) were unemployed, and ten (62.5%) lived with family. The largest age groups were 30–39 years and 50–59 years (five participants; 31.3% each). Twelve participants (75.0%) identified family as their principal source of support. Full characteristics are presented in Table 1.
Seven themes were identified as describing the key barriers and enablers influencing adherence to multiple medicines among participants. These themes captured the complex and interconnected factors affecting treatment-taking behaviours, including individual experiences, treatment-related challenges, psychosocial influences, social support systems, and healthcare-related factors. Table 2 below presents the seven themes that emerged from the data and provides an overview of the factors shaping medication adherence.
Theme 1: Structural and socioeconomic constraints
Structural and socioeconomic barriers emerged as prominent factors influencing treatment adherence. Participants frequently described difficulties attending clinic appointments due to financial constraints and transportation challenges. These barriers affected their ability to access healthcare services consistently and maintain continuity of treatment.
One participant explained:
“I suffer transport costs … sometimes appointments clash with other responsibilities, it’s tough to priorities.” (P01)
“There are days where by it becomes difficult, I struggle to get money on my appointment date so that’s how I end up missing my appointment date to pick my medication again.” (P02)
The inefficiencies in the health system also added to structural barriers. Participants claimed that it had long queues and was overcrowded:
“Waiting a long time in queues at the clinic because of lack of health care workers now we find ourselves waiting for one pharmacist to explain on one patient on how to use her/his medication.” (P03)
This reflects institutional challenges within the healthcare system, where limited resources and staff shortages reduce service efficiency. In some cases, participants were unable to access services at all:
“Firstly the clinic that I collect my medication is far from me so sometimes I don’t have money, I was send back home on the other day because they said it’s full complaining about the few nurses that are helping many patients.” (P15)
Theme 2: Psychological burden and emotional fatigue
The emotional experience of taking multiple medications emerged as a significant barrier. Participants described feelings of depression, fatigue, and emotional distress associated with long-term treatment. These emotional challenges often reduced motivation to maintain consistent medication-taking routines, highlighting the close relationship between psychological well-being and treatment adherence.
One participant stated:
“Taking many medications is depressing, sometimes I forget to drink my medication sometimes I would think of not taking my medication.” (P01)
Another participant added:
“I’m living with HIV and also Diabetes I have to take this medication every day without failing. It is not easy sometimes I feel like quitting and I am a bread winner I’m doing this for my kids.” (P08)
Moreover, participants reported that the physical act of taking medication was a burden:
“It is painful because I have to make sure that and force myself to drink my medication of both illnesses on a correct time without failing.” (P04)
Theme 3: Treatment-related challenges and side effects
Treatment-related factors, particularly side effects and medication burden, were identified as key barriers to adherence. Participants described how persistent or unpleasant side effects disrupted their daily activities, reduced confidence in the treatment, and sometimes led them to delay, skip, or discontinue their medications. Participants reported experiencing various physical symptoms:
“Yes, I feel dizzy and exhausted I sometimes have nausea.” (P06)
These side effects make medication-taking physically uncomfortable, which may discourage consistent use. Another participant reported more severe reactions:
“Yes sometimes my body would be itching, I vomit my urine change colour and my body parts would be so painful.” (P14)
Such experiences demonstrate that treatment itself can become a barrier, particularly when patients associate medication with discomfort.
In some cases, participants avoided medication when feeling unwell:
“When I feel sick … I don’t feel like taking medication.” (P10)
Theme 4: Stigma, non-disclosure and social perceptions
Stigma emerged as a significant psychosocial barrier influencing treatment adherence. Participants expressed fear of being judged or identified when accessing healthcare services. Concerns about unintentional disclosure of their HIV status contributed to reluctance to attend clinics or collect medication, particularly among younger participants, who perceived clinic attendance as exposing their health status to others. These fears encouraged avoidance behaviours that could interfere with timely medication collection and continuity of care. One participant explained:
One participant explained:
“Yes in many people especially to young people, some are scared of going to the clinic because they don’t want others to know about their illnesses.” (P01)
Another participant highlighted similar concerns:
“Yes, because we young man don’t want to attend clinics and we don’t want people to see us collecting medication.” (P08)
Non-disclosure further limited access to support:
“I don’t receive any support from anyone I keep my health conditions privately.” (P08)
The themes presented in this section highlight the key factors that facilitate treatment adherence among participants managing multiple chronic conditions. These enablers encompass supportive caregiving relationships, adaptive coping strategies, and participants’ recommendations for strengthening adherence support, underscoring the importance of individual, interpersonal, and health system approaches in promoting sustained engagement with treatment.
Theme 5: Social support and caregiving dynamics
Social support emerged as one of the most important facilitators of adherence. Participants who received support from family members reported better treatment management and described their relatives as playing an active role in helping them maintain their medication routines. Family members, including partners and children, provided practical assistance through medication reminders, encouragement, and support with collecting medication from the clinic when participants were unable to attend appointments themselves. This support reduced the burden of treatment management and promoted consistent adherence by reinforcing daily medication-taking behaviours and ensuring continuity of care.
One participant explained:
“I can say that I get support from my family and my kids including my boyfriend he supports and always remind me to collect my medication on time. My kids they always remind me to take my medication.” (P04)
This highlights the role of family in reinforcing adherence through reminders. Another participant stated:
“I receive support from my family,my kids they play a very good role in supporting me because sometimes they are able to collect my medication on my appointment dates.” (P02)
Theme 6: Coping strategies and behavioural adaptation
The use of coping strategies and behavioural adaptation emerged as an important facilitator of treatment adherence, particularly among participants who had been managing chronic illnesses over an extended period. Participants described adopting practical and psychological strategies that enabled them to integrate complex medication regimens into their daily lives. These adaptive behaviours reflected a gradual process of adjusting to long-term treatment demands and developing routines that supported consistent adherence.
Several participants reported using technological aids, such as mobile phone alarms and reminders, to minimise forgetfulness and ensure timely medication intake and clinic attendance. These self-management strategies helped participants establish regular medication-taking habits despite the challenges associated with polypharmacy.
One participant explained:
“I set an alarm to remind me and that’s working for me.” (P01)
Similarly, another participant stated:
“I use my phone to remind me about my medication and appointments.” (P12)
Beyond practical reminder systems, participants also described a process of psychological adaptation in which acceptance of their chronic conditions made treatment easier to manage over time. Rather than viewing medication as a burden, they reported becoming accustomed to lifelong therapy through experience and acceptance.
One participant reflected:
“I am getting old now it’s becoming easy now as time goes on I am learning to accept my health matters. I am used at using my diabetes treatment and my HIV treatment.” (P02)
Similarly, another participant highlighted how continued experience with treatment improved their ability to cope with medication-related challenges:
“No, I am used at taking my medication now at first it was really hard I used to vomit, now I found myself using TB treatment.” (P07)
Family support further strengthened participants’ coping efforts by providing encouragement and reinforcing positive medication-taking behaviours. Emotional support from family members helped participants remain motivated and committed to their treatment despite the demands of managing multiple chronic conditions.
As one participant explained:
“Yes my family supports me a lot when it comes to taking my medication and they always encourage me to keep on using my medication they make it easy for me to use my medication without failing.” (P03)
Theme 7: Patient-driven recommendations for improving adherence
Participants offered several recommendations for improving treatment adherence, highlighting the need to address structural, socioeconomic, and healthcare system barriers that affected their ability to remain engaged in long-term treatment. Their suggestions reflected practical solutions informed by their lived experiences and underscored opportunities to improve access to care, reduce treatment burden, and strengthen adherence support.
One of the most frequently suggested interventions was home delivery of medication. Participants believed that receiving medication at home would reduce the burden of travelling to healthcare facilities, minimise transport costs, and lessen concerns about long waiting times and unintended disclosure of their health status during clinic visits.
Participants stated:
“Medication should be delivered to our homes.” (P02)
“It would be easier if they deliver medication at home.” (P04)
“I would prefer my medication to be delivered in my house.” (P14)
Participants also recommended expanding community-based healthcare services through the use of mobile clinics. They perceived mobile clinics as a way to improve access to treatment, particularly for individuals living in rural or underserved communities where distance to healthcare facilities posed a challenge.
One participant explained:
“Mobile clinics in our communities would help.” (P06)
Another added:
“Mobile clinics should be placed in rural areas.” (P12)
Financial challenges were also identified as barriers requiring intervention. Participants suggested that improved financial support through government grants or employment opportunities would reduce the economic pressures associated with long-term treatment and improve their ability to attend clinic appointments and maintain adherence.
As participants explained:
“Grant from the government or my medication to be delivered on my home address.” (P11)
“Getting a job would help me.” (P01)
Participants further recommended improvements within the healthcare system, particularly measures aimed at reducing waiting times and increasing staffing levels. They believed that these changes would improve the quality and efficiency of healthcare services, making it easier to access treatment consistently.
One participant stated:
“If they can try and manage these long queues for the whole day it would be better.” (P13)
Another noted:
“More healthcare workers are needed.” (P03)
Finally, participants emphasised the importance of strengthening psychosocial support services. They viewed counselling, educational workshops, and support programmes as valuable resources that could improve motivation, enhance coping skills, and encourage sustained engagement with treatment.
Participants commented:
“Counselling would help.” (P01)
“Workshops and support programmes are needed.” (P10)
Overall, these recommendations demonstrate that participants viewed optimal treatment adherence as requiring a comprehensive, patient-centred approach that extends beyond individual responsibility to include accessible healthcare services, socioeconomic support, and strengthened psychosocial care.
This study explored the impact of polypharmacy on treatment adherence among people living with HIV attending a primary healthcare facility in Mthatha, Eastern Cape. The findings demonstrate that adherence is influenced by a complex interaction of structural, psychological, treatment-related and social factors rather than individual behaviour alone. The study identified structural and socio-economic constraints, psychological burden, medication-related challenges, stigma and non-disclosure as major barriers to adherence, while social support, coping strategies and behavioural adaptation emerged as important facilitators.
Participants highlighted structural and socio-economic barriers as some of the most significant barriers. Often clinic attendance and collection of medication was interrupted by financial hardship, unemployment, transport costs, long waiting times at healthcare facilities. This is in line with research from sub-Saharan Africa, demonstrating that poverty and health-care barrier issues continue to be significant drivers of non-adherence to HIV treatment (Woldesenbet et al., 2023; UNAIDS, 2024). The results indicate that non-adherence is not just a matter of lack of motivation, but also factors other than the patient’s control. Thus, there is a need for interventions that seek to enhance adherence to consider social determinants of health as well as clinical management.
The study also discovered that emotional fatigue and psychological burden had an adverse effect on adherence. Participants talked about the experience of being frustrated, exhausted and treatment fatigued with the chronic care of HIV and other chronic diseases. Multiple medications were taken daily, which was a reminder of sickness and led to emotional distress. The same has been found in other studies, with depression and stress and fatigue from treatment being noted as key factors in low adherence for people living with HIV (Haberer et al., 2021; Greene et al., 2023). The results indicate the importance of incorporating psychosocial support services into the existing HIV and chronic disease management programmes.
Several factors associated with the treatment were also important barriers. Side effects like dizziness, nausea and physical discomfort were experienced by participants, and this led to decreased adherence to medication taking. Polypharmacy adds to the complexity of treatment regimens and the likelihood of adverse drug reactions and drug–drug interactions, which can all have a negative impact on adherence (Back & Marzolini, 2020). The results thus underscore the need for frequent medication reviews, patient education and counselling to enhance tolerability of medication and reduce burden of multiple medicines. Improvements in HIV treatment raised stigma and non-disclosure as significant issues.
Participants spoke of a fear of being judged by community members and of being identified while attending the clinics, which caused some to avoid health care services and to hide their health issues from others. As in earlier studies, stigma remains a barrier to treatment adherence and impacts access to social support, which are key factors in maintaining treatment (Nyblade et al., 2021). Stigma associated with the HIV virus continues to be a major concern in the improvement of treatment outcomes and it is imperative that it continues to be addressed through community education and awareness programmes.
The study revealed a number of factors which helped to promote adherence, despite these obstacles. One of the most influential enablers of treatment adherence was family members and partners’ social support. Emotional support, reminder medication and support for clinic visits and taking in medication were provided by family members. This study corroborates existing evidence that positive social interactions have been shown to positively influence engagement in care and adherence among people living with HIV (Kim et al., 2021; Wringe et al., 2022).
Coping strategies and behavioural adaptation were also shown to be good coping mechanisms that participants had used to manage their distress. Participants’ use of medication routines and acceptance of chronic illness and the use of phone alarms integrated treatment into their daily lives. Over the years, many participants learned to manage themselves and lower the burden of polypharmacy and adherence. These results underscore the importance of interventions to boost self-efficacy and patient empowerment in chronic disease management.
Overall, the findings indicate that treatment adherence among people living with HIV experiencing polypharmacy is shaped by interconnected structural, psychosocial and treatment-related factors. Improving adherence therefore requires a patient-centred and holistic approach that extends beyond medication provision to include psychosocial support, stigma reduction, healthcare system strengthening and community-based service delivery models. Such interventions may contribute to improved treatment outcomes and quality of life among people living with HIV managing multiple chronic conditions.
The study provides in-depth, context-specific accounts from people managing ART together with medicines for chronic comorbidities, and the inclusion of verbatim quotations strengthens transparency. However, the small purposively selected sample came from one primary healthcare facility, limiting transferability. Adherence and treatment experiences were self-reported and may be affected by recall and social-desirability bias. The study did not objectively measure adherence, pill counts, viral suppression or prescribing appropriateness. Translation from isiXhosa into English may also have reduced some linguistic nuance. These limitations should be considered when interpreting the findings.
Primary healthcare services should integrate ART and chronic-disease reviews, routinely assess adverse effects and treatment burden, and simplify regimens where clinically appropriate. Differentiated medicine delivery, mobile outreach and psychosocial support may reduce structural and emotional barriers. Future multi-site studies should include more diverse rural and urban facilities and combine qualitative accounts with objective adherence, clinical and prescribing measures.
This study found that treatment adherence among people living with HIV who are managing multiple chronic conditions is influenced by a complex interaction of structural, socio-economic, psychological, treatment-related and social factors. Financial constraints, transport challenges, long waiting times, medication side effects, treatment fatigue and HIV-related stigma were identified as major barriers to adherence, while family support, behavioural adaptation and self-management strategies facilitated continued engagement with treatment. The results show that compliance is not a personal choice but also influenced by the wider health system and socio-economic context. Healthcare services should take a patient-centred and an integrated approach to improving adherence outcomes for individuals with polypharmacy, including adherence counseling, psychosocial support, regular medication review, and stigma reduction interventions. Furthermore, strengthening differentiated service delivery models, including medication home delivery, decentralised chronic medication distribution systems and mobile healthcare services, may reduce access barriers and improve continuity of care, particularly in resource-constrained settings. Addressing both the clinical and social determinants of adherence is essential for improving treatment outcomes, quality of life and long-term health among people living with HIV receiving multiple medications.
Ethical approval was granted by the Walter Sisulu University Human Research Ethics Committee (WSU HREC 292/2025), and permission was granted by the Eastern Cape Department of Health (EC 202510 006). All participants provided written informed consent to participate and to audio-record the interviews. No directly identifiable participant information is reported.
Generative artificial intelligence was used to assist with language refinement and restructuring of the manuscript. The authors reviewed and took responsibility for the accuracy, originality, citations and integrity of the final content.
Figshare: Underlying and Extended Data for: Exploring the impact of polypharmacy on treatment adherence among people living with HIV. https://doi.org/10.6084/m9.figshare.33097961 (Putuma & Ncitakalo, 2026).
This project contains the following underlying data:
• Anonymised Interview Responses (Participants P01–P08).pdf – Completed anonymised interview responses from participants P01 to P08 used for thematic analysis.
• Anonymised Interview Responses (Participants P09–P16).pdf – Completed anonymised interview responses from participants P09 to P16 used for thematic analysis.
Figshare: Underlying and Extended Data for: Exploring the impact of polypharmacy on treatment adherence among people living with HIV. https://doi.org/10.6084/m9.figshare.33097961 (Putuma & Ncitakalo, 2026).
This project contains the following extended data:
• Blank Interview Schedule.pdf – Semi-structured interview schedule used to collect qualitative data from participants.
• Blank Informed Consent (English and isiXhosa).pdf – Blank informed consent forms provided to participants before enrolment in the study.
• Participant Demographic Table.pdf – Summary table of participants’ demographic characteristics included to support interpretation of the study findings.
Data are available under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) licence.
The authors thank the study participants, Mthatha Gateway Clinic and the Eastern Cape Department of Health for facilitating the research.