Abstract
Abstract Background: Antiretroviral therapy (ART) adherence among young adults living with HIV in Nigeria remains a significant challenge. This study aimed to explore the effectiveness and challenges of an adherence intervention implemented in Osogbo, Osun State, from the perspective of healthcare workers and adherence case managers. Methods: A qualitative research design was employed, utilizing Key Informant Interviews (KIIs) with healthcare workers and adherence case managers (n=4). Participants were purposively selected based on their experience supporting young adults (15–24 years) living with HIV and managing poor ART adherence. A semi-structured interview guide explored experiences with the intervention, its impact on clients, barriers to adherence, and recommendations for improvement. Data were analysed using thematic content analysis, supported by ATLAS.ti software. Results: The intervention demonstrated some success in improving adherence through personalized counseling, follow-up calls, and home visits. However, significant barriers persisted, including psychosocial factors such as stigma, denial, and fear of disclosure; socioeconomic challenges like financial difficulties and food insecurity; and health system constraints such as workforce shortages and high patient loads. Family dynamics, including non-disclosure and lack of support, also complicated adherence. Conclusions: While the intervention showed promise, a comprehensive and sustainable approach is needed to address the complex interplay of psychosocial, economic, and health system barriers impacting ART adherence among young adults living with HIV in Osun State. Future interventions should prioritize culturally sensitive, adolescent-friendly services that integrate mental health support, address social determinants of health, and strengthen healthcare infrastructure to ensure holistic support and improved adherence outcomes.