This qualitative substudy examined participant perspectives on a person-centred Dynamic Choice HIV care model intended to improve engagement and adherence among mobile individuals. Mobile populations face unique challenges maintaining antiretroviral therapy (ART) and continuous clinic engagement; the intervention aimed to provide flexible, practical options that accommodate mobility.
Investigators conducted 23 qualitative interviews with people enrolled in the dynamic choice intervention and with clinic staff. Interviewees comprised 18 participants receiving the intervention and 5 healthcare providers drawn from eight communities in southwest Uganda and western Kenya. The study focused on lived mobility contexts, experiences of the intervention, preferences as recipients or providers, and perceptions of patient–provider relationships.
The Dynamic Choice intervention included several specific elements designed to reduce barriers related to mobility:
Interview topics included participant life and mobility patterns, detailed experiences with each intervention component, preferences for services, and patient–provider dynamics. The analytic approach applied a framework analysis to selected qualitative codes to identify emergent themes related to the intervention components and to generate participant and provider recommendations for improvement.
Participants reported positive perceptions of the available options and valued having choices that matched varied mobility patterns. Among the intervention components, the travel pack was the most frequently cited preference. Participants described the travel pack as practical for preserving privacy and ensuring an emergency supply of medication while away from primary clinics.
Longer refill intervals—specifically six-month refills—were described as helpful because they reduced the burden of frequent clinic appointments and allowed participants to concentrate on maintaining ART adherence rather than continuously managing visit schedules in the context of unpredictable travel.
Interviewees viewed the flexibility offered by the intervention as supportive of adherence and sustained engagement. By decreasing the need for frequent clinic visits and by providing tangible travel support, participants reported fewer disruptions to medication access during periods of mobility. Providers also observed that facilitated transfers and phone-based coordination could bridge gaps when patients moved between facilities.
Participants appreciated viral load counselling provided within the program. Counselling helped them understand the relationship among medication adherence, viral load results, and the risk of opportunistic infections. This education component was reported as reinforcing adherence behaviours and clarifying clinical goals.
Despite positive reactions to intervention components, participants emphasized enduring structural constraints that limit optimal adherence. Poverty and food insecurity were repeatedly identified as significant obstacles: inadequate food and limited financial resources undermined the ability to take medications consistently and to prioritize health needs during travel or work-related mobility.
Participants recommended expanding these support services to the broader community rather than limiting them to selected individuals. They suggested integrating services to treat additional conditions alongside HIV care and highlighted the importance of addressing social determinants—specifically proposing food or employment support to improve overall health outcomes.
Healthcare providers recommended system-level improvements to support mobile patients, including strengthening drug supply chains to ensure consistent medication availability and deploying electronic medical records across countries to facilitate tracking, transfers, and continuity of care for mobile individuals.
This qualitative analysis identified clear acceptability and perceived benefits of the Dynamic Choice model among mobile people living with HIV and their providers in rural Kenya and Uganda. Participants valued flexibility, with the travel pack and six-month ART refills highlighted as particularly useful. Viral load counselling reinforced adherence understanding. Persistent socioeconomic barriers—poverty and food insecurity—remain critical constraints. Respondents recommended scaling interventions, broadening clinical services, and adding social supports; providers emphasized supply chain and health information system improvements. Details beyond the reported themes, such as quantitative outcome measures or broader generalizability, were not provided in the source abstract.