AIDS and Behavior

, Volume 23, Issue 2, pp 406–417 | Cite as

Multi-level Determinants of Clinic Attendance and Antiretroviral Treatment Adherence Among Fishermen Living with HIV/AIDS in Communities on Lake Victoria, Uganda

  • K. M. SileoEmail author
  • R. K. Wanyenze
  • W. Kizito
  • E. Reed
  • S. K. Brodine
  • H. Chemusto
  • W. Musoke
  • B. Mukasa
  • S. M. Kiene
Original Paper


This cross-sectional study assessed determinants of HIV clinic appointment attendance and antiretroviral treatment (ART) adherence among 300 male fisherfolk on ART in Wakiso District, Uganda. Multi-level factors associated with missed HIV clinic visits included those at the individual (age, AOR = 0.98, 95% CI 0.97–0.99), interpersonal (being single/separated from partner, AOR: 1.25, 95% CI 1.01–1.54), normative (anticipated HIV stigma, AOR: 1.55, 95% CI 1.05–2.29) and physical/built environment-level (travel time to the HIV clinic, AOR: 1.11, 95% CI 1.02–1.20; structural-barriers to ART adherence, AOR: 1.27, 95% CI 1.04–1.56; accessing care on a landing site vs. an island, AOR: 1.35, 95% CI 1.08–1.67). Factors associated with ART non-adherence included those at the individual (age, β: − 0.01, η2 = 0.03; monthly income, β: − 0.01, η2 = 0.02) and normative levels (anticipated HIV stigma, β: 0.10, η2 = 0.02; enacted HIV stigma, β: 0.11, η2 = 0.02). Differentiated models of HIV care that integrate stigma reduction and social support, and reduce the number of clinic visits needed, should be explored in this setting to reduce multi-level barriers to accessing HIV care and ART adherence.


HIV/AIDS ART adherence HIV care engagement Key populations Fisherfolk Uganda 



We thank the research participants for their time and participation. We also are grateful to Mildmay Uganda outreach teams and clinic staff for supporting this study. We thank Rose Naigino and Rose Kisa for their help supporting this study. This manuscript is part of K. Sileo’s doctoral dissertation. We thank Jennifer A. Wagman and Jamila K. Stockman for their feedback on this manuscript.


The GloCal Health Fellowship from the National Institute of Health Fogarty International Center and the University of California Global Health Institute awarded to K. Sileo supported this study (NIH/FIC 5R25TW009343-05). K. Sileo was also supported by a T32 Predoctoral Fellowship Award on Substance Abuse, HIV, and Related Infections from the National Institute of Drug Abuse T32 DA023356, PI: Steffanie Strathdee.

Compliance with Ethical Standards

Conflict of interest

We have no conflicts of interest to disclose.

Ethical Approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • K. M. Sileo
    • 1
    • 2
    Email author
  • R. K. Wanyenze
    • 3
  • W. Kizito
    • 4
  • E. Reed
    • 1
  • S. K. Brodine
    • 1
  • H. Chemusto
    • 4
  • W. Musoke
    • 4
  • B. Mukasa
    • 4
  • S. M. Kiene
    • 1
  1. 1.Graduate School of Public HealthSan Diego State UniversitySan DiegoUSA
  2. 2.Center for Interdisciplinary Research on AIDS at Yale UniversityNew HavenUSA
  3. 3.Makerere School of Public HealthMakerere UniversityKampalaUganda
  4. 4.Mildmay UgandaKampalaUganda

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