Barriers and facilitators to utilization of differentiated hiv service delivery models in Luwero district, Uganda

Background: Differentiated HIV service delivery (DSD) models have improved antiretroviral therapy (ART) adherence, retention in care, and viral suppression globally. However, their utilization in low- and middle-income countries, including Uganda, remains constrained by health system, community, and socioeconomic challenges. This study explored the barriers and facilitators influencing the utilization of differentiated HIV service delivery models among people living with HIV in Luwero District, Uganda. Methods: A cross-sectional qualitative study was conducted in three health facilities in Luwero District: Luwero General Hospital, Katikamu Health Centre III, and Zirobwe Health Centre III. Twelve purposively selected key informants were interviewed, including facility managers, ART clinic in-charges, HIV counsellors, and expert clients (four participants per facility). Data were collected using semi-structured interview guides and analyzed thematically. Results: Utilization of DSD models was influenced by health system, community, and socioeconomic factors. Facilitators included integrated HIV services, shorter waiting times, community health education, peer counselling, lower transportation costs, and proximity of community drug distribution points. Barriers included long travel distances, poor transport networks, poverty, inadequate support from health workers, concerns about confidentiality, and heavy workloads among healthcare providers, which limited access to and utilization of DSD services. Conclusions: Utilization of differentiated HIV service delivery models is shaped by multiple interrelated health system, community, and socioeconomic factors. Strengthening community-based HIV services, improving access to distribution points, addressing transport challenges, increasing staffing levels, and enhancing support for community health workers could improve the utilization of DSD models among people living with HIV.