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Background Globally, countries are working tirelessly to achieve the UNAIDS 95-95-95 treatment targets by 2030. Despite making great strides in improving HIV viral load (VL) testing capacity for treatment monitoring in the past decade, a limited number of people living with HIV ( PLHIV) with high VL complete intensive adherence counselling (IAC) sessions which delays follow-up VL testing, consequently, delaying clinical decision-making. This study explored factors associated with the completion of IAC sessions in resource-limited settings.Methods We conducted a mixed-method study utilizing the explanatory sequential design. The quantitative data were collected from patient records from the period between 1 March 2020 to 30 June 2021 in Neno district, while qualitative data were collected from purposively selected PLHIV with high VL and healthcare workers, through focus group discussions (FGDs) and in-depth interviews respectively. 371 patient records were analyzed, while 6 heterogeneous FGDs of patients with high VL were conducted. 15 healthcare workers were also interviewed. STATA software was used to analyze quantitative data while thematic analysis approach was used for qualitative data analysis.Results The median age of the participants at the most recent VL was 39 years (IQR 31–47 years). The median age of respondents in FGDs was 41 years ( IQR 20–57). We found that having community health worker support (ARR = 0.62; 95% CI = 0.39–0.99) and longer duration on ART (ARR = 1.76; 95% CI = 1.09–2.83) were significant predictors of IAC completion. Provider’s unprofessionalism, poor partner support, and lack of private rooms for conducting IAC sessions dissuaded clients to come for subsequent IAC sessions.Conclusion Clients with high VL encounter multiple challenges that affect IAC attendance. Although personal factors play a greater role in fulfilling IAC attendance, health system factors are equally important. ART Clinics need to devise deliberate and careful approaches that target and motivate at-risk clients to complete IAC sessions and improve overall adherence. There’s an urgent need for ART clinics to designate private rooms for IAC sessions and adequately train expert clients on professionalism.

Introduction Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in low-and middle-income countries (LMICs). Despite this, a lack of funding, training and mentorship for NCD investigators in LMICs exists. In an effort to gain knowledge and skills to address these gaps, participants from the Global Research on Implementation and Translation Science (GRIT), a consortium of studies in eight LMICs and their networks, attended the dissemination and implementation (D&I) massive open online course (MOOC) developed by the Special Programme for Research and Training in Tropical Diseases at the World Health Organization to strengthen D&I capacity building. Here, we report on the feasibility of this MOOC, which was implemented during the SARS COVID-19 pandemic from April- November 2020.Methods Participants completed pre- and post- training questionnaires to assess self-reported D&I competencies, general research skills, and research mentor access and quality. D&I competencies were measured by use of a scale developed for a US-based training program, with change in competency scores assessed by paired t test. We used univariate statistics to analyze the data for all other outcomes.Results Of the 247 participants enrolled, 32 (13%) completed all MOOC components. D&I competency scores suggest improvement for those who had complete pre- and post-assessments. Trainee’s average score on the full competency scale improved 1.45 points (0-5 scale) from pre- to post-test; all four subscales also showed evidence of improvements. There were small but not significant increases in competencies for grant writing, proposal/ manuscript writing and presentations from pre- to post-test assessment. 40% of trainees reported access to a research mentor and 12% reported access to a D&I specific mentor. Participants reported barriers (e.g., unstable internet access and challenges due to COVID-19) and facilitators (e.g., topical interests, collaboration with colleagues) to completing the MOOC.ConclusionsAlthough COVID-19 affected program usage and completion, the MOOC was feasible and effective, showing that among LMIC participants completing the course, there was improvement in D&I competency scores. Recommendations for future D&I trainings in LMICs should include 1) adding more topic specific modules (i.e., NCD research, general research skills) for scalability; 2) fostering more collaboration with participants across LMICs; and 3) establishing partnerships with D&I mentors for course participants.