Background Long-term success of HIV antiretroviral therapy requires near-perfect adherence, maintained throughout one's lifetime. However, perceptions towards ART and patterns of adherence may change during the life course. We assessed challenges to long-term adherence in adolescents and adults in three regional HIV treatment centers in Uganda. Methods We conducted 24 in-depth interviews and 2 focus group discussions with a total of 33 health-care providers and expert clients (HIV patients on long-term ART who assist with adherence support of fellow patients). Interview topics included experiences with patients on long-term treatment with either declining adherence or persistent poor adherence. Transcribed texts were coded and analyzed based on the social-ecological framework highlighting differences and commonalities between adolescents and adults. Results The overarching themes in adolescents were unstructured treatment holidays, delays in disclosure of HIV status by caretakers, stigma, which was mainly experienced in boarding schools, and diminishing or lack of clinical support. In particular, there was minimal support for early and gradual disclosure for caretakers to the infected children, diminishing clinical support for young adults during transition to adult-based care and declining peer-to-peer support group activities. The predominating theme in adults was challenges with treatment access among temporary economic migrants. Common themes to adults and adolescents were challenges with disclosure in intimate relationships, treatment related factors including side effects, supply of single tablets in place of fixed-dose combined drugs, supply of drug brands with unfavorable taste and missed opportunities for counseling due to shortage of staff. © 2016 Inzaule et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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information processing Health Personnel HIV Infections Interpersonal Relations Human immunodeficiency virus infection long term care health care personnel interpersonal communication human highly active antiretroviral therapy Antiretroviral Therapy, Highly Active time factor Anti-Retroviral Agents Time Factors antiretrovirus agent social support medication compliance Uganda qualitative research human relation interview patient counseling Young Adult Humans migrant side effect psychology Adolescent jaundice Interviews as Topic counseling male preschool child female Child, Preschool adolescence Social Stigma stigma peer group Article patient compliance adult health care access drug safety adulthood personnel shortage drug formulation lopinavir atazanavir Medication Adherence Focus Groups Child