Results
Participants’ HRQoL perceptions directly influenced ART readiness and anticipated adherence, with experiences of stigma, mental health burden, transport barriers and economic insecurity sometimes undermining confidence in starting and sustaining treatment. Findings generated from participants' lived experiences highlighted multidimensional HRQoL across physical, psychological, independence, social, environmental and spiritual domains. Participants described highly heterogeneous baseline quality of life, ranging from “brilliant” and unchanged daily functioning to profound illness, fatigue and recurrent hospitalisation. Emotional responses included shock, sadness, fear of job loss and suicidal feelings, but also acceptance and positive reframing, often supported by peer groups and faith. Social experiences ranged from supportive partners, families and community groups to severe rejection, isolation and homelessness. Environmental and structural barriers, including transport, clinic distance, unsafe housing and unemployment, were central concerns that patients linked directly to self-care, nutrition and treatment continuity. Spirituality and religious practice were prominent coping resources, though views on integrating faith into formal care were mixed. Across domains, stigma, economic insecurity and health system constraints emerged as cross-cutting influences on HRQoL and ART readiness. Participants’ HRQoL perceptions directly influenced ART readiness and anticipated adherence, with experiences of stigma, mental health burden, transport barriers and economic insecurity sometimes undermining confidence in starting and sustaining treatment.
