{"paper_id":"3fe25254-ca90-4c2d-b18e-315565fa2f1c","body_text":"Integrating HIV Chaplains into Clinical Care: A Qualitative Evaluation of a Faith-Based Model for Promoting Adherence and Retention in Antiretroviral Therapy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integrating HIV Chaplains into Clinical Care: A Qualitative Evaluation of a Faith-Based Model for Promoting Adherence and Retention in Antiretroviral Therapy Ikenna Nwakamma, Amber Erinmwinhe, Kelechi Okoronkwo, Samuel Danley, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8932683/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Persistent gaps in antiretroviral therapy (ART) adherence, retention in care, and viral suppression continue to limit progress toward the UNAIDS 95-95-95 targets, particularly in settings where psychosocial, spiritual, and stigma-related barriers remain strong. Faith communities exert significant influence on health behaviours in Nigeria, yet structured models that integrate trained religious leaders into routine HIV care remain underexplored. This qualitative study examined the perceived impact, mechanisms, and contextual dynamics of an HIV chaplaincy intervention implemented in Nigerian. Methodology: Using a qualitative design, the study conducted in-depth interviews, key informant interviews and focus group discussions with people living with HIV (PLHIV), chaplains, health workers, and programme managers. Data were analysed thematically using an inductive-deductive approach. Result Findings demonstrate that integrating HIV chaplains into clinical settings can address psychosocial and spiritual barriers to care, reinforce adherence behaviours, and promote self-destigmatization. Five interconnected themes emerged: (1) faith-based psychosocial and improved adherence; (2) stigma and internalised shame decreased through faith-informed sermons and compassionate engagement; (3) faith–biomedical reconciliation aligned spiritual beliefs with ART adherence, reducing reliance on faith-healing-only narratives; (4) spiritual trust facilitated re-engagement of clients who had defaulted from care; and (5) institutional collaboration between faith networks and facilities enhanced programme ownership and sustainability. Conclusion The model bridged the gap in faith and bio-medicine, and offered a culturally grounded pathway to strengthen treatment continuity. These insights provide actionable evidence for scaling faith-sensitive spiritual care as part of comprehensive HIV service delivery in high-burden, faith-influenced contexts. HIV chaplaincy adherence stigma reduction faith-based intervention retention in care Contributions to the Literature The Study provides empirical qualitative evidence on a structured HIV chaplaincy model embedded within HIV treatment and care services. It demonstrates how faith actors can be integrated into health systems to support adherence, retention, and stigma reduction without undermining biomedical care. Expands population health literature on community-engaged HIV service delivery in highly religious settings. It informs public health policy on ethical and scalable faith–health collaborations for chronic disease management Background Despite dramatic advances in antiretroviral therapy (ART) and huge global scale-up efforts, gaps in viral suppression, retention in care and adherence persist and continue to limit epidemic control in many settings. The 2023 UNAIDS Global AIDS Update documented major progress in expanding treatment but highlighted remaining gaps in viral suppression and inequalities in outcomes across populations and regions. 1 National surveys likewise show substantial heterogeneity: Nigeria’s 2018 Population-based HIV Impact Assessment (NAIIS) estimated adult HIV prevalence and provided the baseline measures that underlie national efforts to reach the UNAIDS 95-95-95 targets, while national monitoring continues to demonstrate gaps in viral suppression for certain populations and geographic areas. 2 , 3 Poor adherence, loss to follow up, and psychosocial barriers remain principal drivers of suboptimal treatment outcomes, especially in low- and middle-income countries. 4 – 6 HIV-related stigma, mental health problems (including depression and anxiety), substance use, and social isolation are consistently associated with lower ART adherence and worse virological outcomes. Systematic reviews and large cohort studies have shown that internalized stigma and healthcare-related discrimination undermine retention and adherence, and that longitudinal increases in stigma predict poorer treatment behaviors and viral non-suppression. 7 – 10 Conversely, psychosocial interventions that address stigma and mental health have been shown to improve adherence and some clinical outcomes, although effect sizes vary and methodological limitations remain in the evidence base. 11 – 14 Religion, spirituality and faith communities are highly salient social determinants of health for many people living with HIV (PLHIV). Across multiple settings, positive religious coping, spiritual well-being, and supportive faith community engagement have been associated with improved mental health, greater resilience, and better self-reported adherence; longitudinal cohort work has even linked positive spiritual coping to slower immunologic decline and higher odds of viral suppression. 15 – 19 At the same time, negative religious coping, for example, beliefs that illness is punishment, insistence on faith-only healing, or stigmatizing sermons, can delay care seeking, reduce adherence, and increase internalized stigma. 20 – 22 Thus, religion and spirituality can function as either facilitators or barriers to HIV treatment, depending on the content and context of faith engagement. Faith-based organisations (FBOs) and religious leaders are major stakeholders in health systems in many low and middle-income countries as they often provide clinical services, reach marginalized communities, and exert strong normative influence on health behaviour. 23 – 25 In Nigeria and many sub-Saharan African countries, congregation-based and faith-partnered interventions have increased HIV testing, improved linkage to care and influenced health-seeking behaviours mostly through initiatives such as the congregation-based HIV testing outreaches which significantly increased HIV testing and linkage among pregnant women. 26 – 28 International agencies and national programmes have therefore encouraged strategic engagement with faith actors as part of comprehensive HIV responses. 29 – 31 Despite the plausibility of faith-based approaches, few intervention studies have evaluated structured, facility-linked spiritual care models (often termed “chaplaincy” in clinical settings) as a deliberate component of HIV service delivery. The clinical pastoral care and chaplaincy literature, largely generated in high-income country hospital and palliative care settings, demonstrates that trained spiritual care providers can improve spiritual well-being, coping and satisfaction with care, 32–35 but high-quality evidence on effects on biomedical outcomes, such as adherence or viral suppression, is scarce and heterogeneous. In the HIV field specifically, psychosocial and peer-support interventions that incorporate elements of faith or spirituality have been reported to improve service uptake, adherence and mental health, 13,14,36–38 however, robust evidence on the impact of chaplaincy integrated into routine HIV services on virologic outcomes is limited. This study sought to address the evidence gap by evaluating a standardized faith-based chaplaincy intervention. The primary aim is to understand whether exposure to HIV chaplaincy can improve ART adherence and retention in care; secondary impact on stigma, psychosocial well-being and spiritual coping. Methods Study Design Participatory monitoring and Evaluation approach was adopted in the programmatic design. It employed a qualitative exploration of the perceived impact of HIV Chaplains in improving ART outcomes among PLHIV engaged in faith-based HIV interventions across three Nigerian states. Study Setting The study was conducted in three Nigerian states where the project was being implemented: Lagos, Kaduna and Kogi States. Each state had at least two facilities implementing the chaplaincy intervention. Description of the Intervention The project was implemented by Nigerian Network of Religious Leaders living with or Personally Affected by HIV and AIDS (NINERELA+) beginning from October, 2023 and on-going. The intervention involved the recruitment and training of 60 religious leaders, 30 Christians and 30 Muslims, who were designated as “HIV Chaplains.” These chaplains underwent a 4-day intensive training on HIV basics, communication in HIV, counselling, stigma mitigation, and management of support groups. They received a faith-sensitive sermon guide on HIV, which was developed by a team of theologians, containing biblical and Qur’anic references supporting messages on HIV prevention, treatment, and care, self and anticipated stigma, adherence to treatment, disclosure, and rejection of false claims of faith healing, validated by representatives from the different faiths and denominations in Nigeria. Following the training, the chaplains were attached to selected HIV treatment facilities where they facilitated monthly Faith Clinic Sessions using the sermon guide, they provided group talk to ART clients, and also personal sessions for individual counselling. The healthcare workers shared line lists of clients who had defaulted on ART with the chaplains for follow-up. With client consent, chaplains provided one-on-one faith-based tel-counselling, spiritual support, and home visits. They also convened support group meetings within their faith communities for clients who desired ongoing faith-integrated psychosocial support. All counselling and support interactions were documented with clients’ informed consent. Study Population and Sampling The study population comprised PLHIV who benefited from the faith-based interventions led by HIV Chaplains, health workers at participating facilities, and the chaplains themselves. Others were key stakeholders from the state government and program managers. Participants were purposively selected to ensure diversity in gender, faith affiliation, facility type, and ART experience. Engagement across data collection methods was strategically balanced by participant category: KIIs involved program managers and implementing partner representatives, IDIs captured individual narratives from health providers and a subset of PLHIV, and FGDs were primarily conducted with PLHIV and chaplains to elicit group-level insights and collective experiences of the faith clinic model Data Collection Semi-structured interview and focus group discussion guides were developed specifically for this study. The guides were informed by the study objectives, existing literature on ART adherence, retention in care, faith-based health interventions, and stigma mitigation, as well as the operational framework of the HIV chaplaincy model implemented by NINERELA+. The guides were designed to explore participants’ experiences with the chaplaincy intervention, perceived mechanisms influencing adherence and retention, stigma experiences, psychosocial support pathways, and health system integration processes. Separate guides were developed for (1) people living with HIV, (2) religious leaders serving as HIV chaplains, (3) healthcare providers, and (4) programme managers to ensure role-specific depth of inquiry. The tools were reviewed by members of the research team with expertise in qualitative research, HIV service delivery, and faith-health integration to ensure content validity and contextual relevance. Minor refinements were made following pilot testing in one facility to improve clarity and flow. Data collection took place between March and September 2025. Interviews and FGDs were guided by semi-structured tools developed around key thematic domains: perceptions of faith-based counselling, chaplains’ influence on ART adherence, stigma reduction, and experiences with spiritual support. Guides were pilot-tested and revised for clarity and contextual sensitivity. FGDs and IDI were conducted in English or local languages (Hausa and Yoruba) depending on participants’ preference. All sessions were audio-recorded with consent and complemented by detailed field notes. Interviews were held in private spaces within health facilities or neutral community venues to ensure confidentiality and comfort. Data Management and Analysis Audio recordings were transcribed verbatim and, where necessary, translated into English. Transcripts were imported into NVivo 14 for data management and analysis. Thematic analysis was conducted following six-step approach: familiarization with data, initial coding, searching for themes, reviewing themes, defining and naming themes, and producing the final narrative. Both inductive and deductive coding were applied, deductive codes reflecting predefined areas such as adherence, stigma, and faith influence, while inductive codes captured emergent patterns. Ethics and Consent to Participate Ethical approval for this study was obtained from the Kaduna State Ministry of Health Research Ethics Committee, Nigeria (Approval No: MOH/ADM/744/Vol.1/1110037). All participants provided written informed consent prior to participation, including consent for audio recording. Participation was voluntary, and participants were informed of their right to withdraw at any time without consequence. Confidentiality and privacy were strictly maintained. No identifying information was included in transcripts or reports. The study was conducted in accordance with the principles of the Declaration of Helsinki and relevant national ethical guidelines for health research involving human participants. This study was a qualitative evaluation of an implemented program and did not involve prospective assignment of participants to health-related interventions. Therefore, it did not meet the definition of a clinical trial and clinical trial registration was not required (Clinical trial number: Not applicable). Results Participant Characteristics A total of 138 respondents contributed to the dataset through KII ( n = 28), IDI (n = 20), and FGD (n = 90) conducted across Lagos, Kaduna, and Kogi States. Table 1 had the details of participants in the different methods of data collection. Most participants were aged between 30–44 years (40.6%), with females comprising 59.4% of all participants. Christians constituted 60.1% and Muslims 39.9%. Of the religious leaders, 55% were Christian clergy (pastors or priests) and 45% were Muslim clerics (imams or scholars). Most participants were aged between 30–54 years (58.9%), with females comprising 59% of all participants. Christians constituted 60.3% and Muslims 39.7%. Of the religious leaders, 55% were Christian clergy (pastors or priests) and 45% were Muslim clerics (imams or scholars). Table 1 Participant Sociodemographic and Data Collection Profile (N = 138) Characteristic Category n (%) KII (n = 28) IDI (n = 20) FGD (n = 90) Age Group 18–29 26 (18.8%) 1 (3.6%) 4 (20.0%) 21 (23.3%) 30–44 56 (40.6%) 10 (35.7%) 10 (50.0%) 36 (40.0%) 45–59 38 (27.5%) 12 (42.9%) 6 (30.0%) 20 (22.2%) ≥ 60 18 (13.0%) 5 (17.9%) 0 (0.0%) 13 (14.4%) Sex Male 56 (40.6%) 14 (50.0%) 6 (30.0%) 36 (40.0%) Female 82 (59.4%) 14 (50.0%) 14 (70.0%) 54 (60.0%) Religion Christian 83 (60.1%) 17 (60.7%) 12 (60.0%) 54 (60.0%) Muslim 55 (39.9%) 11 (39.3%) 8 (40.0%) 36 (40.0%) Participant Type PLHIV 66 (47.8%) 0 (0.0%) 0 (0.0%) 66 (73.3%) Health Service Provider 18 (13.0%) 8 (28.6%) 10 (50.0%) 0 (0.0%) Implementing Partner / Manager 14 (10.1%) 14 (50.0%) 0 (0.0%) 0 (0.0%) Religious Leader 40 (29.0%) 6 (21.4%) 10 (50.0%) Thematic Overview Across all transcripts, five interrelated but distinct themes emerged, which captured the multidimensional role of HIV chaplains in shaping psychosocial, behavioral, clinical and spiritual outcomes for PLHIV. The themes and their corresponding frequency densities in the coded data are presented in Table 2 . Faith-based psychosocial support and stigma reduction represented the most prevalent codes, accounting jointly for over half of the coded references, followed by faith-biomedical reconciliation, linkage and retention through spiritual trust, and institutional collaboration and sustainability. Table 2 Emergent Themes and Relative Frequency in the Coding Corpus Theme Description Coded References (n) % of Total Codes Faith-Based Psychosocial Support Enhances Adherence Chaplains provided ongoing, trust-based emotional and spiritual counselling that reinforced ART adherence and resilience. 578 30.0% Reduced Anticipated and Internalized Shame Sermons and faith-clinic dialogues reframed HIV as a manageable condition rather than a moral failing, promoting disclosure and self-acceptance. 433 22.5% Faith–Biomedical Reconciliation Addressed misconceptions (e.g., faith-healing only); reinforced ART adherence as a divine-supported act, aligning faith with science. 368 19.1% Improved Linkage and Retention through Spiritual Trust Patients' spiritual connection with chaplains increased willingness to return to care after default and participate in follow-up. 321 16.7% Institutional Collaboration and Sustainability Strengthened partnerships between faith leaders and health facilities for long-term community engagement and health system ownership. 225 11.7% Total 1,925 100% Faith-Based Psychosocial Support and Treatment Adherence Participants consistently described the chaplaincy sessions as deep, introspective and promoted a sense of divine partnership in the treatment plan. PLHIV respondents reported that the compassionate, non-judgmental presence of chaplains redefined their relationship with medication from a symbol of shame to an act of faithfulness. One participant shared: “Before, I never wanted to discuss about my HIV status and medication, not even with my family members because I felt deep sense of fear and shame. But when the pastor said taking ARVs is part of taking care of the body God gave you, I started feeling responsible for my well-being again.” (Female PLHIV, FGD – Lagos) Providers corroborated this effect, noting improved consistency in clinic attendance and reduced missed refills among clients participating in chaplain sessions. The psychosocial anchoring provided by chaplains appeared to substitute for weak family networks, especially among clients facing stigma or domestic rejection. “ I am so happy I could find a way to unburden my heart. You cannot believe it, not all of us have strong family support. But, when I come for support group meetings, the prayers and the word of God we share really boost our spirit” [Female PLHIV, FGD - Kaduna] Stigma Reduction The incorporation of HIV-sensitive messages into sermons in faith the clinics, supported by verses from the Bible and the Quran, dismantled long-standing moral framings of HIV. A key element in the messaging of the chaplains was emphasis dismantling self-judgement and reframing HIV as a health condition rather than a sin. Across all states, participants reported greater openness during support groups and more willingness to discuss HIV related issues and needs in families. In Kogi, a female participant in the FGD reflected: After the Imam spoke about mandate to care for self as a divine injunction and mentioned that he had family members who are HIV positives, that changes a lot of things about how some of us felt about ourselves Many of the participants in the IDI and KII held the view that the faith-endorsed destigmatization messages carry social legitimacy that secular campaigns sometimes lack, and can lead to sustainable shifts in attitudes at community and congregational levels. “ I used to watch how the clients express themselves more freely during the faith clinics, more than they even open up to us when the come for adherence counselling” [Male healthcare worker, IDI, Kogi] Faith-Biomedical Reconciliation A recurrent barrier identified over time was conflict between ART adherence and faith-healing claims. Both healthcare workers and clergy described how the engagements were able to address the issues through a structured communication that ARV is gift from God and must be understood as compatible with faith in divine healing. An Imam in Kaduna remarked: I encountered some persons who held that if it is the wish of Allah that they become HIV positive, they have to rely on his will for their healing and not interfere with medication. Now, we teach that medicine is one of Allah’s tools. Faith and treatment are not enemies.Trust me, we are changing the story This conceptual reconciliation was among the most profound transformations observed and directly linked to improved adherence and re-engagement in care. A participants in the FGD had this to say: “ A priest asked a question in one of those their visits, that is it fair to deny God the glory and honour for the discovery of ARV. He said, rejecting the medicine is being ungrateful and not appreciating God for his gift. That really touched me, and I promised myself to take my medication seriously” [Female PLHIV, FGD - Kaduna] Spiritual Trust and Re-engagement in Care Clients’ self-reported data shared by chaplains, (triangulated with healthcare providers information) indicated that a substantial number of clients previously lost defaulted in their treatment plans were successfully reconnected to care following chaplain outreach. While quantitative validation was beyond the study’s scope, narratives consistently highlighted how spiritual trust acted as a gateway for clinical re-engagement. PLHIV emphasized that spiritual counseling offered by chaplains felt safer and more confidential than institutional contact, as it reduced defensiveness and facilitated re-entry into ART programs. Service provider described this collaboration as “a new bridge between the community and the clinic.” [ Male Program Manager - KII Lagos] Institutional Collaboration and Sustainability Across states, chaplains and healthcare workers developed informal but functional referral linkages that enhanced coordination of psychosocial and clinical support. Facilities reported that faith clinic days boosted attendance and encouraged cross-learning between providers and religious leaders, in a way that promoted mutual respect and demystified ART among faith leaders. Program Managers and representatives of relevant government agencies emphasized sustainability potential, as faith networks have stable community structures and moral authority that can sustain HIV care initiatives beyond donor cycles. “ We should look at the brighter side of this initiative, with the right investment made in building the capacity of the chaplains and connection made with the health facilities, what we are seeing is a sustainable model that will outlive donor funding, because the faith leaders will always be there.” [Program Manager, KII - Lagos] Discussion This qualitative study explored the influence of HIV chaplaincy on treatment outcomes among PLHIV. The findings demonstrate that chaplain-led engagement, integrating spiritual support, stigma mitigation, and personalized counseling, enhanced ART adherence, retention in care, and psychosocial wellbeing. These results contribute novel evidence to a growing body of literature highlighting the critical role of faith actors in advancing healthcare outcomes outcomes through compassionate, and faith-anchored approaches. 39, 40 Consistent with earlier studies, participants described spiritual care as instrumental in restoring hope and promoting adherence by reframing HIV as a manageable condition rather than a divine punishment or moral failure. Religious coping mechanisms, when positively oriented, have been associated with slower disease progression, better immune recovery, and improved viral suppression rates in PLHIV. 41 Faith-based counselling, as reflected in this intervention, aligns with prior evidence suggesting that that psychosocial and peer support models improve ART adherence and retention. Studies have shown that group-based counselling and psychosocial interventions can improve adherence and mental health outcomes in PLHIV. 19 Similarly, peer and community support models have been shown to reduce virologic failure and enhance retention, which shows the potential of relationally embedded interventions to sustain adherence in resource-limited settings. 42 The chaplaincy model demonstrated in this study brings spiritual well-being into care by integrating faith-based counselling into clinical service delivery. Chaplains, trained in both HIV literacy and counselling ethics, can act as brokers between healthcare intervention and spiritual care. This dual role strengthened patient trust and improved re-engagement among treatment defaulters. Notably, participants emphasized that chaplain interactions mitigated internalized stigma and reduced the impact of erroneous narratives around HIV healing. These results affirm that faith engagement, when structured and evidence-based, may complement biomedical care by addressing the existential and psychosocial dimensions of living with HIV. Conclusion HIV chaplaincy interventions can promote a faith-informed ecosystem of care, anchored on psychosocial support, stigma reduction, faith-science reconciliation, and trust-based support for continuity in HIV treatment and care. The positioning of chaplains as mediators between the spiritual and biomedical domain achieved not only behavioral outcomes but also social and theological shifts that realigned religious narratives with public health goals. However, as with other faith-linked health interventions, fidelity and sustainability remain critical concerns. Without ongoing mentorship and standardized competency frameworks, such as those proposed for chaplaincy training, impact may vary across contexts. Future studies should integrate longitudinal assessments to measure outcomes at 12 months post-intervention, and evaluate how chaplaincy models might be scaled within National HIV programs. Abbreviations ART Antiretroviral Therapy CIOMS Council for International Organizations of Medical Sciences HIV Human Immunodeficiency Virus INERELA+ International Network of Religious Leaders Living with or Personally Affected by HIV and AIDS PEPFAR President’s Emergency Plan for AIDS Relief PLHIV People Living with HIV Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and the CIOMS International Ethical Guidelines for Health-related Research Involving Humans (2016). In accordance with Nigerian and international guidelines on participatory monitoring and evaluation, a formal prospective review by an institutional ethics committee was not sought. Written informed consent was obtained from all participants before involvement, including permission for audio recording. Participants were informed of the study's purpose, assured of confidentiality, and told they could withdraw at any time without any consequences. Consent for publication Not applicable. This manuscript does not contain any individual person’s data in an identifiable form. Availability of data and materials Data are not publicly available due to ethical restrictions related to participant confidentiality and the sensitive nature of the data. Anonymised excerpts may be made available from the corresponding author upon reasonable request and subject to appropriate approvals. Competing interests The authors declare no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The programme evaluated was implemented with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and institutional support from INERELA+. The funders had no role in data analysis, interpretation, or manuscript preparation. Authors’ contributions I. N: Conceptualization; Methodology; Investigation; Formal analysis; Data curation; Writing original draft; Writing review & editing; Supervision; Project administration. A. E: Conceptualization; Resources; Supervision; Writing review & editing. K. O: Investigation; Data curation; Formal analysis; Writing review & editing. S. D: Investigation; Data curation; Formal analysis; Writing review & editing. O. A: Formal analysis; Methodology; Writing review & editing. Acknowledgements The authors thank the programme implementers, faith leaders, health-care workers, and people living with HIV who contributed to the implementation and evaluation of the chaplaincy intervention. References UNAIDS. 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Palliat Med. 2025;39(1):70–85. 10.1177/02692163241287650 . UNAIDS. Highlighting the role that faith communities are playing to end AIDS in children and adolescents. UNAIDS. Published June 27. 2023. Accessed October 7, 2025. https://www.unaids.org/en/resources/presscentre/featurestories/2023/june/20230627_faith-communities Chaudri NA. Adherence to Long-term Therapies Evidence for Action. Ann Saudi Med. 2004;24(3):221–2. 10.5144/0256-4947.2004.221 . Costa-Cordella S, Rossi A, Grasso-Cladera A, Duarte J, Cortes CP. Characteristics of psychosocial interventions to improve ART adherence in people living with HIV: A systematic review. PLOS Glob Public Health. 2022;2(10):e0000956. 10.1371/journal.pgph.0000956 . Published 2022 Oct 26. Braun A, Löwe B, Uhlenbusch N. Peer Support in Chronic Conditions from the Peer Supporters' Perspective: A Systematic Review. Psychosoc Interv. 2025;34(3):175–88. 10.5093/pi2025a14 . Published 2025 Jul 29. Pugh LE, Roberts JS, Viswasam N, et al. Systematic review of interventions aimed at improving HIV adherence to care in low- and middle-income countries in Sub-Saharan Africa. J Infect Public Health. 2022;15(10):1053–60. 10.1016/j.jiph.2022.08.012 . Rosie XJSS, Visser A, Damen A, et al. Goals and outcomes of chaplaincy in varying outpatient, primary, and community care contexts. J Health Care Chaplain. 2025;31(4):246–60. 10.1080/08854726.2025.2507411 . Leszcz M. Group Therapy for Patients With Medical Illness. Am J Psychother. 2020;73(4):131–6. 10.1176/appi.psychotherapy.20200005 . Blevins J, Doan S, Thurman S, Walsh T, Buckingham W, Davison D, DeLuca K, Kiser M, Martin C, Mugweru M, Mombo E, Okaalet P. A firm foundation: the PEPFAR consultation on the role of faith-based organizations in sustaining community and country leadership in the response to HIV/AIDS . 2012. Nwakamma IJ, Erinmwinhe A, Ajogwu A, Udoh A, Ada-Ogoh A. Mitigating Gender and Maternal and Child Health Injustices through Faith Community-Led Initiatives. Int J MCH AIDS. 2019;8(2):146–55. 10.21106/ijma.326 . Harris SL, Shaw M. The value of chaplains to healthcare systems: a qualitative study of the perspectives of executives, nurses, patients, and family members. J Health Care Chaplain. 2025;31(3):183–200. 10.1080/08854726.2025.2481816 . Desmet L, Dezutter J, Vandenhoeck A, Dillen A. Healthcare Chaplaincy for Geriatric Patients: A Quasi-Experimental Study into the Outcomes of Catholic Chaplaincy Interventions in Belgium. J Relig Health. 2024;63(3):1985–2010. 10.1007/s10943-023-01982-6 . Ironson G, Stuetzle R, Fletcher MA. An increase in religiousness/spirituality occurs after HIV diagnosis and predicts slower disease progression over 4 years in people with HIV. J Gen Intern Med. 2006;21(Suppl 5):S62–8. 10.1111/j.1525-1497.2006.00648.x . Nachega JB, Adetokunboh O, Uthman OA, et al. Community-Based Interventions to Improve and Sustain Antiretroviral Therapy Adherence, Retention in HIV Care and Clinical Outcomes in Low- and Middle-Income Countries for Achieving the UNAIDS 90-90-90 Targets. Curr HIV/AIDS Rep. 2016;13(5):241–55. 10.1007/s11904-016-0325-9 . Additional Declarations No competing interests reported. Supplementary Files IDIChaplainsguide.pdf IDIHealthworkersguide.pdf FGDguide.pdf IDIPLHIVguide.pdf KIIstakeholders.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8932683\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":608664551,\"identity\":\"b2dd529a-006c-4a7a-b448-acdb1d9de89a\",\"order_by\":0,\"name\":\"Ikenna Nwakamma\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBACNh4IbQAmP4BE2EnRwjgDJMJMyBpkLcxgDiEtfDyHDzAXttkZ8087nfjZ5tc2eT5mBsYPH3PwOIy3LYF5ZluymcTt3M3SuX23DduYGZglZ27Do4Wfx4CZdxuzDcPt3A3SuT23GYFa2IAi+LTwfwAqqLeRB9ry27Lntj1hLbw9DEAFh80Mbuduk2b4cTuRsBaeYwaHef8dNzYEarHsbbid3MbM2IzXL/I9yQ8f85ypNpwHdNiNH39u285vbz744SMeLSBwAM5ibAOTDfjVo4I/pCgeBaNgFIyCkQIA9atKtt1YuFIAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Nigerian Network of Religious Leaders Living with or Personally Affected by HIV and AIDS (NINERELA+)\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Ikenna\",\"middleName\":\"\",\"lastName\":\"Nwakamma\",\"suffix\":\"\"},{\"id\":608664552,\"identity\":\"9e76a6bb-bbeb-487a-a9ea-cecbba73f308\",\"order_by\":1,\"name\":\"Amber Erinmwinhe\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Nigerian Network of Religious Leaders Living with or Personally Affected by 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12:45:47\",\"extension\":\"pdf\",\"order_by\":3,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":138010,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"IDIPLHIVguide.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8932683/v1/07f8b91ce59d1b0c03b752a4.pdf\"},{\"id\":105093332,\"identity\":\"986b7f4c-85e9-4e1e-9b7f-431d0ab7c64b\",\"added_by\":\"auto\",\"created_at\":\"2026-03-21 01:41:31\",\"extension\":\"pdf\",\"order_by\":4,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":119643,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"KIIstakeholders.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8932683/v1/0e99c8a08c17b57de4c09c35.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Integrating HIV Chaplains into Clinical Care: A Qualitative Evaluation of a Faith-Based Model for Promoting Adherence and Retention in Antiretroviral Therapy\",\"fulltext\":[{\"header\":\"Contributions to the Literature\",\"content\":\"\\n\\u003cul\\u003e\\n\\u003cli\\u003eThe Study provides empirical qualitative evidence on a structured HIV chaplaincy model embedded within HIV treatment and care services.\\u003c/li\\u003e\\n\\u003cli\\u003eIt demonstrates how faith actors can be integrated into health systems to support adherence, retention, and stigma reduction without undermining biomedical care. \\u003c/li\\u003e\\n\\u003cli\\u003eExpands population health literature on community-engaged HIV service delivery in highly religious settings. \\u003c/li\\u003e\\n\\u003cli\\u003eIt informs public health policy on ethical and scalable faith\\u0026ndash;health collaborations for chronic disease management\\u003c/li\\u003e\\n\\u003c/ul\\u003e\"},{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eDespite dramatic advances in antiretroviral therapy (ART) and huge global scale-up efforts, gaps in viral suppression, retention in care and adherence persist and continue to limit epidemic control in many settings. The 2023 UNAIDS Global AIDS Update documented major progress in expanding treatment but highlighted remaining gaps in viral suppression and inequalities in outcomes across populations and regions.\\u003csup\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u003c/sup\\u003e National surveys likewise show substantial heterogeneity: Nigeria\\u0026rsquo;s 2018 Population-based HIV Impact Assessment (NAIIS) estimated adult HIV prevalence and provided the baseline measures that underlie national efforts to reach the UNAIDS 95-95-95 targets, while national monitoring continues to demonstrate gaps in viral suppression for certain populations and geographic areas.\\u003csup\\u003e\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u003c/sup\\u003e Poor adherence, loss to follow up, and psychosocial barriers remain principal drivers of suboptimal treatment outcomes, especially in low- and middle-income countries.\\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR5\\\" citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eHIV-related stigma, mental health problems (including depression and anxiety), substance use, and social isolation are consistently associated with lower ART adherence and worse virological outcomes. Systematic reviews and large cohort studies have shown that internalized stigma and healthcare-related discrimination undermine retention and adherence, and that longitudinal increases in stigma predict poorer treatment behaviors and viral non-suppression.\\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR8 CR9\\\" citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u003c/sup\\u003e Conversely, psychosocial interventions that address stigma and mental health have been shown to improve adherence and some clinical outcomes, although effect sizes vary and methodological limitations remain in the evidence base.\\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR12 CR13\\\" citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eReligion, spirituality and faith communities are highly salient social determinants of health for many people living with HIV (PLHIV). Across multiple settings, positive religious coping, spiritual well-being, and supportive faith community engagement have been associated with improved mental health, greater resilience, and better self-reported adherence; longitudinal cohort work has even linked positive spiritual coping to slower immunologic decline and higher odds of viral suppression.\\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR16 CR17 CR18\\\" citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e\\u003c/sup\\u003e At the same time, negative religious coping, for example, beliefs that illness is punishment, insistence on faith-only healing, or stigmatizing sermons, can delay care seeking, reduce adherence, and increase internalized stigma.\\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR21\\\" citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e\\u003c/sup\\u003e Thus, religion and spirituality can function as either facilitators or barriers to HIV treatment, depending on the content and context of faith engagement.\\u003c/p\\u003e \\u003cp\\u003eFaith-based organisations (FBOs) and religious leaders are major stakeholders in health systems in many low and middle-income countries as they often provide clinical services, reach marginalized communities, and exert strong normative influence on health behaviour.\\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR24\\\" citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e\\u003c/sup\\u003e In Nigeria and many sub-Saharan African countries, congregation-based and faith-partnered interventions have increased HIV testing, improved linkage to care and influenced health-seeking behaviours mostly through initiatives such as the congregation-based HIV testing outreaches which significantly increased HIV testing and linkage among pregnant women.\\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR27\\\" citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e\\u003c/sup\\u003e International agencies and national programmes have therefore encouraged strategic engagement with faith actors as part of comprehensive HIV responses.\\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR30\\\" citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eDespite the plausibility of faith-based approaches, few intervention studies have evaluated structured, facility-linked spiritual care models (often termed \\u0026ldquo;chaplaincy\\u0026rdquo; in clinical settings) as a deliberate component of HIV service delivery. The clinical pastoral care and chaplaincy literature, largely generated in high-income country hospital and palliative care settings, demonstrates that trained spiritual care providers can improve spiritual well-being, coping and satisfaction with care,\\u003csup\\u003e32\\u0026ndash;35\\u003c/sup\\u003e but high-quality evidence on effects on biomedical outcomes, such as adherence or viral suppression, is scarce and heterogeneous. In the HIV field specifically, psychosocial and peer-support interventions that incorporate elements of faith or spirituality have been reported to improve service uptake, adherence and mental health,\\u003csup\\u003e13,14,36\\u0026ndash;38\\u003c/sup\\u003e however, robust evidence on the impact of chaplaincy integrated into routine HIV services on virologic outcomes is limited.\\u003c/p\\u003e \\u003cp\\u003eThis study sought to address the evidence gap by evaluating a standardized faith-based chaplaincy intervention. The primary aim is to understand whether exposure to HIV chaplaincy can improve ART adherence and retention in care; secondary impact on stigma, psychosocial well-being and spiritual coping.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy Design\\u003c/h2\\u003e \\u003cp\\u003eParticipatory monitoring and Evaluation approach was adopted in the programmatic design. It employed a qualitative exploration of the perceived impact of HIV Chaplains in improving ART outcomes among PLHIV engaged in faith-based HIV interventions across three Nigerian states.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eStudy Setting\\u003c/h3\\u003e\\n\\u003cp\\u003eThe study was conducted in three Nigerian states where the project was being implemented: Lagos, Kaduna and Kogi States. Each state had at least two facilities implementing the chaplaincy intervention.\\u003c/p\\u003e\\n\\u003ch3\\u003eDescription of the Intervention\\u003c/h3\\u003e\\n\\u003cp\\u003eThe project was implemented by Nigerian Network of Religious Leaders living with or Personally Affected by HIV and AIDS (NINERELA+) beginning from October, 2023 and on-going. The intervention involved the recruitment and training of 60 religious leaders, 30 Christians and 30 Muslims, who were designated as \\u0026ldquo;HIV Chaplains.\\u0026rdquo; These chaplains underwent a 4-day intensive training on HIV basics, communication in HIV, counselling, stigma mitigation, and management of support groups. They received a faith-sensitive sermon guide on HIV, which was developed by a team of theologians, containing biblical and Qur\\u0026rsquo;anic references supporting messages on HIV prevention, treatment, and care, self and anticipated stigma, adherence to treatment, disclosure, and rejection of false claims of faith healing, validated by representatives from the different faiths and denominations in Nigeria.\\u003c/p\\u003e \\u003cp\\u003e Following the training, the chaplains were attached to selected HIV treatment facilities where they facilitated monthly Faith Clinic Sessions using the sermon guide, they provided group talk to ART clients, and also personal sessions for individual counselling. The healthcare workers shared line lists of clients who had defaulted on ART with the chaplains for follow-up. With client consent, chaplains provided one-on-one faith-based tel-counselling, spiritual support, and home visits. They also convened support group meetings within their faith communities for clients who desired ongoing faith-integrated psychosocial support. All counselling and support interactions were documented with clients\\u0026rsquo; informed consent.\\u003c/p\\u003e\\n\\u003ch3\\u003eStudy Population and Sampling\\u003c/h3\\u003e\\n\\u003cp\\u003eThe study population comprised PLHIV who benefited from the faith-based interventions led by HIV Chaplains, health workers at participating facilities, and the chaplains themselves. Others were key stakeholders from the state government and program managers. Participants were purposively selected to ensure diversity in gender, faith affiliation, facility type, and ART experience.\\u003c/p\\u003e \\u003cp\\u003eEngagement across data collection methods was strategically balanced by participant category: KIIs involved program managers and implementing partner representatives, IDIs captured individual narratives from health providers and a subset of PLHIV, and FGDs were primarily conducted with PLHIV and chaplains to elicit group-level insights and collective experiences of the faith clinic model\\u003c/p\\u003e\\n\\u003ch3\\u003eData Collection\\u003c/h3\\u003e\\n\\u003cp\\u003eSemi-structured interview and focus group discussion guides were developed specifically for this study. The guides were informed by the study objectives, existing literature on ART adherence, retention in care, faith-based health interventions, and stigma mitigation, as well as the operational framework of the HIV chaplaincy model implemented by NINERELA+.\\u003c/p\\u003e \\u003cp\\u003eThe guides were designed to explore participants\\u0026rsquo; experiences with the chaplaincy intervention, perceived mechanisms influencing adherence and retention, stigma experiences, psychosocial support pathways, and health system integration processes. Separate guides were developed for (1) people living with HIV, (2) religious leaders serving as HIV chaplains, (3) healthcare providers, and (4) programme managers to ensure role-specific depth of inquiry.\\u003c/p\\u003e \\u003cp\\u003eThe tools were reviewed by members of the research team with expertise in qualitative research, HIV service delivery, and faith-health integration to ensure content validity and contextual relevance. Minor refinements were made following pilot testing in one facility to improve clarity and flow.\\u003c/p\\u003e \\u003cp\\u003eData collection took place between March and September 2025. Interviews and FGDs were guided by semi-structured tools developed around key thematic domains: perceptions of faith-based counselling, chaplains\\u0026rsquo; influence on ART adherence, stigma reduction, and experiences with spiritual support. Guides were pilot-tested and revised for clarity and contextual sensitivity.\\u003c/p\\u003e \\u003cp\\u003eFGDs and IDI were conducted in English or local languages (Hausa and Yoruba) depending on participants\\u0026rsquo; preference. All sessions were audio-recorded with consent and complemented by detailed field notes. Interviews were held in private spaces within health facilities or neutral community venues to ensure confidentiality and comfort.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData Management and Analysis\\u003c/h2\\u003e \\u003cp\\u003eAudio recordings were transcribed verbatim and, where necessary, translated into English. Transcripts were imported into NVivo 14 for data management and analysis. Thematic analysis was conducted following six-step approach: familiarization with data, initial coding, searching for themes, reviewing themes, defining and naming themes, and producing the final narrative. Both inductive and deductive coding were applied, deductive codes reflecting predefined areas such as adherence, stigma, and faith influence, while inductive codes captured emergent patterns.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eEthics and Consent to Participate\\u003c/h3\\u003e\\n\\u003cp\\u003e \\u003cstrong\\u003eEthical approval\\u003c/strong\\u003e \\u003cp\\u003e for this study was obtained from the Kaduna State Ministry of Health Research Ethics Committee, Nigeria (Approval No: MOH/ADM/744/Vol.1/1110037).\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e All participants provided written informed consent prior to participation, including consent for audio recording. Participation was voluntary, and participants were informed of their right to withdraw at any time without consequence.\\u003c/p\\u003e \\u003cp\\u003eConfidentiality and privacy were strictly maintained. No identifying information was included in transcripts or reports. The study was conducted in accordance with the principles of the Declaration of Helsinki and relevant national ethical guidelines for health research involving human participants.\\u003c/p\\u003e \\u003cp\\u003eThis study was a qualitative evaluation of an implemented program and did not involve prospective assignment of participants to health-related interventions. Therefore, it did not meet the definition of a clinical trial and clinical trial registration was not required (Clinical trial number: Not applicable).\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eParticipant Characteristics\\u003c/p\\u003e \\u003cp\\u003eA total of 138 respondents contributed to the dataset through KII ( n\\u0026thinsp;=\\u0026thinsp;28), IDI (n\\u0026thinsp;=\\u0026thinsp;20), and FGD (n\\u0026thinsp;=\\u0026thinsp;90) conducted across Lagos, Kaduna, and Kogi States. Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e had the details of participants in the different methods of data collection.\\u003c/p\\u003e \\u003cp\\u003eMost participants were aged between 30\\u0026ndash;44 years (40.6%), with females comprising 59.4% of all participants. Christians constituted 60.1% and Muslims 39.9%. Of the religious leaders, 55% were Christian clergy (pastors or priests) and 45% were Muslim clerics (imams or scholars). Most participants were aged between 30\\u0026ndash;54 years (58.9%), with females comprising 59% of all participants. Christians constituted 60.3% and Muslims 39.7%. Of the religious leaders, 55% were Christian clergy (pastors or priests) and 45% were Muslim clerics (imams or scholars).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eParticipant Sociodemographic and Data Collection Profile (N\\u0026thinsp;=\\u0026thinsp;138)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCharacteristic\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCategory\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eKII (n\\u0026thinsp;=\\u0026thinsp;28)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eIDI (n\\u0026thinsp;=\\u0026thinsp;20)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eFGD (n\\u0026thinsp;=\\u0026thinsp;90)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge Group\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e18\\u0026ndash;29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e26 (18.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1 (3.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4 (20.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e21 (23.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e30\\u0026ndash;44\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e56 (40.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10 (35.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e36 (40.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e45\\u0026ndash;59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e38 (27.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12 (42.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6 (30.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e20 (22.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;60\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18 (13.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5 (17.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e13 (14.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSex\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e56 (40.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6 (30.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e36 (40.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e82 (59.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e14 (70.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e54 (60.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eReligion\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eChristian\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e83 (60.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e17 (60.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e12 (60.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e54 (60.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMuslim\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e55 (39.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11 (39.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8 (40.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e36 (40.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eParticipant Type\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePLHIV\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e66 (47.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e66 (73.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eHealth Service Provider\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18 (13.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8 (28.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eImplementing Partner / Manager\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e14 (10.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eReligious Leader\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e40 (29.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6 (21.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eThematic Overview\\u003c/h2\\u003e \\u003cp\\u003eAcross all transcripts, five interrelated but distinct themes emerged, which captured the multidimensional role of HIV chaplains in shaping psychosocial, behavioral, clinical and spiritual outcomes for PLHIV. The themes and their corresponding frequency densities in the coded data are presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e Faith-based psychosocial support and stigma reduction represented the most prevalent codes, accounting jointly for over half of the coded references, followed by faith-biomedical reconciliation, linkage and retention through spiritual trust, and institutional collaboration and sustainability.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eEmergent Themes and Relative Frequency in the Coding Corpus\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTheme\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDescription\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCoded References (n)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e% of Total Codes\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFaith-Based Psychosocial Support Enhances Adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eChaplains provided ongoing, trust-based emotional and spiritual counselling that reinforced ART adherence and resilience.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e578\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e30.0%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eReduced Anticipated and Internalized Shame\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSermons and faith-clinic dialogues reframed HIV as a manageable condition rather than a moral failing, promoting disclosure and self-acceptance.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e433\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e22.5%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFaith\\u0026ndash;Biomedical Reconciliation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAddressed misconceptions (e.g., faith-healing only); reinforced ART adherence as a divine-supported act, aligning faith with science.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e368\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e19.1%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eImproved Linkage and Retention through Spiritual Trust\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePatients' spiritual connection with chaplains increased willingness to return to care after default and participate in follow-up.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e321\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16.7%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eInstitutional Collaboration and Sustainability\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStrengthened partnerships between faith leaders and health facilities for long-term community engagement and health system ownership.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e225\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11.7%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1,925\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e100%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eFaith-Based Psychosocial Support and Treatment Adherence\\u003c/h2\\u003e \\u003cp\\u003e Participants consistently described the chaplaincy sessions as deep, introspective and promoted a sense of divine partnership in the treatment plan. PLHIV respondents reported that the compassionate, non-judgmental presence of chaplains redefined their relationship with medication from a symbol of shame to an act of faithfulness. One participant shared:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Before, I never wanted to discuss about my HIV status and medication, not even with my family members because I felt deep sense of fear and shame. But when the pastor said taking ARVs is part of taking care of the body God gave you, I started feeling responsible for my well-being again.\\u0026rdquo; (Female PLHIV, FGD \\u0026ndash; Lagos)\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eProviders corroborated this effect, noting improved consistency in clinic attendance and reduced missed refills among clients participating in chaplain sessions. The psychosocial anchoring provided by chaplains appeared to substitute for weak family networks, especially among clients facing stigma or domestic rejection.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026ldquo; I am so happy I could find a way to unburden my heart. You cannot believe it, not all of us have strong family support. But, when I come for support group meetings, the prayers and the word of God we share really boost our spirit\\u0026rdquo; [Female PLHIV, FGD - Kaduna]\\u003c/em\\u003e \\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStigma Reduction\\u003c/h2\\u003e \\u003cp\\u003eThe incorporation of HIV-sensitive messages into sermons in faith the clinics, supported by verses from the Bible and the Quran, dismantled long-standing moral framings of HIV. A key element in the messaging of the chaplains was emphasis dismantling self-judgement and reframing HIV as a health condition rather than a sin.\\u003c/p\\u003e \\u003cp\\u003e Across all states, participants reported greater openness during support groups and more willingness to discuss HIV related issues and needs in families. In Kogi, a female participant in the FGD reflected:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eAfter the Imam spoke about mandate to care for self as a divine injunction and mentioned that he had family members who are HIV positives, that changes a lot of things about how some of us felt about ourselves\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003e Many of the participants in the IDI and KII held the view that the faith-endorsed destigmatization messages carry social legitimacy that secular campaigns sometimes lack, and can lead to sustainable shifts in attitudes at community and congregational levels.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo; I used to watch how the clients express themselves more freely during the faith clinics, more than they even open up to us when the come for adherence counselling\\u0026rdquo; [Male healthcare worker, IDI, Kogi]\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eFaith-Biomedical Reconciliation\\u003c/h2\\u003e \\u003cp\\u003eA recurrent barrier identified over time was conflict between ART adherence and faith-healing claims. Both healthcare workers and clergy described how the engagements were able to address the issues through a structured communication that ARV is gift from God and must be understood as compatible with faith in divine healing.\\u003c/p\\u003e \\u003cp\\u003eAn Imam in Kaduna remarked:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eI encountered some persons who held that if it is the wish of Allah that they become HIV positive, they have to rely on his will for their healing and not interfere with medication. Now, we teach that medicine is one of Allah\\u0026rsquo;s tools. Faith and treatment are not enemies.Trust me, we are changing the story\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eThis conceptual reconciliation was among the most profound transformations observed and directly linked to improved adherence and re-engagement in care. A participants in the FGD had this to say:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026ldquo; A priest asked a question in one of those their visits, that is it fair to deny God the glory and honour for the discovery of ARV. He said, rejecting the medicine is being ungrateful and not appreciating God for his gift. That really touched me, and I promised myself to take my medication seriously\\u0026rdquo; [Female PLHIV, FGD - Kaduna]\\u003c/em\\u003e \\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSpiritual Trust and Re-engagement in Care\\u003c/h2\\u003e \\u003cp\\u003eClients\\u0026rsquo; self-reported data shared by chaplains, (triangulated with healthcare providers information) indicated that a substantial number of clients previously lost defaulted in their treatment plans were successfully reconnected to care following chaplain outreach. While quantitative validation was beyond the study\\u0026rsquo;s scope, narratives consistently highlighted how spiritual trust acted as a gateway for clinical re-engagement.\\u003c/p\\u003e \\u003cp\\u003ePLHIV emphasized that spiritual counseling offered by chaplains felt safer and more confidential than institutional contact, as it reduced defensiveness and facilitated re-entry into ART programs. Service provider described this collaboration as \\u003cem\\u003e\\u0026ldquo;a new bridge between the community and the clinic.\\u0026rdquo; [ Male Program Manager - KII Lagos]\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eInstitutional Collaboration and Sustainability\\u003c/h2\\u003e \\u003cp\\u003eAcross states, chaplains and healthcare workers developed informal but functional referral linkages that enhanced coordination of psychosocial and clinical support. Facilities reported that faith clinic days boosted attendance and encouraged cross-learning between providers and religious leaders, in a way that promoted mutual respect and demystified ART among faith leaders.\\u003c/p\\u003e \\u003cp\\u003eProgram Managers and representatives of relevant government agencies emphasized sustainability potential, as faith networks have stable community structures and moral authority that can sustain HIV care initiatives beyond donor cycles.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026ldquo; We should look at the brighter side of this initiative, with the right investment made in building the capacity of the chaplains and connection made with the health facilities, what we are seeing is a sustainable model that will outlive donor funding, because the faith leaders will always be there.\\u0026rdquo; [Program Manager, KII - Lagos]\\u003c/em\\u003e \\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThis qualitative study explored the influence of HIV chaplaincy on treatment outcomes among PLHIV. The findings demonstrate that chaplain-led engagement, integrating spiritual support, stigma mitigation, and personalized counseling, enhanced ART adherence, retention in care, and psychosocial wellbeing. These results contribute novel evidence to a growing body of literature highlighting the critical role of faith actors in advancing healthcare outcomes outcomes through compassionate, and faith-anchored approaches. \\u003csup\\u003e39, 40\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eConsistent with earlier studies, participants described spiritual care as instrumental in restoring hope and promoting adherence by reframing HIV as a manageable condition rather than a divine punishment or moral failure. Religious coping mechanisms, when positively oriented, have been associated with slower disease progression, better immune recovery, and improved viral suppression rates in PLHIV. \\u003csup\\u003e41\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eFaith-based counselling, as reflected in this intervention, aligns with prior evidence suggesting that that psychosocial and peer support models improve ART adherence and retention. Studies have shown that group-based counselling and psychosocial interventions can improve adherence and mental health outcomes in PLHIV. \\u003csup\\u003e19\\u003c/sup\\u003e Similarly, peer and community support models have been shown to reduce virologic failure and enhance retention, which shows the potential of relationally embedded interventions to sustain adherence in resource-limited settings. \\u003csup\\u003e42\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eThe chaplaincy model demonstrated in this study brings spiritual well-being into care by integrating faith-based counselling into clinical service delivery. Chaplains, trained in both HIV literacy and counselling ethics, can act as brokers between healthcare intervention and spiritual care. This dual role strengthened patient trust and improved re-engagement among treatment defaulters. Notably, participants emphasized that chaplain interactions mitigated internalized stigma and reduced the impact of erroneous narratives around HIV healing. These results affirm that faith engagement, when structured and evidence-based, may complement biomedical care by addressing the existential and psychosocial dimensions of living with HIV.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eHIV chaplaincy interventions can promote a faith-informed ecosystem of care, anchored on psychosocial support, stigma reduction, faith-science reconciliation, and trust-based support for continuity in HIV treatment and care. The positioning of chaplains as mediators between the spiritual and biomedical domain achieved not only behavioral outcomes but also social and theological shifts that realigned religious narratives with public health goals.\\u003c/p\\u003e \\u003cp\\u003eHowever, as with other faith-linked health interventions, fidelity and sustainability remain critical concerns. Without ongoing mentorship and standardized competency frameworks, such as those proposed for chaplaincy training, impact may vary across contexts. Future studies should integrate longitudinal assessments to measure outcomes at 12 months post-intervention, and evaluate how chaplaincy models might be scaled within National HIV programs.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eART\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eAntiretroviral Therapy\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eCIOMS\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eCouncil for International Organizations of Medical Sciences\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eHIV\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eHuman Immunodeficiency Virus\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eINERELA+\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eInternational Network of Religious Leaders Living with or Personally Affected by HIV and AIDS\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePEPFAR\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ePresident\\u0026rsquo;s Emergency Plan for AIDS Relief\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePLHIV\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ePeople Living with HIV\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was conducted in accordance with the Declaration of Helsinki and the CIOMS International Ethical Guidelines for Health-related Research Involving Humans (2016).\\u003c/p\\u003e\\n\\u003cp\\u003eIn accordance with Nigerian and international guidelines on participatory monitoring and evaluation, a formal prospective review by an institutional ethics committee was not sought. Written informed consent was obtained from all participants before involvement, including permission for audio recording. Participants were informed of the study\\u0026apos;s purpose, assured of confidentiality, and told they could withdraw at any time without any consequences.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable. This manuscript does not contain any individual person\\u0026rsquo;s data in an identifiable form.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eData are not publicly available due to ethical restrictions related to participant confidentiality and the sensitive nature of the data. Anonymised excerpts may be made available from the corresponding author upon reasonable request and subject to appropriate approvals.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The programme evaluated was implemented with support from the U.S. President\\u0026rsquo;s Emergency Plan for AIDS Relief (PEPFAR) and institutional support from INERELA+. The funders had no role in data analysis, interpretation, or manuscript preparation.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eI. N: Conceptualization; Methodology; Investigation; Formal analysis; Data curation; Writing original draft; Writing review \\u0026amp; editing; Supervision; Project administration.\\u003c/p\\u003e\\n\\u003cp\\u003eA. E: Conceptualization; Resources; Supervision; Writing review \\u0026amp; editing.\\u003c/p\\u003e\\n\\u003cp\\u003eK. O: Investigation; Data curation; Formal analysis; Writing review \\u0026amp; editing.\\u003c/p\\u003e\\n\\u003cp\\u003eS. D: Investigation; Data curation; Formal analysis; Writing review \\u0026amp; editing.\\u003c/p\\u003e\\n\\u003cp\\u003eO. A: Formal analysis; Methodology; Writing review \\u0026amp; editing.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors thank the programme implementers, faith leaders, health-care workers, and people living with HIV who contributed to the implementation and evaluation of the chaplaincy intervention.\\u003c/p\\u003e\\n\\n\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eUNAIDS. The path that ends AIDS: 2023 UNAIDS Global AIDS Update. Geneva: UNAIDS; 2023.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAliyu GG, et al. The burden of HIV, hepatitis B and hepatitis C by armed conflict setting: the Nigeria AIDS Indicator and Impact Survey, 2018. 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J Health Care Chaplain. 2025;31(3):183\\u0026ndash;200. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1080/08854726.2025.2481816\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/08854726.2025.2481816\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDesmet L, Dezutter J, Vandenhoeck A, Dillen A. Healthcare Chaplaincy for Geriatric Patients: A Quasi-Experimental Study into the Outcomes of Catholic Chaplaincy Interventions in Belgium. J Relig Health. 2024;63(3):1985\\u0026ndash;2010. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s10943-023-01982-6\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s10943-023-01982-6\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eIronson G, Stuetzle R, Fletcher MA. An increase in religiousness/spirituality occurs after HIV diagnosis and predicts slower disease progression over 4 years in people with HIV. J Gen Intern Med. 2006;21(Suppl 5):S62\\u0026ndash;8. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1111/j.1525-1497.2006.00648.x\\u003c/span\\u003e\\u003cspan address=\\\"10.1111/j.1525-1497.2006.00648.x\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNachega JB, Adetokunboh O, Uthman OA, et al. Community-Based Interventions to Improve and Sustain Antiretroviral Therapy Adherence, Retention in HIV Care and Clinical Outcomes in Low- and Middle-Income Countries for Achieving the UNAIDS 90-90-90 Targets. Curr HIV/AIDS Rep. 2016;13(5):241\\u0026ndash;55. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s11904-016-0325-9\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s11904-016-0325-9\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"HIV chaplaincy, adherence, stigma reduction, faith-based intervention, retention in care\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8932683/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8932683/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003ePersistent gaps in antiretroviral therapy (ART) adherence, retention in care, and viral suppression continue to limit progress toward the UNAIDS 95-95-95 targets, particularly in settings where psychosocial, spiritual, and stigma-related barriers remain strong. Faith communities exert significant influence on health behaviours in Nigeria, yet structured models that integrate trained religious leaders into routine HIV care remain underexplored. This qualitative study examined the perceived impact, mechanisms, and contextual dynamics of an HIV chaplaincy intervention implemented in Nigerian.\\u003c/p\\u003e\\u003ch2\\u003eMethodology:\\u003c/h2\\u003e \\u003cp\\u003eUsing a qualitative design, the study conducted in-depth interviews, key informant interviews and focus group discussions with people living with HIV (PLHIV), chaplains, health workers, and programme managers. Data were analysed thematically using an inductive-deductive approach.\\u003c/p\\u003e\\u003ch2\\u003eResult\\u003c/h2\\u003e \\u003cp\\u003eFindings demonstrate that integrating HIV chaplains into clinical settings can address psychosocial and spiritual barriers to care, reinforce adherence behaviours, and promote self-destigmatization. Five interconnected themes emerged: (1) faith-based psychosocial and improved adherence; (2) stigma and internalised shame decreased through faith-informed sermons and compassionate engagement; (3) faith\\u0026ndash;biomedical reconciliation aligned spiritual beliefs with ART adherence, reducing reliance on faith-healing-only narratives; (4) spiritual trust facilitated re-engagement of clients who had defaulted from care; and (5) institutional collaboration between faith networks and facilities enhanced programme ownership and sustainability.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eThe model bridged the gap in faith and bio-medicine, and offered a culturally grounded pathway to strengthen treatment continuity. These insights provide actionable evidence for scaling faith-sensitive spiritual care as part of comprehensive HIV service delivery in high-burden, faith-influenced contexts.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Integrating HIV Chaplains into Clinical Care: A Qualitative Evaluation of a Faith-Based Model for Promoting Adherence and Retention in Antiretroviral Therapy\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-03-21 01:41:15\",\"doi\":\"10.21203/rs.3.rs-8932683/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"74817627-fdd2-456d-9f9e-37db28288360\",\"owner\":[],\"postedDate\":\"March 21st, 2026\",\"published\":true,\"recentEditorialEvents\":[{\"type\":\"decision\",\"content\":\"Withdrawn\",\"date\":\"2026-05-13T08:25:58+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-13T08:46:36+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-03-21 01:41:15\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8932683\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8932683\",\"identity\":\"rs-8932683\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}