Perspective of People Living With HIV and Healthcare Workers on the Uptake, Barriers, and Benefits of Multimonth Dispensing: A Qualitative Systematic Review

Introduction: Multimonth dispensing (MMD) is a strategy in the HIV care continuum for people living with HIV (PLWH), especially for those who are virally suppressed. With the increase in MMD following the COVID-19 pandemic, there is a dearth of data on its impact on HIV care outcomes, such as viral suppression. Therefore, we conducted a qualitative systematic review to explore how PLWH and healthcare workers (HCWs) perceive the uptake, barriers, challenges, and benefits of MMD, as well as its effects on viral suppression. Methods: In January 2025, following the PRISMA approach, we searched CINAHL, Embase, PubMed, and Scopus databases for articles. Two reviewers independently performed the screen, extraction, and appraisal processes. We descriptively reported the findings in line with our objectives. Results: Of the 3521 studies found, only 15 were included in this review, and most were from sub-Saharan Africa. HCWs initiated PLWH on MMD because of the COVID-19 pandemic, particularly to reduce clinic traffic, even when they did not meet the criteria for MMD. The barriers to PLWH initiating MMD, confirmed by HCWs, include privacy concerns and the stigma associated with having multiple antiretroviral therapy (ART) medication bottles and the stockout of ART medications in clinics. Furthermore, some PLWH refused MMD because plenty of ART bottles can increase the risk of unintended HIV disclosure. Confirmed by HCWs, PLWH share their medication with others and, at times, misuse it. Regarding MMD benefits, PLWH reported job stability as a benefit because of reduced permission from work to refill ART medication and waiting time in the clinics, a decrease in stigma and discrimination, and a generally improved HIV care experience; all confirmed by HCWs. Furthermore, HCWs reported benefits, including reduced workload and burnout. Interestingly, unlike PLWH’s claim that MMD improved adherence and viral suppression, HCWs reported the opposite. Conclusion: The COVID-19 pandemic increased MMD rollout to those who met and those who did not meet its criteria, leading to shorter waiting times, job stability, and reduced HCWs’ burnout. However, HIV clinics should initiate MMD for PLWH who meet the criteria, which allows for closer monitoring of the unsuppressed PLWH.