BACKGROUND:
Men’s linkage and adherence to and retention in antiretroviral therapy (ART) remain a critical gap in the HIV treatment continuum in South Africa. This study explores factors that encourage or discourage ART initiation, adherence and retention in HIV care among men in two townships in Cape Town, South Africa.

METHODS:
Individual interviews were conducted with men (n=15), healthcare workers (n=5), community health workers (n=4), and community leaders (n=6) from Khayelitsha and Gugulethu. In addition, six focus group discussions (n=2 only men; n=2 only women; n=2 men and women mixed) were conducted in the two communities. Purposive sampling was used to recruit participants. All interviews and FGDs were transcribed verbatim, translated into English and analysed using an inductive and deductive thematic approach, guided by the COM-B model.

RESULTS:
The findings indicate that men’s ability to initiate ART is closely tied to their psychological capabilities, such as their reactions to the news of an HIV positive diagnosis. ART adherence and retention in care were impacted by negative side effects of ART and positive health outcomes, such as feeling well and healthy. Men were motivated by support from close social ties to initiate ART, adhere to, and remain in care. Among those who initiated ART, the set-up of health facilities, such as separate rooms for HIV patients, created missed opportunities, as men worried that this arrangement could inadvertently disclose their HIV status. Discussion and

CONCLUSIONS:
The study findings suggest that men’s behaviour towards ART initiation, adherence and retention in care is shaped by their capacity, opportunity and motivation as ascribed in the COM-B model. The model offers a holistic approach and may be useful in developing targeted, multifaceted and multi-level interventions to address these intersecting webs of factors that shape ART initiation and adherence.