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Individual-level factors may include intrapersonal obstacles, such as negative emotions, problems coping, or lack of motivation. The Theory of Triadic Influence integrates constructs from previous theories of health behavior change (e.g., Health Beliefs Model, Theory of Planned Behavior, Social Learning Theory), and posits that factors at each of these levels independently and interactively affect decisions to engage or not engage in health behaviors ( 7). Yet, reaching the UNAIDS targets will be challenging in high HIV prevalence countries like South Africa where approximately half of the seven million PLWH are not yet accessing ART despite universal eligibility ( 6).īarriers to ART initiation may exist at the individual, social, and structural levels ( 7). ART initiation is a key step in achieving viral suppression, which is critical to preventing transmission of the virus and extending the longevity of people living with HIV (PLWH) ( 2– 5). The UNAIDS 90-90-90 treatment targets aim to dramatically increase the number of people who initiate antiretroviral therapy (ART) and achieve viral suppression by 2020 ( 1). Research is needed to evaluate their feasibility and efficacy in high HIV prevalence countries. Results suggested high acceptability for intervention strategies involving trained HIV-positive peers among South African PLWH and healthcare providers. Consistent with the Theory of Triadic Influence, barriers to ART initiation were identified at the individual, social, and structural levels. An inductive content analytic approach was applied to the data. Interviews explored barriers to ART initiation and acceptability of theory-based intervention strategies to optimize ART initiation. Qualitative semi-structured interviews were conducted with 30 participants in Gugulethu Township, South Africa, including 10 healthcare providers and 20 people living with HIV (PLWH) who did not initiate ART. Greater understanding of barriers to ART initiation in high prevalence countries like South Africa is critical. The UNAIDS 90-90-90 treatment targets aim to dramatically increase the number of people who initiate antiretroviral therapy (ART) by 2020.