Factors Associated with Non-Adherence to Antiretroviral Therapy: A
Health-Facility-Based Cross-Sectional Study in the Amahlathi Sub-District of the
Eastern Cape, South Africa
#MMPMID41340714
May NS
; Wagner JD
; Okafor UB
HIV AIDS (Auckl)
2025[]; 17
(?): 385-397
PMID41340714
show ga
INTRODUCTION: The Joint United Nations Programme on HIV and AIDS (UNAIDS) aims
for 95% ART adherence to achieve global viral suppression against HIV/AIDS, which
is a major health issue worldwide, especially in southern Africa. This study
investigated ART non-adherence among adult HIV-positive clients in the Amahlathi
sub-district of the Eastern Cape, South Africa. METHODS: A cross-sectional study
of 400 HIV/AIDS-positive persons (PLWHA) was undertaken at multiple facilities. A
Survey was used to collect data, while medical records were used to ascertain the
viral load. Responses were captured on an ordinal adherence scale and
triangulated with viral load records from patient files. Univariate, bivariate,
and multiple logistic regression analyses were performed to determine factors
associated with ART non-adherence, and 95% CIs reported. RESULTS: The ART
non-adherence rate was 28%. In the bivariate analysis (odds ratio [OR]), living
with children (OR = 2.59), living with parents (OR = 4.12), alcohol use (OR =
2.08), HIV non-disclosure to family (OR = 0.31), non-sharing of HIV status to
partner (OR = 0.41), staying with partners (OR = 0.41), taking treatment regimen
II (OR = 5.74), taking ART doses twice a day (OR = 4.80), use of traditional
medicine (OR = 2.83), and missed dosage (OR = 3.98) were associated with non-ART
adherence. Multivariate analysis revealed that young age (<30-40 years) (AOR =
0.95; 95% CI: 0.93-0.98), female sex (AOR = 0.41; 95% CI: 0.21-0.77), partner HIV
disclosure (AOR = 0.49; 95% CI: 0.26-0.92), and use of traditional medicine (AOR
= 2.45; 95% CI: 1.05-5.68) were independent predictors of ART adherence.
CONCLUSION: ART adherence remains below UNAIDS targets in the study area.
Tailored interventions that address traditional medicine use, strengthen partner
disclosure support, and provide adherence counseling for young adults and men are
urgently needed. Future programs could integrate digital adherence monitoring and
reminder systems as practical tools to enhance treatment outcomes.
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