Factors Associated with Non-Adherence to Antiretroviral Therapy among People Living with HIV Receiving Care in Military Health Facilities in C？te d’Ivoire
Introduction: Non-adherence to antiretroviral therapy remains a barrier to achieving and maintaining virological suppression. This study aimed to explore factors associated with antiretroviral therapy non-adherence among people living with HIV receiving care in military health facilities in C？te d’Ivoire. Methods: A multicentre cross-sectional study was conducted among 213 people living with HIV receiving antiretroviral therapy. Adherence was assessed using a composite criterion combining good self-reported adherence and an undetectable viral load. Sociodemographic, socioeconomic, treatment-related, healthcare-related, and psychosocial factors, including HIV-related stigma, were explored using unadjusted bivariate analyses. The Benjamini-Hochberg procedure was applied within families of related variables to control the false discovery rate. Results: Based on the composite criterion, 28.2% of participants were classified as non-adherent, whereas 82.6% had good self-reported adherence and 81.2% met the predefined undetectable viral load threshold. After correction for multiple comparisons, adherence remained associated with the ability to meet basic needs, circumstances of HIV testing, ART duration, concomitant treatment for a chronic condition, and several psychosocial dimensions. Associations with access to support services, confidentiality or management of medical records, guilt, and worthlessness did not remain statistically significant after correction. No association was found with sociodemographic characteristics or experiences of discrimination in healthcare settings. Conclusion: Among people living with HIV receiving care in the military health facilities included in this study, ART adherence appeared to reflect socioeconomic, psychosocial, and treatment-related circumstances beyond medication-taking behaviour alone. These findings support a person-centred approach to adherence, while healthcare support and confidentiality warrant further investigation.
References
[1]
UNAIDS (2023) UNAIDS Data 2023. Joint United Nations Programme on HIV/AIDS (UNAIDS).
[2]
Mosha, I.H., Nyondo, G.G., Munishi, C.G., Njiro, B.J. and Bwire, G.M. (2024) Prevalence and Factors Associated with Viral Non-Suppression in People Living with HIV Receiving Antiretroviral Therapy in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Reviews in Medical Virology, 34, e2540. https://doi.org/10.1002/rmv.2540
[3]
Boadu, I., Manu, A., Aryeetey, R.N.O., Kesse, K.A., Abdulai, M., Acheampong, E., et al. (2023) Adherence to Antiretroviral Therapy among HIV Patients in Ghana: A Systematic Review and Meta-Analysis. PLOS Global Public Health, 3, e0002448. https://doi.org/10.1371/journal.pgph.0002448
[4]
Buh, A., Deonandan, R., Gomes, J., Krentel, A., Oladimeji, O. and Yaya, S. (2023) Barriers and Facilitators for Interventions to Improve ART Adherence in Sub-Saharan African Countries: A Systematic Review and Meta-Analysis. PLOS ONE, 18, e0295046. https://doi.org/10.1371/journal.pone.0295046
[5]
Esber, A., Dear, N., Reed, D., Bahemana, E., Owouth, J., Maswai, J., et al. (2021) Temporal Trends in Self-Reported HIV Stigma and Association with Adherence and Viral Suppression in the African Cohort Study. AIDS Care, 34, 78-85. https://doi.org/10.1080/09540121.2021.1984380
Abrogoua, D.P., Nandjui, T.D.E. and Doffou, E. (2016) évaluation de la pertinence des interventions pharmaceutiques au cours de la dispensation des antirétroviraux à Abidjan-C？te d’Ivoire. Le Pharmacien Hospitalier et Clinicien, 51, 202-209. https://doi.org/10.1016/j.phclin.2015.07.088
[8]
Mannheimer, S.B., Mukherjee, R., Hirschhorn, L.R., Dougherty, J., Celano, S.A., Ciccarone, D., et al. (2006) The CASE Adherence Index: A Novel Method for Measuring Adherence to Antiretroviral Therapy. AIDS Care, 18, 853-861. https://doi.org/10.1080/09540120500465160
[9]
World Health Organization (2021) Guidelines: Updated Recommendations on HIV Prevention, Infant Diagnosis, Antiretroviral Initiation and Monitoring. https://iris.who.int/items/396e27dd-8532-4243-b4b5-bff30eeebc1b
[10]
Friedland, B.A., Gottert, A., Hows, J., Baral, S.D., Sprague, L., Nyblade, L., et al. (2020) The People Living with HIV Stigma Index 2.0: Generating Critical Evidence for Change Worldwide. AIDS, 34, S5-S18. https://doi.org/10.1097/qad.0000000000002602
[11]
Kiweewa, F., Esber, A., Musingye, E., Reed, D., Crowell, T.A., Cham, F., et al. (2019) HIV Virologic Failure and Its Predictors among HIV-Infected Adults on Antiretroviral Therapy in the African Cohort Study. PLOS ONE, 14, e0211344. https://doi.org/10.1371/journal.pone.0211344
[12]
Heestermans, T., Browne, J.L., Aitken, S.C., Vervoort, S.C. and Klipstein-Grobusch, K. (2016) Determinants of Adherence to Antiretroviral Therapy among HIV-Positive Adults in Sub-Saharan Africa: A Systematic Review. BMJ Global Health, 1, e000125. https://doi.org/10.1136/bmjgh-2016-000125
[13]
Kokolomami, J., Shongo, L., Mavula, A., Felo, M. and N’tangu, D. (2026) Index de stigmatisation 2.0 des personnes vivant avec le VIH en République Démocratique du Congo. Revue des Sciences de la Sante, 5, 533-540. https://doi.org/10.71004/rss.026.v5.i1.101
[14]
Ouner, J.J., Thompson, R.G.A., Dey, N.E.Y., Alhassan, R.K. and Gyamerah, A.O. (2025) Correlates of Internalized Stigma and Antiretroviral Therapy Adherence among People Living with HIV in the Volta Region of Ghana. BMC Public Health, 25, Article No. 342. https://doi.org/10.1186/s12889-025-21500-5
[15]
Mbah, P., Iroezindu, M., Esber, A.L., Dear, N., Reed, D., Adamu, Y., et al. (2021) Assessing the Impact of HIV Support Groups on Antiretroviral Therapy Adherence and Viral Suppression in the African Cohort Study. BMC Infectious Diseases, 21, Article No. 694. https://doi.org/10.1186/s12879-021-06390-3
[16]
Somi, N., Dear, N., Reed, D., Parikh, A., Lwilla, A., Bahemana, E., et al. (2021) Perceived Satisfaction with HIV Care and Its Association with Adherence to Antiretroviral Therapy and Viral Suppression in the African Cohort Study. AIDS Research and Therapy, 18, Article No. 89. https://doi.org/10.1186/s12981-021-00414-3
[17]
Réseau Ivoirien des organisations de Personnes vivant avec le VIH (2022) Index de la stigmatisation et la discrimination envers les personnes vivant avec le VIH en C？te d’Ivoire 2.0 (Index Stigma 2.0). RIP+. https://www.stigmaindex.org/wp-content/uploads/2021/11/Cote-dIvoire-SI-2.0-Report-2022_French.pdf
