Predictors of Treatment Adherence and Virological Failure Among People Living with HIV Receiving Antiretroviral Therapy in a South African Rural Community

A large proportion of people living with HIV (PLHIV) in sub-Saharan Africa reside in rural areas. Knowledge of enablers and barriers of adherence to antiretroviral treatment (ART) in these populations is limited. We conducted a cohort study of 501 adult PLHIV on ART at a rural South African treatment facility as a sub-study of a clinical trial (ClinicalTrials.gov NCT03357588). Socio-economic, psychosocial and behavioral characteristics were assessed as covariates of self-reported adherence difficulties, suboptimal pill count adherence and virological failure during 96 weeks of follow-up. Male gender was an independent risk factor for all outcomes. Food insecurity was associated with virological failure in males. Depressive symptoms were independently associated with virological failure in both males and females. Household income and task-oriented coping score were protective against suboptimal pill-count adherence. These results underscore the impact of low household income, food insecurity and depression on outcomes of ART in rural settings and confirm other previously described risk factors. Recognition of these factors and targeted adherence support strategies may improve patient health and treatment outcomes

Cohort study · Environmental health · Health psychology · Pill · Psychiatry · Psychosocial · Public health · Demography · HIV Research and Treatment · HIV/AIDS drug development and treatment · HIV/AIDS Research and Interventions · Medicine · Nursing · Gerontology · Internal Medicine

• Barriers to ART adherence in sub-Saharan Africa

  Open Access•Judie Magura, Sibongile Ruth Nhari et al.•Frontiers in Public Health•2025

  Incluir item

• Standardization of the depression screener Patient Health Questionnaire (PHQ-9) in the general population

  Open Access•Rüya‐Daniela Kocalevent, Rüya-Daniela Kocalevent et al.•General Hospital Psychiatry•2013

  Incluir item

• Food Insufficiency Is Associated with High-Risk Sexual Behavior among Women in Botswana and Swaziland

  Open Access•Sheri D Weiser, Karen Leiter et al.•PLoS Medicine•2007

  Incluir item

• Adherence to Haart

  Open Access•Edward J Mills, Jean B Nachega et al.•PLoS Medicine•2006

  Incluir item

• Patient-Reported Barriers to Adherence to Antiretroviral Therapy

  Open Access•Zara Shubber, Edward J Mills et al.•PLoS Medicine•2016

  Incluir item

• Barriers to Care for Rural People Living With HIV

  Open Access•Jennifer A Pellowski•Journal of the Association of…•2013

  Incluir item

• Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa

  Open Access•Sydney Rosen, Matthew P Fox et al.•PLoS Medicine•2007

  Incluir item

• Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users

  Barbara J Turner, Christine Laine et al.•Journal of General Internal…•2003

  Incluir item

• Self-report measures of medication adherence behavior

  Michael J Stirratt, Jacqueline Dunbar-Jacob et al.•Translational Behavioral Medicine•2015

  Incluir item

• HIV testing attitudes, Aids stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa

  Seth C Kalichman•Sexually Transmitted Infections•2003

  Incluir item

• The PHQ-9

  Kurt Kroenke, Robert L Spitzer et al.•Journal of General Internal…•2001

  Incluir item

• Barriers to care among persons living with HIV/Aids in urban and rural areas

  Timothy G Heckman, Anton M Somlai et al.•AIDS Care•1998

  Incluir item

• Gendered differences in perceptions and reports of wellbeing

  Corrina Moucheraud, Jenna Paul-Schultz et al.•AIDS Care•2022

  Incluir item

• The Case adherence index

  Sharon Mannheimer, S B Mannheimer et al.•AIDS Care•2006

  Incluir item

• Barriers to accessing HIV/Aids care in North Carolina

  Susan Reif, Carol E Golin et al.•AIDS Care•2005

  Incluir item

• Gender differences in antiretroviral treatment outcomes of HIV patients in rural Uganda

  Walter Kipp, Arif Alibhai et al.•AIDS Care•2010

  Incluir item

• Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa

  Open Access•Karl Peltzer, Natalie Friend-Du Preez et al.•BMC Public Health•2010

  Incluir item

• Can Short-Term Use of Electronic Patient Adherence Monitoring Devices Improve Adherence in Patients Failing Second-Line Antiretroviral Therapy? Evidence from a Pilot Study in Johannesburg, South Africa

  Open Access•Denise Evans, Rebecca Berhanu et al.•AIDS and Behavior•2016

  Incluir item

• Health Literacy in the Context of HIV Treatment

  Open Access•Chandra Y Osborn, Terry C Davis et al.•AIDS and Behavior•2008

  Incluir item

• Income inequality and depressive symptoms in South Africa

  Open Access•Kafui Adjaye-Gbewonyo, Mauricio Avendaño et al.•Health & Place•2016

  Incluir item

• Psycho-social experiences and coping among caregivers of people living with HIV/Aids in the North-West province of South Africa

  Open Access•Acheampong Yaw Amoateng, Ishmael Kalule-Sabiti et al.•South African Journal of Psychology•2015

  Incluir item

• Masculinity as a barrier to men's use of HIV services in Zimbabwe

  Open Access•Morten Skovdal, Catherine Campbell et al.•Globalization and Health•2011

  Incluir item

• Gender bias in the food insecurity experience of Ethiopian adolescents

  Open Access•Craig Hadley, David Lindstrom et al.•Social Science & Medicine•2008

  Incluir item