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Prevalence, determinants & impact of suboptimal adherence to HIV medication in 25 countries

Prevalence, determinants, and impact of suboptimal adherence to HIV medication in 25 countries

Preventive Medicine, Volume 139, October 2020

Patriciade los Rios (a), Chinyere Okoli (b), Yogesh Punekar (b), Brent Allan (c) Marvelous Muchenje (d), Erika Castellanos (e), Bruce Richman (f), Giulio Maria Corbelli (g), W. David Hardy (h), Benjamin Young (a) Nicolas Van de Velde (b)

(a) ViiV Healthcare, Research Triangle Park, NC, USA; (b) ViiV Healthcare, Brentford, Middlesex, United Kingdom; (c) The International Council of AIDS Service Organizations (ICASO), Toronto, Canada; (d) ViiV Healthcare ULC, 245 Armand-Frappier Boulevard, Laval, Quebec H7V 4A7, Canada; (e) Global Action for Trans Equality (GATE), Belize; (f) Prevention Access Campaign, USA; (g) European AIDS Treatment Group, Rome, Lazio, Italy; (h) Division of Infectious Diseases, Johns Hopkins University School of Medicine, MD, USA.


Modern antiretroviral therapy (ART) has improved the lives of people living with HIV (PLHIV) but currently requires daily adherence. We assessed prevalence and correlates of suboptimal adherence, and measured associations with self-reported health outcomes. Data were from web-based surveys of confirmed HIV+ adults on antiretroviral treatment within 25 countries during 2019 (n = 2389). Suboptimal adherence was a report of ≥1 reason for missing ART ≥5 times within the past month. Multivariable logistic regression examined associations between suboptimal adherence and self-reported overall health and virologic suppression. Overall, 24.1% (575/2389) reported suboptimal adherence, from 10.0% (5/50) in Austria, to 62.0% (31/50) in China.

The most common reasons for missing ART ≥5 times in the overall population were feeling depressed/overwhelmed (7.4%, 176/2389), trying to forget about HIV (7.0%, 168/2389), and work (6.1%, 145/2389). Correlates of suboptimal adherence included being heterosexual, <50 years old, ≤high school, having gastrointestinal treatment side effects, and privacy concerns.

Odds of suboptimal overall health were 1.41 (95%CI, 1.11–1.80), 2.10 (95%CI, 1.65–2.68), and 2.55 (95%CI, 2.00–3.25) among those who reported the maximum number of times missed ART for any reason within the past month as 1, 2–4, or ≥5 times respectively, vs not missing at all. Odds of virologic nonsuppression were 1.80 (95%CI, 1.33–2.45), and 2.24 (95%CI, 1.66–3.02) for 2–4, or ≥5 times of missed ART respectively, vs not missing at all; missing for only 1 time was not significantly associated with virologic nonsuppression.

Novel ART strategies designed to improve adherence along with interventions to empower PLHIV and support self-medication may improve health outcomes and quality of life.


  • Overall, 24.1% reported suboptimal adherence to antiretroviral therapy (ART).
  • Emotional challenges (e.g., depressed/overwhelmed) were the top reasons for missing ART.
  • Poorer adherence was noted among younger adults and those with unmet treatment needs.
  • Suboptimal adherence was significantly associated with poorer health outcomes.
  • Patient-centered care and flexible treatment alternatives may improve adherence.