The level of non-adherence and its associated factors among adult HIV patients on antiretroviral therapy in Nyamasheke district, Rwanda: a cross-sectional study, 2023

Abstract

Background Antiretroviral therapy (ART) has been crucial in managing HIV, but its success heavily relies on patient adherence. In sub-Saharan African countries, including Rwanda, adherence remains a challenge. Moreover, adults living with HIV (ALHIV) account for the majority of clients on ART in Rwanda, with 3.80% of them in Nyamasheke district. However, information regarding adherence to ART among these ALHIV is limited. This study aimed to assess the level of non-adherence to ART and its associated factors among ALHIV in Nyamasheke district. Methods A cross-sectional study was conducted in 22 randomly selected health facilities and included 416 participants. Data were collected through medical record reviews and interviews. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with non-adherence. Adherence was measured based on pill count. Odds ratio, 95% confidence interval and p-value were reported. Data were managed using MS Excel and analysed using Stata version 16. Results Of the 416 participants, 92.50% had past-month ART adherence level of 95% or higher. The following factors; age of 15–24 years (adjusted odds ratio [AOR]: 5.76, 95% CI: 1.68–19.73), shorter duration on ART (< 5 years) (AOR: 3.10, 95% CI: 1.11– 8.68), those who had treatment interruption (AOR: 4.08, 95% CI: 1.54–10.83), alcohol consumption (AOR: 4.42, 95% CI: 1.79–10.9), and forgetfulness (AOR: 4.53, 95% CI: 1.34–15.22) were significantly associated with non-adherence among ALHIV in Nyamasheke district. Conclusion The overall level of adherence was lower than the World Health Organization (WHO) standard, highlighting the importance of addressing the associated factors to improve adherence rates and treatment outcomes. The study emphasizes the need for more intensive counselling and regular follow-up, particularly for younger HIV patients, patients during their early stages on medication, ALHIV with treatment interruption, forgetfulness, and those who consume alcohol.