What are the determinants of antiretroviral therapy adherence among people living with HIV? A cross-sectional study in Cambodia

Abstract

Background Understanding context-specific determinants of antiretroviral therapy (ART) adherence is crucial for developing tailored interventions for improving health outcomes and achieving the UNAIDS’ third 95% target. This cross-sectional study explores factors associated with ART adherence among stable people living with HIV on ART in Cambodia. Methods We used baseline cross-sectional survey data from a quasi-experimental study conducted in 2021. The participants were recruited from 20 ART clinics in nine provinces for face-to-face interviews. A structured questionnaire collected information on sociodemographic characteristics, ART adherence, perceived ART self-efficacy, mental health, quality of life, stigma, and discrimination. We conducted a multiple logistic regression analysis using a backward stepwise method. Results Out of the 4101 participants, 86.5% reported being adhered to ART. After adjusting for other variables in the multiple logistic regression model, the odds of non-adherence to ART were significantly higher among participants who were aged 15–29 years (AOR 1.74, 95% CI 1.28–2.35), had elevated cholesterol (AOR 1.61, 95% CI 1.16, 2.23), exhibited poor self-efficacy in health responsibility to maintain life (AOR 1.83, 95% CI 1.51–2.22), experienced higher discrimination (AOR 1.87, 95% CI 1.38–2.54) and internal stigma (AOR 1.39, 95% CI 1.14–1.70), and scored lower than 42 in the mental component of the quality-of-life scale (AOR 1.60, 95% CI 1.28–1.99) than their reference groups. The odds of non-adherence to ART were significantly lower among participants who earned ≤100 USD per month than those who earned > 300 USD per month (AOR 0.49, 95% CI 0.37–0.66). Conclusion The ART adherence rate found in this study is consistent with previous studies in Cambodia. The results suggest the need for public education to reduce stigma and discrimination and strategies to improve the self-efficacy and mental health of people living with HIV. Additional efforts are needed to promote adherence among adolescents and young adults.