Determinants of Antiretroviral Therapy Nonadherence among People Living with HIV: A Cross-sectional Study from a Tertiary Care Hospital in Jabalpur, Madhya Pradesh, India

Abstract

Background: Nonadherence to antiretroviral therapy (ART) remains a critical barrier to achieving optimal treatment outcomes among people living with HIV (PLHIV). Understanding multidimensional factors influencing adherence is essential for targeted interventions. Aim and Objective: This study aimed to assess determinants of nonadherence to ART among PLHIV attending a tertiary care hospital in Jabalpur, Madhya Pradesh, India. Materials and Methods: A cross-sectional study was conducted among 1,067 PLHIV aged ≥18 years receiving ART for ≥6 months at a tertiary care hospital in Jabalpur, Madhya Pradesh. Adherence was assessed using the pill count method, with <95% defined as nonadherence. Data on sociodemographic, patient-related, condition-related, therapy-related, and health system-related factors were collected through structured interviews and medical records review. Chi-square tests and odds ratios were calculated to identify significant associations. Results: Nonadherence prevalence was 17.5%. Significant predictors included dissatisfaction with family support (aOR = 38.61), NGO linkage (aOR = 3.82), non-heterosexual transmission routes (aOR = 3.09), current CD4 count <200 cells/mm3 (aOR = 2.90), and age ≤35 years (aOR = 1.51). Conclusion: This study found a 17.5% nonadherence rate among PLHIV on ART in Jabalpur. Younger age, non-heterosexual transmission, poor family support, and low CD4 counts were key predictors. Strengthening social support, addressing stigma, and focusing on vulnerable groups may help improve ART adherence and contribute to progress toward the 95-95-95 targets.