Factors Associated with Antiretroviral Therapy Adherence and HIV-Related Stigma among People Living with HIV at a Tertiary Care Centre: A Cross-sectional Study

Background: Antiretroviral therapy (ART) has significantly improved the survival and quality of life of people living with HIV (PLHIV). However, sustained treatment success depends on optimal medication adherence, which may be influenced by several sociodemographic, clinical, and psychosocial factors, including HIV-related stigma. This study assessed ART adherence, HIV-related stigma, and factors associated with adherence among PLHIV attending a tertiary care centre.

Methods: A hospital-based cross-sectional study was conducted among 320 PLHIV receiving ART at a tertiary care centre between August and October 2022. Data were collected using a structured questionnaire. ART adherence was assessed using the Medication Adherence Rating Scale (MARS), while HIV-related stigma was measured using the 12-item HIV Stigma Scale. Descriptive statistics were used to summarize the data. Associations between categorical variables were analysed using the Chi-square test, mean differences were compared using analysis of variance (ANOVA), and correlations between adherence and stigma scores were assessed using Pearson's correlation coefficient.

Results: Of the 320 participants, 268 (83.8%) were adherent to ART according to the MARS scoring system. ART-related adverse effects (p = 0.030), health status before ART initiation (p = 0.014), and health status following ART initiation (p = 0.016) were significantly associated with adherence. Participants experiencing higher levels of personalised stigma and negative self-image demonstrated significantly lower adherence scores. Although disclosure concerns and concerns regarding public attitudes contributed substantially to overall stigma, these domains were not significantly correlated with adherence.

Conclusions: ART adherence was high among the study population; however, HIV-related stigma and treatment-related factors remained important barriers to optimal adherence. Interventions focusing on stigma reduction, early identification and management of treatment-related adverse effects, and individualized adherence counselling may further improve long-term treatment outcomes among PLHIV