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

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 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 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study, 2023 Christophe Nkundabaza, Caroline Stamatakis, Judith Mukamurigo, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4575128/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version 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. Adherence Antiretroviral therapy Adult HIV patients Rwanda Figures Figure 1 Background HIV/AIDS remains a significant global health challenge, affecting millions of individuals worldwide. At the end of 2022, an estimation of people living with HIV(PLWH) were 39 million, two-thirds of whom were in African Region ( 1 ). During the same year, 1.3 million individuals acquired new infections, and 630,000 people died from HIV-related causes ( 1 ). The advent of antiretroviral therapy (ART) has transformed the management of HIV, leading to improved life expectancy and quality of life for those living with the virus ( 2 ). ART not only enhances the quality of life for individuals living with HIV, but also plays a pivotal role in reducing viral load, preventing disease progression, and decreasing the risk of transmission ( 3 ). However, the effectiveness of ART relies heavily on strict adherence to prescribed medication ( 4 ). Non-adherence to ART, defined as the failure to consistently take medications as prescribed by healthcare providers ( 5 ), is a critical concern in the management of HIV ( 6 ). .The World Health Organization (WHO) standard necessitates near-perfect adherence rates (as high as 95%) for all patients initiated on ART ( 6 ). Non-adherence can result in treatment failure, increased viral load, drug resistance, and the progression of HIV to more advanced stages, ultimately jeopardizing the health and well-being of HIV-positive individuals ( 6 ). Since 2016, Rwanda has implemented different strategies to enhance adherence to ART, accelerate United Nations Programme on HIV/AIDS (UNAIDS) targets and achieve the 95% targets by 2030. These include “treat all” and a differentiated service delivery model (DSDM)( 7 ). With this strategy, all HIV patients are linked immediately to ART regardless of disease progression, with more focused services towards higher-risk unstable patients (new patients < 12 months on ART,HIV infected with mental disorder or malnutrition, children < 2 years, pregnant and lactating women, patients with no viral suppression and patients on 3rd line), and a reduction in the frequency of routine clinical visits and drug pickups for stable patients ( 8 ). Under DSDM, stable patients attend clinical visits every six months and pick up drugs quarterly, while unstable patients have monthly drug pickups and quarterly clinical visits combined with community support services ( 8 ). Despite the implementation of these strategies, a gap in achieving epidemic control still exists in viral load suppression among adult HIV patients, with only 90% of those on ART achieving suppression, and a difference of 10% of adult HIV patients with unsuppressed HIV viral loads ( 9 ). Normally, viral load suppression among PLWH goes along with good adherence to ART medication ( 10 ). Adult living with HIV(ALHIV) account for the majority of ART clients in Rwanda, and this age category is particularly at risk of HIV-related complications due to early sexual activity, and early marriage,( 11 ). Nyamasheke district has approximately 8,042 ALHIV on ART, representing 3.80% of ALHIV nationally (almost 210,200 adult HIV-infected patients according to the Rwanda population-based HIV impact assessment of 2019)( 9 ). However, there is no information available regarding their level of non-adherence and the associated factors. Therefore, this study aims to assess the level of non-adherence to ART and its associated factors among ALHIV in Nyamasheke district. Methods Study design and setting A cross-sectional, health facility-based study was conducted to assess the level of non-adherence to ART and its associated factors among ALHIV who were under treatment in September 2022. The study was conducted in 22 health facilities, including one provincial hospital, one district hospital, and 20 health centers located in Nyamasheke district, in the Western province of Rwanda. The district is home to approximately 8,042 ALHIV, out of a total population of 476,653. It is situated near Lake Kivu and is bordered by Rusizi district to the south, Karongi district to the north, Nyamagabe district to the east, and the Democratic Republic of Congo (DRC) to the west. Study population The study targeted ALHIV who were receiving ART medication in selected health facilities. Inclusion criteria were patients aged 15 years and above, residing in Nyamasheke district, and receiving HIV treatment at any of the selected health facilities, on ART for at least six months at the time of data collection, had records of adherence for their last clinical visit, and who were able to communicate with data collectors. Sampling Using 49% as the proportion of non-adherent patients to the program as determined in a preceding study conducted in Ethiopia ( 12 ), the margin of error of 5%, and a 95% confidence interval, the sample size was estimated to be 384 patients. An estimated 10% non-response rate was added for selected participants who might refuse to participate (384 * 0.1 = 38.4), resulting in a final sample size of 422 after adjustment for non-response. Probability proportional to size (PPS) sampling technique was used to calculate the sample size for each health facility. The health facility ratio was calculated by dividing the number of ART adult patients in a particular facility by the total number of ALHIV in all selected health facilities. A sample size for each facility was then calculated by multiplying the total sample size by the obtained ratio. A systematic random sampling method was employed to select patients from each health facility. Patient files were assigned numeric labels, and a starting point and sampling interval were determined based on the required sample size at each health facility. Random numbers for selected files were generated using an Excel sheet. All patients whose files were selected were invited to participate in face-to-face interviews to gather additional information that not found in their health facility-based files. Data collection methods and tools A structured questionnaire with closed-ended questions, customized from previous conducted studies, was used to collect data ( 12 , 13 ). Data collection was paper-based and performed by trained nurses. Both the review of medical records and interviews were used to collect data from all consenting clients. Data on socio-demographic and clinical characteristics were retrieved from patients’ files, while additional information related to psychosocial factors or any missing information in files were obtained through interviews. Study variables The dependent variable was the adherence status to ART (adherent or non-adherent). Adherence was calculated as a proportion of doses taken (doses taken defined as missing ≤ 3 pills per prescribed dose) to doses prescribed over the previous month. Patients with a percentage of ≥ 95% were classified as adherent, and patients with a percentage of < 95% were classified as non-adherent. The socio-demographic independent variables included the age in years, presented into three categories: 15–24 years old (young adult), 25–49 years old (adult), 50 years old and above (elderly); sex categorized as male or female; marital status classified as single, married, widow or other (divorced, cohabited and separated); educational status categorized as not educated, attended primary level or secondary level, or university level; occupation categorized as farmer, student, and public or private servant; Ubudehe category (wealth categories, in Kinyarwanda ( 14 ) ) graded as 1, 2, 3 and 4 (where 4 consisted of households with the highest income); religions categorized as no religion, catholic, protestant or other, and distance to reach health facility categorized as 0 to 2 kilometres (km) and > 2km. Clinical characteristics included the current ART regimen (first line or second line); baseline WHO clinical staging for HIV ranked from I up to IV; Body Mass Index (BMI) classified as underweight (BMI < 18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25–29.9) or obese (BMI ≥ 30); duration on ART categorized as < 5 years or ≥ 5 years; treatment interruption defined as a failure of patient to respond to expected clinical contact for 28 days since the last expected contact (yes or no); co-infections which included taking anti-TB drugs (yes or no), diabetes mellitus (yes or no); physical disability (yes or no); opportunistic infections (yes or no) and recent viral load status categorized as below 200 cp/ml or ≥ 200 cp/ml. Psychosocial characteristics included forgetfulness, referred to as the ability of not recalling the schedule of taking ART drugs (yes or no); alcohol consumption stated as someone who certainly drinks alcohol (yes or no); smoking defined as someone one who smokes in his/her daily life (yes or no); getting family support which refers to the ability of family members to provide both nutritional, and psychological support to the patient (yes or no); HIV status disclosure to family members (yes or no), and number of pills per day ranked from 0 to 2 and > 2. Data management and analysis Data collected were entered in a computer and aggregated using Microsoft Excel. After assessing the completeness and consistency of collected data, the dataset was imported into Stata 16.0 (StataCorp. 2019) for further cleaning and analysis. A review of recorded data was performed, and possible typing errors were corrected using the initial recording on the data collection form. All records were considered for analysis, as no missing data were found in the dataset. Descriptive statistics for all the study variables such as median, interquartile range, proportions, and frequencies were presented using tables and graphs. As bivariate analysis, binary logistic regression models were plotted to examine the association between each independent variable and non-adherence to ART. All statistically significant variables from the bivariate analysis were considered for multivariable logistic regression to determine associated factors of non-adherence to ART. Odds ratios (OR), a confidence interval (CI) of 95%, and a p-value were reported; and our results were significant at a 95% confidence level. Results Description of the study participants A total of 422 participants were recruited in the study, and 416 consented to respond to the study questions (98.60%). The median age of the participants was 48 years (16–92 years). Approximately half (49.52%) of the participants were aged between 25 and 49 years. The majority of participants were female (61.78%), married (58.65%), had attended primary education (73.56%), were farmers (93.03%), in socioeconomic category (Ubudehe) one (59.38%), and Catholic as religion affiliates (37.74%). Approximately half (52.88%) lived in more than two Kilometers away from the health facility where they received medication (Table 1 ). Table 1 Socio-demographic characteristics of adult HIV patients who were on ART in Nyamasheke district, Rwanda, September 2023 . Variables Adherence status to ART Total n = 416 (%) COR 95%C. I P Value Non adherent, n(%) Adherent, n (%) Age_group 15–24 years 9(29.03) 23(5.97) 32(7.69) 9.55 (3.24–28.13) < 0.001 25–49 years 15(48.39) 191(49.61) 206(49.52) 1.91 (0.76–4.81) 0.16 50 + Years 7(22.58) 171(44.42) 178(42.79) 1 Sex Female 16(51.61) 241(62.6) 257(61.78) 0.63 (0.3–1.32) 0.23 Male 15(48.39) 144(37.4) 159(38.22) 1 Marital status Single 11(35.48) 60(15.58) 71(17.07) 3.85 (0.46–31.64) 0.21 Married 16(51.61) 228(59.23) 244(58.65) 1.47 (0.18–11.66) 0.71 Widow 3(9.68) 76(19.74) 79(18.99) 0.82 (0.08–8.38) 0.87 Other 1(3.23) 21(5.45) 22(5.29) 1 Education Not educated 5(16.13) 83(21.56) 88(21.15) 0.2 (0.05–0.078) 0.02 Primary 21(67.74) 285(74.03) 306(73.56) 0.25 (0.08–0.74) 0.01 Secondary or University 5(16.13) 17(4.42) 22(5.29) 1 Occupation Student 3(9.68) 8(2.08) 11(2.64) 1.87 (0.3–11.52) 0.49 Farmer 25(80.65) 362(94.03) 387(93.03) 0.34 (0.09–1.27) 0.11 Public or private servant 3(9.68) 15(3.9) 18(4.33) 1 Ubudehe Category Cat 1 18(58.06) 229(59.48) 247(59.38) 0.53 (0.21–1.36) 0.19 Cat 2 6(19.35) 108(28.05) 114(27.40) 0.38 (0.12–1.19) 0.09 Cat 3 7(22.58) 48(12.47) 55(13.22) 1 Religions None 1(3.23) 24(6.23) 25(6.01) 0.67 (0.07–6.06) 0.72 Catholic 9(29.03) 148(38.44) 157(37.74) 0.98 (0.31–3.03) 0.97 Protestant 16(51.61) 132(34.29) 148(35.58) 1.96 (0.69–5.56) 0.2 Other 5(16.13) 81(21.04) 86(20.67) 1 Distance to HF >2 km 19(61.29) 201(52.21) 220(52.88) 1.44 (0.68–3.06) 0.33 0–2 km 12(38.71) 184(47.79) 196(47.12) 1 Note : COR = crude odds ratio, 95%CI = 95% confidence interval Regarding clinical and psychosocial characteristics, out of 416 participants, 95.19% were on the first line of ART treatment, 76.20% were in WHO clinical stage I, while 90.14% had been on ART treatment for 5 years or more. The majority (90.14%) fell into the stable category of the DSDM, and 98.32% had recent viral loads below 200 cp/ml. Most participants (93.51%) reported occasionally forgetting to take their medications and approximately, 40.14% acknowledged drinking alcohol. Nearly all participants (95.67%) reported receiving support from their family members, while 3.37% reported smoking. Nearly all participants (98.32%) took two or fewer pills per day (Table 2 ). Table 2 Clinical and psychosocial characteristics of adult HIV patients who were on ART in Nyamasheke district, Rwanda, September 2023 Variables Adherence status to ART Total n = 416(%) COR 95%C. I P Value Non-adherent n (%) Adherent, n (%) ART Regimen First line 30(96.77) 366(95.06) 396(95.19) 1.56 (0.2–12.03) 0.67 Second line 1(3.23) 19(4.94) 20(4.81) 1 WHO HIV stage I 24(77.42) 293(76.1) 317(76.20) 0.24 (0.02–2.45) 0.23 II 3(9.68) 47(12.21) 50(12.02) 0.19 (0.02–2.44) 0.2 III 3(9.68) 42(10.91) 45(10.82) 0.21 (0.02–2.73) 0.23 IV 1(3.23) 3(0.78) 4(0.96) 1 Duration on ART < 5years 10(32.26) 31(8.05) 41(9.86) 5.43 (2.35–12.56) < 0.001 5 + years 21(67.74) 354(91.95) 375(90.14) 1 0.56 Treatment interruption Yes 12(38.71) 29(7.53) 41(9.86) 7.75 (3.42–17.53) < 0.001 No 19(61.29) 356(92.47) 375(90.14) 1 Last Viral Load Results ≥ 200 cp/ml 1(3.23) 6(1.56) 7(1.68) 2.1 (0.24–18.06) 0.49 Below 200 cp/ml 30(96.77) 379(98.44) 409(98.32) 1 Forgetfulness Yes 7(22.58) 20(5.19) 27(6.49) 5.32 (2.04–13.82) 0.001 No 24(77.42) 365(94.81) 389(93.51) 1 Drinks alcohol Yes 22(70.97) 145(37.66) 167(40.14) 4.04 (1.81–9.02) 0.001 No 9(29.03) 240(62.34) 249(59.86) 1 Smokes Yes 3(9.68) 11(2.86) 14(3.37) 3.64 (0.96–13.81) 0.06 No 28(90.32) 374(97.14) 402(96.63) 1 Has family support Yes 29(95.55) 369(95.84) 398(95.67) 0.62 (0.13–2.86) 0.54 No 2(6.45) 16(4.16) 18(4.33) 1 Number of pills per day > 2 pills per day 1(3.23) 6(1.56) 7(1.68) 2.1 (0.24–18.06) 0.49 ≤2 pills per day 30(96.77) 379(98.32) 409(98.32) 1 Note : COR = crude odds ratio, 95%CI = 95% confidence interval As the prevalence of non-adherence to ART, 92.50% of ALHIV in Nyamasheke district had adherence levels greater than or equal to 95% and were considered adherent to ART in the past month, and non-adherence (< 95%) (Fig. 1 ). Factors associated with non-adherence to ART among ALHIV in Nyamasheke district The bivariate analysis assessed the association between socio-demographic, clinical, and psychosocial characteristics of ALHIV in Nyamasheke district and non-adherence to ART through a binary logistic regression model. The age category of 15–24 years, being on ART for less than 5 years, treatment interruption, forgetfulness, and alcohol consumption were reported with higher odds of non-adherence to ART among ALHIV in Nyamasheke district (Tables 1 and 2 ). From the multivariate logistic regression, patients aged 15–24 years had 4.83 times higher odds of non-adherence to ART compared to those aged 50 years and above (adjusted odds ratio [AOR]: 4.83, 95% CI: 1.28–18.16). Patients who were on ART for less than five years had 2.91 times higher odds of non-adherence to ART compared to patients on ART for five years and more (AOR: 2.91, 95% CI: 1.02–8.28). ALHIV with treatment interruption had 4.72 times higher odds of non-adherence to ART compared to stable patients (AOR: 4.72, 95% CI: 1.72–12.94). Patients who were drinking alcohol had 4.53 times higher odds of non-adherence to their medication compared to those who were not (AOR: 4.53, 95% CI: 1.81–11.34), and those who forgot to take their medication had 4.16 times higher odds of non-adherence to ART compared to those who did not forget (AOR: 4.16, 95% CI: 1.20–14.42) (Table 3 ). Table 3 Multivariable analysis of the factors associated with non-adherence to ART among ALHIV in Nyamasheke district, Rwanda, September 2023 Variables AOR 95% C. I P. Value Age_group 15–24 years 4.83 (1.28–18.16) 0.02 25–49 years NA 50 + Years 1 Education level Not educated 0.41 (0.75–2.26) 0.309 Primary 0.24 (0.09–1.37) 0.134 Secondary or University 1 Duration on ART < 5years 2.91 (1.02–8.28) 0.04 5 + years 1 Treatment interruption Yes 4.72 (1.72–12.94) 0.003 No 1 Drink alcohol? Yes 4.53 (1.81–11.34) 0.001 No 1 Forgetfulness? Yes 4.16 (1.2–14.42) 0.02 No 1 Note : AOR = Adjusted Odds Ratio Discussion The study found that 7.50% of patients had adherence level below the 95% adherence target. This non-adherence level is lower compared to findings from two recent studies conducted in Ethiopia ( 8 , 15 ) and the central China ( 16 ). This study found a strong association between non-adherence to ART and the category of patients aged 15–24 years, followed by forgetfulness, alcohol drinking, ALHIV with treatment interruption, and a shorter duration on ART. The odds of non-adherence to ART among HIV patients aged between 15–24 years were 4.83 times higher compared to those aged 50 years and above. This corroborates with studies conducted in Ethiopia ( 17 ), and Haiti ( 18 ), which suggest that adherence levels increase as patients age beyond 25 years. Older patients may have better compliance with the regimen due to their familiarity with routines, maturity, and discipline. Therefore, targeting appropriate interventions toward young adult is essential. The study also found that the odds of non-adherence among ALHIV who were on ART for less than five years were near three times higher than for those on ART for five years and above. The significant association between duration on ART, as determined in this study, is consistent with previous studies in Malawi, Haiti and Nepal ( 18 – 20 ), which emphasize that patients are more likely to be non-adherent at their early period of infection. Previous studies highlighted that this may be due to increased occurrence of opportunistic infections in early months of taking ART( 6 ), however, this was not the same in our study. The reason of non-adherence to ART among patients in our study could be due to the concern of stigma and failure to adapt quickly with life change. In contrast to our study, a study conducted in the United States showed that patients who were on ART for five years and more were more likely to be non-adherent as compared to those who were on ART for less than five years( 21 ). This difference between findings may be due the cultural differences and differences in health care infrastructure. Therefore, more intensive counselling and regular follow-up may better support HIV patients during their early stages of their medication regimen. The finding of this study revealed that non-adherence was associated with forgetting to take prescribed medication. The odds of non-adherence among ALHIV who forgot to take their medication was more than four times higher than those who did not. This finding is consistent with several studies conducted elsewhere ( 5 , 22 – 24 ), including Rwanda, where a study identified forgetfulness as one of the major causes of non-adherence ( 13 ). Patients often attributed forgetting to take their medications to the absence of someone to remind them about the drugs, and some linked forgetfulness to alcohol consumption ( 5 ). Hence interventions addressing this type of non-adherence may need to focus on providing reminders to patients to take their medications and supporting patients to make intake of medications part of their daily routine. Our study found that the odds of non-adherence among adult HIV-infected people who drink alcohol was more than four times higher than those who do not. This is consistent with several studies, including a systematic review and meta-analysis conducted in Sub-Saharan Africa ( 25 ). Indeed, alcohol consumption is a common problem among PLWH ( 26 ), and research suggests that HIV-infected individuals, mostly men, may use alcohol to cope with the stress of being HIV-positive ( 27 ). Alcohol consumption contributes to non-adherence to ART, as it is disruptive to dose timing, not adhering to clinical and counselling advice, and interfering with normal social life ( 28 ). Also, excessive alcohol consumption can cause liver damage, and increase enzymes which leads to a shorter than expected drug half-life ( 29 ). The association between alcohol consumption and ART non-adherence underscores the need to prioritize alcohol counselling as priority of ART services to help HIV-infected patients to adhere to their medications, for longer and healthier lives. This study also found that patients with treatment interruption had more than 4 times higher odds of non-adherence to ART than patients who did not. This finding is in line with a study conducted in Nigeria which revealed that patients who had treatment interruption are more likely to have poor adherence than patients who did not have ART interruption ( 30 ). In most studies, this interruption was attributed to the fact that patients want to have a break from treatment regimens due to treatment fatigue ( 31 , 32 ). In this study, the association between non-adherence and treatment interruption may be attributed to duration on ART and distance to health facility as more than 70% of patients who had treatment interruption were on ART for more than 5 years and live in the distance of 2 km and above from the health facility. However, further investigation is warranted to find the tangible cause of non-adherence to ART in these patients as they receive more frequent clinical and counselling advice during their initiation to ART. Limitations of the Study Our study employed a combination of primary and secondary data collection methods to assess adherence to ART. Adherence was determined based on pill count data from the previous month, which may introduce recall bias among participants. To mitigate this potential bias, participants were provided with comprehensive information about the study's significance and the importance of providing accurate data. Data collection was conducted by trained healthcare professionals who received adequate training on the data collection process, ensuring the reliability and accuracy of the collected information. Furthermore, the generalizability of the study findings is limited to Nyamasheke district. However, our findings align with other studies conducted in Rwanda and elsewhere, suggesting similarities and potential applicability of the results to similar settings. Of course, it also represents limitations related to its cross-sectional design; especially the lack of causal relationship establishment. Conclusion Our study revealed a low level of adherence to ART compared to the standard set by the WHO, which necessitates an adherence rate of at least 95% for all patients initiated on ART. Several factors were found to be significantly associated with non-adherence to ART, including being 15–24 years of age, having a shorter duration of ART treatment, being classified among ALHIV with treatment interruption, forgetting to take drugs, and engaging in alcohol consumption. Countries can consider these factors to strengthen counseling sessions, and while implementing tailored interventions to enhance adherence rates, ultimately improving treatment outcomes for ALHIV. Abbreviations AIDS Acquired Immunodeficiency Syndrome ART Anti-retroviral therapy BMI Body mass index CD4 Cluster of differentiation 4 CMHS College of Medicine and Health Sciences DSDM Differentiated Service Delivered Model HIV Human Immunodeficiency Virus IRB Institution Review Board PLWH People living with HIV ALHIV Adult living with HIV RPHIA Rwanda Population-based HIV Impact Assessment TB Tuberculosis UNAIDS United Nations against HIV and AIDS UR University of Rwanda WHO World Health Organization Declarations Ethics approval and consent to participate This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy § . The study was approved by the Institutional Review Board (IRB) of the College of Medicine and Health Sciences (CMHS) with the ethical approval reference number CMHS/IRB/125/2023. Informed consenting was obtained from participants prior to data collection. Consent forms were signed by participants before data collection. Participation was voluntary and interviews were conducted in comfortable and private locations. To ensure the confidentiality of research data, personal identifiers (names, tracnet or national identification number) were not collected. Data collected were kept in a secure place before aggregation, and once merged, they were stored in a computer with restricted access. §See e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq. Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due the fact that they contain very sensitive information like HIV status, address of the patients and their treatment history, but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Authors of the current study assert that they received no financial support for the research, authorship and/or publication of this study. Authors' contributions NC conceived the study idea, collected data, analyzed them, and drafted the manuscript. CS and JM contributed to the results interpretation and discussion, reviewed the manuscript. AN supervised this study and supported the study design, results interpretation and reviewed the manuscript. All authors read and approved the final manuscript. Acknowledgments Authors thank the University of Rwanda, College of Medical and Health Sciences for its ethical review Process, the Ministry of Health/Rwanda Biomedical Center for the financial support. They also thank supervisors, mentors, data collectors and Nyamasheke district leadership as well as health facilities for their contributions throughout this work. Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the funding agencies. This study has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC). References Unated Nations. AIDS program. People living with HIV accessing antiretroviral therapy. Global HIV & AIDS statistics 2023. https://www.unaids.org/en/resources/fact-sheet . 2023. Iacob SA, Iacob DG, Jugulete G. Improving the Adherence to Antiretroviral Therapy, a Difficult but Essential Task for a Successful HIV Treatment — Clinical Points of View and Practical Considerations. Front Pharmacol. 2017;8(11):1–12. Dube M, Stein J, Aberg J. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. NIH. 2022;13(1):1–334. https://www.ncbi.nlm.nih.gov/books/NBK586306/ . Baryakova TH, Pogostin BH, Langer R, McHugh KJ. Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. 2023;22(5):387–409. https://doi.org/10.1038/s41573-023-00670-0 . Lantche MW, Fokam J, Jocelyne A, Cheudjui N, Brice J, Tchatchueng M et al. Factors associated with non-adherence to antiretroviral therapy among adolescents aged 15–19 years: a snapshot from the Mother and Child Center in Yaounde, Cameroon.PAMJ. 2021;1:13. 10.11604/pamj.2021.39.154.27623 . Bongfen MC, Torpey K, Ganle J, Ankomah A. Level of adherence and associated factors among HIV-positive adolescents on antiretroviral therapy in Northern Ethiopia.Retrospective Analysis. Afr J AIDS Res. 2020;19(4):269–75. Rwanda Ministry of Health R. Taking Differentiated Service Delivery to Scale in Rwanda: Annual DSD Implementation Updates. 2020;1(11):1. https://cquin.icap.columbia.edu/wp-content/uploads/2022/11/Rwanda_MOH-Updates_Poster_Final_Final_for-printing.pdf . Zewude SB, Ajebe TM. Magnitude of optimal adherence and predictors for a low level of adherence among HIV/AIDS-infected adults in South Gondar zone, Northwest Ethiopia: a multifacility cross-sectional study. BMJ Open. 2022;12(1):1–7. PHIA P. Rwanda Population-based HIV Impact Assessment 2018–2019. Rwanda Public Health Bulletin. 2020;(9):232. https://phia.icap.columbia.edu/rwanda-final-report/ . Tale AH, Tegegne AS, Belay DB. Predictors of Viral Load and Medication Adherence Among HIV-Positive Adults Under Treatment at Felege-Hiwot Comprehensive Specialized Hospital, North-West, Ethiopia. HIV/AIDS -. Res Palliat Care. 2023;15(July):477–89. Rwanda Ministry of Health R. National HIV and Viral Hepatitis annual report,2020–2021. rwanda Biomed Cent [Internet].:62. https://medium.com/@arifwicaksanaa/pengertian-use-case-a7e576e1b6bf . Nigusso FT, Mavhandu-Mudzusi AH. Magnitude of non-adherence to antiretroviral therapy and associated factors among adult people living with HIV/AIDS in Benishangul-Gumuz Regional State, Ethiopia. PeerJ. 2020;8:20. Habumugisha E, Nyishimirente S, Katende G, Nkurunziza A, Mukeshimana M, Ngerageze I, et al. Factors Influencing Adherence to Antiretroviral Therapy (ART) among Adolescents Living with Human Immunodeficiency virus (HIV) in Rwanda. Rwanda J Med Heal Sci. 2022;5(3):251–63. RGB. The assessment of the impact of home grown initiatives.Rwanda Governance Board. 2014;IV(11):186. https://www.rgb.rw/publications/reports-assessments/hgs-assessment . Angelo AT, Alemayehu DS. Adherence and its associated factors among adult hiv-infected patients on antiretroviral therapy in South Western Ethiopia, 2020. Patient Prefer Adherence. 2021;15:299–308. Yu Y, Luo D, Chen X, Huang Z, Wang M, Xiao S. Medication adherence to antiretroviral therapy among newly treated people living with HIV. BMC Public Health. 2018;1–8. Tolossa T, Wakuma B, Mulisa D, Besho M, Tsegaye R, Tigistu M et al. ART Adherence Among People Living with HIV Seeking Services from Public Health Facilities in Western Ethiopia. HIV/AIDS - Res Palliat Care. 2021;13(9):1149–58. Dorcélus L, Bernard J, Georgery C, Vanessa C. Factors associated with antiretroviral therapy adherence among people living with HIV in Haiti: a cross-sectional study. AIDS Res Ther [Internet]. 2021;18(1):1–9. https://doi.org/10.1186/s12981-021-00405-4 . Neupane S, Dhungana GP, Ghimire HC. Adherence to antiretroviral treatment and associated factors among people living with HIV and AIDS in CHITWAN, Nepal. BMC Public Health. 2019;19(1):1–9. Bvumbwe M, Mhango J, Justice E, a. K. Factors associated with antiretroviral therapy adherence among adolescents living with HIV in the era of isoniazid preventive therapy as part of HIV care. PLOS Glob Public Heal. 2022;2(6):e0000418. Kyser M, Buchacz K, Bush TJ, Conley LJ, Hammer J, Henry K, et al. Factors associated with non-adherence to antiretroviral therapy in the SUN study. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2011;23(5):601–11. Chirambo L, Valeta M, Banda Kamanga TM, Nyondo-Mipando AL. Factors influencing adherence to antiretroviral treatment among adults accessing care from private health facilities in Malawi. BMC Public Health. 2019;19(1382):1–11. https://doi.org/10.1186/s12889-019-7768-z . 2019;1–11. Usman SA, Shehu A, Ajumobi O, Gidado S, Dalhatu I, Balogun M et al. Predictors of non-adherence to antiretroviral therapy among HIV patients in secondary health care facilities in Kano State- Nigeria: a case-control study. 2019;32(Supp 1):3):1–4. Aye WL, Puckpinyo A, Peltzer K. Non-adherence to anti-retroviral therapy among HIV infected adults in Mon State of Myanmar. BMC Public Health. 2017;17(1):1–10. Velloza J, Kemp CG, Aunon FM, Ramaiya MK, Creegan E, Simoni JM. Alcohol Use and Antiretroviral Therapy Non-Adherence Among Adults Living with HIV/AIDS in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. AIDS Behav. 2020;24(6):1727–42. Mekuriaw B, Belayneh Z, Molla A, Mehare T. Alcohol use and its determinants among adults living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis. Harm Reduct J [Internet]. 2021;18(1):1–12. https://doi.org/10.1186/s12954-021-00503-6 . Heestermans T, Browne JL, Aitken SC, Vervoort SC, Klipstein-Grobusch K. Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: A systematic review. BMJ Glob Heal. 2016;1(4):1–13. Adrawa N, Alege JB, Izudi J. Alcohol consumption increases nonadherence to ART among people living with HIV enrolled to the community-based care model in rural northern Uganda. PLoS One [Internet]. 2020;15(11 November):1–12. http://dx.doi.org/10.1371/journal.pone.0242801 . Donohue TM, Kharbanda KK, Osna NA. Alcoholic Liver Disease: Pathogenesis and Current Management. Alcohol Res Curr Rev. 2017;38(2):147–61. Tomescu S, Crompton T, Adebayo J, Kinge CW, Akpan F, Rennick M et al. Factors associated with an interruption in treatment of people living with HIV in USAID-supported states in Nigeria: a retrospective study from 2000–2020. BMC Public Health [Internet]. 2021;21(1):1–8. https://doi.org/10.1186/s12889-021-12264-9 . Bukenya D, Mayanja BN, Nakamanya S, Muhumuza R, Seeley J. What causes non-adherence among some individuals on long term antiretroviral therapy? Experiences of individuals with poor viral suppression in Uganda. AIDS Res Ther [Internet]. 2019;16(1):1–9. https://doi.org/10.1186/s12981-018-0214-y . Ma J, Jin Y, Jiao K, Wang Y, Gao L, Li X et al. Antiretroviral treatment interruption and resumption within 16 weeks among HIV-positive adults in Jinan, China: a retrospective cohort study. Front Public Heal. 2023;11. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4575128","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":315006125,"identity":"01e06b72-262d-4039-a4c0-3d47d70d78d7","order_by":0,"name":"Christophe Nkundabaza","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYDACHjA+AGIyPgCx+UjRwmwAYrORooVNAkwS0mHOc8bswZuaO/Ly7YefVX7NsZNhY2B++OgGHi2WvT3mhnOOPTNs7Ekzuy27LRnoMDZj4xw8WgzO85hJ87AdZmxmyGG7LbmNGaiFh02asJZ/h+3b+N+wFUtuqydCy9keM2netsOJPRI5bIwftx0mQsuZY2WSc/ueJc+QeGYszbjtOA8bMyG/nEneJvHm2x3b+f3JDz/+3FZtz8/e/PAxPi0ogJkHTBKrHAQYf5CiehSMglEwCkYMAACRu0TmF9v1zwAAAABJRU5ErkJggg==","orcid":"","institution":"University of Rwanda","correspondingAuthor":true,"prefix":"","firstName":"Christophe","middleName":"","lastName":"Nkundabaza","suffix":""},{"id":315006128,"identity":"29a5b0c2-a5a1-4684-876f-826cbe3d2d87","order_by":1,"name":"Caroline Stamatakis","email":"","orcid":"","institution":"US Centers for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Caroline","middleName":"","lastName":"Stamatakis","suffix":""},{"id":315006129,"identity":"67826284-9767-4570-9f7c-c4cd76a3de8a","order_by":2,"name":"Judith Mukamurigo","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Judith","middleName":"","lastName":"Mukamurigo","suffix":""},{"id":315006132,"identity":"98c46052-d8d9-46c1-adcd-47307cebd39d","order_by":3,"name":"Albert Ndagijimana","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Albert","middleName":"","lastName":"Ndagijimana","suffix":""}],"badges":[],"createdAt":"2024-06-13 09:33:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4575128/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4575128/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60199160,"identity":"5e47b510-7e31-40d1-bb7e-4c9b09b3194d","added_by":"auto","created_at":"2024-07-13 02:18:50","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":111901,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLevel of non-adherence among ALPHIV in Nyamasheke district, Rwanda, September-2023\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"FIGURE11.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4575128/v1/7c0db8e1172dafa9355c2b5d.jpeg"},{"id":72249320,"identity":"63ec4166-beff-411d-a9fb-238c8ddcf40b","added_by":"auto","created_at":"2024-12-24 08:16:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1021639,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4575128/v1/5505c93d-da89-426f-8cb5-8756261a00a0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"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","fulltext":[{"header":"Background","content":"\u003cp\u003eHIV/AIDS remains a significant global health challenge, affecting millions of individuals worldwide. At the end of 2022, an estimation of people living with HIV(PLWH) were 39\u0026nbsp;million, two-thirds of whom were in African Region (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). During the same year, 1.3\u0026nbsp;million individuals acquired new infections, and 630,000 people died from HIV-related causes (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The advent of antiretroviral therapy (ART) has transformed the management of HIV, leading to improved life expectancy and quality of life for those living with the virus (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). ART not only enhances the quality of life for individuals living with HIV, but also plays a pivotal role in reducing viral load, preventing disease progression, and decreasing the risk of transmission (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). However, the effectiveness of ART relies heavily on strict adherence to prescribed medication (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNon-adherence to ART, defined as the failure to consistently take medications as prescribed by healthcare providers (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), is a critical concern in the management of HIV (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). .The World Health Organization (WHO) standard necessitates near-perfect adherence rates (as high as 95%) for all patients initiated on ART (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Non-adherence can result in treatment failure, increased viral load, drug resistance, and the progression of HIV to more advanced stages, ultimately jeopardizing the health and well-being of HIV-positive individuals (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince 2016, Rwanda has implemented different strategies to enhance adherence to ART, accelerate United Nations Programme on HIV/AIDS (UNAIDS) targets and achieve the 95% targets by 2030. These include \u0026ldquo;treat all\u0026rdquo; and a differentiated service delivery model (DSDM)(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). With this strategy, all HIV patients are linked immediately to ART regardless of disease progression, with more focused services towards higher-risk unstable patients (new patients\u0026thinsp;\u0026lt;\u0026thinsp;12 months on ART,HIV infected with mental disorder or malnutrition, children\u0026thinsp;\u0026lt;\u0026thinsp;2 years, pregnant and lactating women, patients with no viral suppression and patients on 3rd line), and a reduction in the frequency of routine clinical visits and drug pickups for stable patients (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Under DSDM, stable patients attend clinical visits every six months and pick up drugs quarterly, while unstable patients have monthly drug pickups and quarterly clinical visits combined with community support services (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the implementation of these strategies, a gap in achieving epidemic control still exists in viral load suppression among adult HIV patients, with only 90% of those on ART achieving suppression, and a difference of 10% of adult HIV patients with unsuppressed HIV viral loads (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Normally, viral load suppression among PLWH goes along with good adherence to ART medication (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Adult living with HIV(ALHIV) account for the majority of ART clients in Rwanda, and this age category is particularly at risk of HIV-related complications due to early sexual activity, and early marriage,(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNyamasheke district has approximately 8,042 ALHIV on ART, representing 3.80% of ALHIV nationally (almost 210,200 adult HIV-infected patients according to the Rwanda population-based HIV impact assessment of 2019)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, there is no information available regarding their level of non-adherence and the associated factors. Therefore, this study aims to assess the level of non-adherence to ART and its associated factors among ALHIV in Nyamasheke district.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eA cross-sectional, health facility-based study was conducted to assess the level of non-adherence to ART and its associated factors among ALHIV who were under treatment in September 2022. The study was conducted in 22 health facilities, including one provincial hospital, one district hospital, and 20 health centers located in Nyamasheke district, in the Western province of Rwanda. The district is home to approximately 8,042 ALHIV, out of a total population of 476,653. It is situated near Lake Kivu and is bordered by Rusizi district to the south, Karongi district to the north, Nyamagabe district to the east, and the Democratic Republic of Congo (DRC) to the west.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThe study targeted ALHIV who were receiving ART medication in selected health facilities. Inclusion criteria were patients aged 15 years and above, residing in Nyamasheke district, and receiving HIV treatment at any of the selected health facilities, on ART for at least six months at the time of data collection, had records of adherence for their last clinical visit, and who were able to communicate with data collectors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSampling\u003c/h2\u003e \u003cp\u003eUsing 49% as the proportion of non-adherent patients to the program as determined in a preceding study conducted in Ethiopia (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), the margin of error of 5%, and a 95% confidence interval, the sample size was estimated to be 384 patients. An estimated 10% non-response rate was added for selected participants who might refuse to participate (384 * 0.1\u0026thinsp;=\u0026thinsp;38.4), resulting in a final sample size of 422 after adjustment for non-response.\u003c/p\u003e \u003cp\u003eProbability proportional to size (PPS) sampling technique was used to calculate the sample size for each health facility. The health facility ratio was calculated by dividing the number of ART adult patients in a particular facility by the total number of ALHIV in all selected health facilities. A sample size for each facility was then calculated by multiplying the total sample size by the obtained ratio. A systematic random sampling method was employed to select patients from each health facility. Patient files were assigned numeric labels, and a starting point and sampling interval were determined based on the required sample size at each health facility. Random numbers for selected files were generated using an Excel sheet. All patients whose files were selected were invited to participate in face-to-face interviews to gather additional information that not found in their health facility-based files.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData collection methods and tools\u003c/h2\u003e \u003cp\u003eA structured questionnaire with closed-ended questions, customized from previous conducted studies, was used to collect data (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Data collection was paper-based and performed by trained nurses. Both the review of medical records and interviews were used to collect data from all consenting clients. Data on socio-demographic and clinical characteristics were retrieved from patients\u0026rsquo; files, while additional information related to psychosocial factors or any missing information in files were obtained through interviews.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables\u003c/h2\u003e \u003cp\u003eThe dependent variable was the adherence status to ART (adherent or non-adherent). Adherence was calculated as a proportion of doses taken (doses taken defined as missing\u0026thinsp;\u0026le;\u0026thinsp;3 pills per prescribed dose) to doses prescribed over the previous month. Patients with a percentage of \u0026ge;\u0026thinsp;95% were classified as adherent, and patients with a percentage of \u0026lt;\u0026thinsp;95% were classified as non-adherent.\u003c/p\u003e \u003cp\u003eThe socio-demographic independent variables included the age in years, presented into three categories: 15\u0026ndash;24 years old (young adult), 25\u0026ndash;49 years old (adult), 50 years old and above (elderly); sex categorized as male or female; marital status classified as single, married, widow or other (divorced, cohabited and separated); educational status categorized as not educated, attended primary level or secondary level, or university level; occupation categorized as farmer, student, and public or private servant; Ubudehe category (wealth categories, in Kinyarwanda (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003cb\u003e)\u003c/b\u003e graded as 1, 2, 3 and 4 (where 4 consisted of households with the highest income); religions categorized as no religion, catholic, protestant or other, and distance to reach health facility categorized as 0 to 2 kilometres (km) and \u0026gt;\u0026thinsp;2km.\u003c/p\u003e \u003cp\u003eClinical characteristics included the current ART regimen (first line or second line); baseline WHO clinical staging for HIV ranked from I up to IV; Body Mass Index (BMI) classified as underweight (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5), normal weight (BMI 18.5\u0026ndash;24.9), overweight (BMI 25\u0026ndash;29.9) or obese (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30); duration on ART categorized as \u0026lt; 5 years or \u0026ge;\u0026thinsp;5 years; treatment interruption defined as a failure of patient to respond to expected clinical contact for 28 days since the last expected contact (yes or no); co-infections which included taking anti-TB drugs (yes or no), diabetes mellitus (yes or no); physical disability (yes or no); opportunistic infections (yes or no) and recent viral load status categorized as below 200 cp/ml or \u0026ge;\u0026thinsp;200 cp/ml.\u003c/p\u003e \u003cp\u003ePsychosocial characteristics included forgetfulness, referred to as the ability of not recalling the schedule of taking ART drugs (yes or no); alcohol consumption stated as someone who certainly drinks alcohol (yes or no); smoking defined as someone one who smokes in his/her daily life (yes or no); getting family support which refers to the ability of family members to provide both nutritional, and psychological support to the patient (yes or no); HIV status disclosure to family members (yes or no), and number of pills per day ranked from 0 to 2 and \u0026gt;\u0026thinsp;2.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData management and analysis\u003c/h2\u003e \u003cp\u003eData collected were entered in a computer and aggregated using Microsoft Excel. After assessing the completeness and consistency of collected data, the dataset was imported into Stata 16.0 (StataCorp. 2019) for further cleaning and analysis. A review of recorded data was performed, and possible typing errors were corrected using the initial recording on the data collection form. All records were considered for analysis, as no missing data were found in the dataset. Descriptive statistics for all the study variables such as median, interquartile range, proportions, and frequencies were presented using tables and graphs. As bivariate analysis, binary logistic regression models were plotted to examine the association between each independent variable and non-adherence to ART. All statistically significant variables from the bivariate analysis were considered for multivariable logistic regression to determine associated factors of non-adherence to ART. Odds ratios (OR), a confidence interval (CI) of 95%, and a p-value were reported; and our results were significant at a 95% confidence level.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDescription of the study participants\u003c/h2\u003e \u003cp\u003eA total of 422 participants were recruited in the study, and 416 consented to respond to the study questions (98.60%). The median age of the participants was 48 years (16\u0026ndash;92 years). Approximately half (49.52%) of the participants were aged between 25 and 49 years. The majority of participants were female (61.78%), married (58.65%), had attended primary education (73.56%), were farmers (93.03%), in socioeconomic category (Ubudehe) one (59.38%), and Catholic as religion affiliates (37.74%). Approximately half (52.88%) lived in more than two Kilometers away from the health facility where they received medication (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eSocio-demographic characteristics of adult HIV patients who were on ART in Nyamasheke district, Rwanda, September 2023\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdherence status to ART\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal n\u0026thinsp;=\u0026thinsp;416 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%C. I\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon adherent,\u003c/p\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdherent,\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge_group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(29.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23(5.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32(7.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(3.24\u0026ndash;28.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;49 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15(48.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e191(49.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e206(49.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.76\u0026ndash;4.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026thinsp;+\u0026thinsp;Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(22.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e171(44.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e178(42.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16(51.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e241(62.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e257(61.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.3\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15(48.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144(37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e159(38.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11(35.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60(15.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71(17.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.46\u0026ndash;31.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16(51.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e228(59.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e244(58.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.18\u0026ndash;11.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(9.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76(19.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79(18.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.08\u0026ndash;8.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(3.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(5.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22(5.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot educated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(16.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83(21.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88(21.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.05\u0026ndash;0.078)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(67.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e285(74.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e306(73.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.08\u0026ndash;0.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary or University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(16.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17(4.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22(5.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(9.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11(2.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.3\u0026ndash;11.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25(80.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e362(94.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e387(93.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.09\u0026ndash;1.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic or private servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(9.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18(4.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUbudehe Category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCat 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18(58.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e229(59.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e247(59.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.21\u0026ndash;1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCat 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6(19.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108(28.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e114(27.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.12\u0026ndash;1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCat 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(22.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48(12.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55(13.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(3.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24(6.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25(6.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.07\u0026ndash;6.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(29.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e148(38.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e157(37.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.31\u0026ndash;3.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16(51.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e132(34.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e148(35.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.69\u0026ndash;5.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(16.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81(21.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e86(20.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistance to HF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;2 km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19(61.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e201(52.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e220(52.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.68\u0026ndash;3.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;2 km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(38.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e184(47.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e196(47.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eNote\u003c/b\u003e: COR\u0026thinsp;=\u0026thinsp;crude odds ratio,\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e95%CI\u0026thinsp;=\u0026thinsp;95% confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding clinical and psychosocial characteristics, out of 416 participants, 95.19% were on the first line of ART treatment, 76.20% were in WHO clinical stage I, while 90.14% had been on ART treatment for 5 years or more. The majority (90.14%) fell into the stable category of the DSDM, and 98.32% had recent viral loads below 200 cp/ml. Most participants (93.51%) reported occasionally forgetting to take their medications and approximately, 40.14% acknowledged drinking alcohol. Nearly all participants (95.67%) reported receiving support from their family members, while 3.37% reported smoking. Nearly all participants (98.32%) took two or fewer pills per day (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical and psychosocial characteristics of adult HIV patients who were on ART in Nyamasheke district, Rwanda, September 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdherence status to ART\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;416(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%C. I\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-adherent\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdherent, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART Regimen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst line\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30(96.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e366(95.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e396(95.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.2\u0026ndash;12.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond line\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(3.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19(4.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20(4.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWHO HIV stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24(77.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e293(76.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e317(76.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.02\u0026ndash;2.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(9.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47(12.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50(12.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.02\u0026ndash;2.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(9.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42(10.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45(10.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.02\u0026ndash;2.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(3.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(0.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration on ART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 5years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10(32.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31(8.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41(9.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(2.35\u0026ndash;12.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(67.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e354(91.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e375(90.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment interruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(38.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(7.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41(9.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(3.42\u0026ndash;17.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19(61.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e356(92.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e375(90.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLast Viral Load Results\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge; 200 cp/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(3.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(1.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7(1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.24\u0026ndash;18.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelow 200 cp/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30(96.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e379(98.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e409(98.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForgetfulness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(22.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(5.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27(6.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(2.04\u0026ndash;13.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24(77.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e365(94.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e389(93.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinks alcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22(70.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e145(37.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e167(40.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(1.81\u0026ndash;9.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(29.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e240(62.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e249(59.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmokes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(9.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(2.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14(3.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.96\u0026ndash;13.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28(90.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e374(97.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e402(96.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas family support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29(95.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e369(95.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e398(95.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.13\u0026ndash;2.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(6.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(4.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18(4.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of pills per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 2 pills per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(3.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(1.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7(1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.24\u0026ndash;18.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;2 pills per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30(96.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e379(98.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e409(98.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eNote\u003c/b\u003e: COR\u0026thinsp;=\u0026thinsp;crude odds ratio,\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e95%CI\u0026thinsp;=\u0026thinsp;95% confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs the prevalence of non-adherence to ART, 92.50% of ALHIV in Nyamasheke district had adherence levels greater than or equal to 95% and were considered adherent to ART in the past month, and non-adherence (\u0026lt;\u0026thinsp;95%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with non-adherence to ART among ALHIV in Nyamasheke district\u003c/h2\u003e \u003cp\u003eThe bivariate analysis assessed the association between socio-demographic, clinical, and psychosocial characteristics of ALHIV in Nyamasheke district and non-adherence to ART through a binary logistic regression model. The age category of 15\u0026ndash;24 years, being on ART for less than 5 years, treatment interruption, forgetfulness, and alcohol consumption were reported with higher odds of non-adherence to ART among ALHIV in Nyamasheke district (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrom the multivariate logistic regression, patients aged 15\u0026ndash;24 years had 4.83 times higher odds of non-adherence to ART compared to those aged 50 years and above (adjusted odds ratio [AOR]: 4.83, 95% CI: 1.28\u0026ndash;18.16). Patients who were on ART for less than five years had 2.91 times higher odds of non-adherence to ART compared to patients on ART for five years and more (AOR: 2.91, 95% CI: 1.02\u0026ndash;8.28). ALHIV with treatment interruption had 4.72 times higher odds of non-adherence to ART compared to stable patients (AOR: 4.72, 95% CI: 1.72\u0026ndash;12.94). Patients who were drinking alcohol had 4.53 times higher odds of non-adherence to their medication compared to those who were not (AOR: 4.53, 95% CI: 1.81\u0026ndash;11.34), and those who forgot to take their medication had 4.16 times higher odds of non-adherence to ART compared to those who did not forget (AOR: 4.16, 95% CI: 1.20\u0026ndash;14.42) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable analysis of the factors associated with non-adherence to ART among ALHIV in Nyamasheke district, Rwanda, September 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% C. I\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP. Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge_group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(1.28\u0026ndash;18.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;49 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026thinsp;+\u0026thinsp;Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot educated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.75\u0026ndash;2.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.309\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.09\u0026ndash;1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary or University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration on ART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(1.02\u0026ndash;8.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment interruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(1.72\u0026ndash;12.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrink alcohol?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(1.81\u0026ndash;11.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForgetfulness?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(1.2\u0026ndash;14.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eNote\u003c/b\u003e: AOR\u0026thinsp;=\u0026thinsp;Adjusted Odds Ratio\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study found that 7.50% of patients had adherence level below the 95% adherence target. This non-adherence level is lower compared to findings from two recent studies conducted in Ethiopia (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and the central China (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study found a strong association between non-adherence to ART and the category of patients aged 15\u0026ndash;24 years, followed by forgetfulness, alcohol drinking, ALHIV with treatment interruption, and a shorter duration on ART.\u003c/p\u003e \u003cp\u003eThe odds of non-adherence to ART among HIV patients aged between 15\u0026ndash;24 years were 4.83 times higher compared to those aged 50 years and above. This corroborates with studies conducted in Ethiopia (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and Haiti (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), which suggest that adherence levels increase as patients age beyond 25 years. Older patients may have better compliance with the regimen due to their familiarity with routines, maturity, and discipline. Therefore, targeting appropriate interventions toward young adult is essential.\u003c/p\u003e \u003cp\u003eThe study also found that the odds of non-adherence among ALHIV who were on ART for less than five years were near three times higher than for those on ART for five years and above. The significant association between duration on ART, as determined in this study, is consistent with previous studies in Malawi, Haiti and Nepal (\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), which emphasize that patients are more likely to be non-adherent at their early period of infection. Previous studies highlighted that this may be due to increased occurrence of opportunistic infections in early months of taking ART(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), however, this was not the same in our study. The reason of non-adherence to ART among patients in our study could be due to the concern of stigma and failure to adapt quickly with life change. In contrast to our study, a study conducted in the United States showed that patients who were on ART for five years and more were more likely to be non-adherent as compared to those who were on ART for less than five years(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This difference between findings may be due the cultural differences and differences in health care infrastructure. Therefore, more intensive counselling and regular follow-up may better support HIV patients during their early stages of their medication regimen.\u003c/p\u003e \u003cp\u003eThe finding of this study revealed that non-adherence was associated with forgetting to take prescribed medication. The odds of non-adherence among ALHIV who forgot to take their medication was more than four times higher than those who did not. This finding is consistent with several studies conducted elsewhere (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), including Rwanda, where a study identified forgetfulness as one of the major causes of non-adherence (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Patients often attributed forgetting to take their medications to the absence of someone to remind them about the drugs, and some linked forgetfulness to alcohol consumption (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Hence interventions addressing this type of non-adherence may need to focus on providing reminders to patients to take their medications and supporting patients to make intake of medications part of their daily routine.\u003c/p\u003e \u003cp\u003eOur study found that the odds of non-adherence among adult HIV-infected people who drink alcohol was more than four times higher than those who do not. This is consistent with several studies, including a systematic review and meta-analysis conducted in Sub-Saharan Africa (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Indeed, alcohol consumption is a common problem among PLWH (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), and research suggests that HIV-infected individuals, mostly men, may use alcohol to cope with the stress of being HIV-positive (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Alcohol consumption contributes to non-adherence to ART, as it is disruptive to dose timing, not adhering to clinical and counselling advice, and interfering with normal social life (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Also, excessive alcohol consumption can cause liver damage, and increase enzymes which leads to a shorter than expected drug half-life (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The association between alcohol consumption and ART non-adherence underscores the need to prioritize alcohol counselling as priority of ART services to help HIV-infected patients to adhere to their medications, for longer and healthier lives.\u003c/p\u003e \u003cp\u003eThis study also found that patients with treatment interruption had more than 4 times higher odds of non-adherence to ART than patients who did not. This finding is in line with a study conducted in Nigeria which revealed that patients who had treatment interruption are more likely to have poor adherence than patients who did not have ART interruption (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In most studies, this interruption was attributed to the fact that patients want to have a break from treatment regimens due to treatment fatigue (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). In this study, the association between non-adherence and treatment interruption may be attributed to duration on ART and distance to health facility as more than 70% of patients who had treatment interruption were on ART for more than 5 years and live in the distance of 2 km and above from the health facility. However, further investigation is warranted to find the tangible cause of non-adherence to ART in these patients as they receive more frequent clinical and counselling advice during their initiation to ART.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the Study\u003c/h2\u003e \u003cp\u003eOur study employed a combination of primary and secondary data collection methods to assess adherence to ART. Adherence was determined based on pill count data from the previous month, which may introduce recall bias among participants. To mitigate this potential bias, participants were provided with comprehensive information about the study's significance and the importance of providing accurate data. Data collection was conducted by trained healthcare professionals who received adequate training on the data collection process, ensuring the reliability and accuracy of the collected information. Furthermore, the generalizability of the study findings is limited to Nyamasheke district. However, our findings align with other studies conducted in Rwanda and elsewhere, suggesting similarities and potential applicability of the results to similar settings. Of course, it also represents limitations related to its cross-sectional design; especially the lack of causal relationship establishment.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study revealed a low level of adherence to ART compared to the standard set by the WHO, which necessitates an adherence rate of at least 95% for all patients initiated on ART. Several factors were found to be significantly associated with non-adherence to ART, including being 15\u0026ndash;24 years of age, having a shorter duration of ART treatment, being classified among ALHIV with treatment interruption, forgetting to take drugs, and engaging in alcohol consumption. Countries can consider these factors to strengthen counseling sessions, and while implementing tailored interventions to enhance adherence rates, ultimately improving treatment outcomes for ALHIV.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAIDS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcquired Immunodeficiency Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eART\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnti-retroviral therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCD4\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCluster of differentiation 4\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCMHS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCollege of Medicine and Health Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDSDM\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDifferentiated Service Delivered Model\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHIV\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIRB\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitution Review Board\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePLWH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePeople living with HIV\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eALHIV\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdult living with HIV\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eRPHIA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRwanda Population-based HIV Impact Assessment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eTB\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTuberculosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUNAIDS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited Nations against HIV and AIDS\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUniversity of Rwanda\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eWHO\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch4\u003eEthics approval and consent to participate\u003c/h4\u003e\n\u003cp\u003eThis activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy\u003csup\u003e\u0026sect;\u003c/sup\u003e. The study was approved by the Institutional Review Board (IRB) of the\u0026nbsp;College of Medicine and Health Sciences (CMHS) with the ethical approval reference number CMHS/IRB/125/2023. Informed consenting was obtained from participants prior to data collection. Consent\u0026nbsp;forms were\u0026nbsp;signed by participants before data collection.\u0026nbsp;Participation\u0026nbsp;was voluntary and\u0026nbsp;interviews were\u0026nbsp;conducted in comfortable and private\u0026nbsp;locations. To ensure the confidentiality of research data, personal identifiers (names, tracnet or national identification number) were not collected.\u0026nbsp;Data collected were kept in a secure place before aggregation,\u0026nbsp;and once merged, they were stored in a computer with restricted access.\u003c/p\u003e\n\u003cp\u003e\u0026sect;See e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. \u0026sect;241(d); 5 U.S.C. \u0026sect;552a; 44 U.S.C. \u0026sect;3501 et seq.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due the fact that they contain very sensitive information like HIV status, address of the patients and their treatment history, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch4\u003eCompeting interests\u003c/h4\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch4\u003eFunding\u003c/h4\u003e\n\u003cp\u003eAuthors of the current study assert that they received no financial support for the research, authorship and/or publication of this study.\u003c/p\u003e\n\u003ch4\u003eAuthors\u0026apos; contributions\u003c/h4\u003e\n\u003cp\u003eNC conceived the study idea, collected data, analyzed them, and drafted the manuscript.\u0026nbsp;CS and JM contributed to the results interpretation and discussion, reviewed the manuscript. AN\u0026nbsp;supervised this study and supported the study design, results interpretation and reviewed the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAuthors thank the University of Rwanda, College of Medical and Health Sciences\u0026nbsp;for its ethical review Process, the Ministry of Health/Rwanda Biomedical Center for the financial support. They also thank supervisors, mentors, data collectors and Nyamasheke district leadership as well as health facilities for their contributions throughout this work.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDisclaimer\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the funding agencies. This study has been supported by the President\u0026rsquo;s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUnated Nations. AIDS program. People living with HIV accessing antiretroviral therapy. Global HIV \u0026amp; AIDS statistics 2023.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unaids.org/en/resources/fact-sheet\u003c/span\u003e\u003cspan address=\"https://www.unaids.org/en/resources/fact-sheet\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIacob SA, Iacob DG, Jugulete G. Improving the Adherence to Antiretroviral Therapy, a Difficult but Essential Task for a Successful HIV Treatment \u0026mdash; Clinical Points of View and Practical Considerations. 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BMC Public Health. 2019;19(1382):1\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-019-7768-z\u003c/span\u003e\u003cspan address=\"10.1186/s12889-019-7768-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2019;1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUsman SA, Shehu A, Ajumobi O, Gidado S, Dalhatu I, Balogun M et al. Predictors of non-adherence to antiretroviral therapy among HIV patients in secondary health care facilities in Kano State- Nigeria: a case-control study. 2019;32(Supp 1):3):1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAye WL, Puckpinyo A, Peltzer K. Non-adherence to anti-retroviral therapy among HIV infected adults in Mon State of Myanmar. BMC Public Health. 2017;17(1):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVelloza J, Kemp CG, Aunon FM, Ramaiya MK, Creegan E, Simoni JM. Alcohol Use and Antiretroviral Therapy Non-Adherence Among Adults Living with HIV/AIDS in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. AIDS Behav. 2020;24(6):1727\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMekuriaw B, Belayneh Z, Molla A, Mehare T. Alcohol use and its determinants among adults living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis. 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AIDS Res Ther [Internet]. 2019;16(1):1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12981-018-0214-y\u003c/span\u003e\u003cspan address=\"10.1186/s12981-018-0214-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa J, Jin Y, Jiao K, Wang Y, Gao L, Li X et al. Antiretroviral treatment interruption and resumption within 16 weeks among HIV-positive adults in Jinan, China: a retrospective cohort study. Front Public Heal. 2023;11.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adherence, Antiretroviral therapy, Adult HIV patients, Rwanda","lastPublishedDoi":"10.21203/rs.3.rs-4575128/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4575128/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAntiretroviral 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 416 participants, 92.50% had past-month ART adherence level of 95% or higher. The following factors; age of 15\u0026ndash;24 years (adjusted odds ratio [AOR]: 5.76, 95% CI: 1.68\u0026ndash;19.73), shorter duration on ART (\u0026lt;\u0026thinsp;5 years) (AOR: 3.10, 95% CI: 1.11\u0026ndash; 8.68), those who had treatment interruption (AOR: 4.08, 95% CI: 1.54\u0026ndash;10.83), alcohol consumption (AOR: 4.42, 95% CI: 1.79\u0026ndash;10.9), and forgetfulness (AOR: 4.53, 95% CI: 1.34\u0026ndash;15.22) were significantly associated with non-adherence among ALHIV in Nyamasheke district.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e","manuscriptTitle":"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","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-13 02:18:45","doi":"10.21203/rs.3.rs-4575128/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b5bb5ba-c843-44e9-8172-eb5f4c0f05ec","owner":[],"postedDate":"July 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-24T08:08:48+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-13 02:18:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4575128","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4575128","identity":"rs-4575128","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}