Antiretroviral Therapy Adherence in HIV/AIDS Management

Adherence to antiretroviral therapy (ART) is fundamental to achieving and sustaining viral suppression, minimising the risk of drug resistance and reducing HIV transmission. Optimal adherence—often defined as taking at least 95% of prescribed doses—ensures durable immune recovery and prevents virological rebound. Behavioural, structural and clinical determinants interact to shape adherence patterns. Complex regimens and high pill burden can undermine daily consistency, while simple fixed-dose combinations improve convenience. Psychological factors such as self-efficacy, beliefs about treatment necessity and stigma influence patients’ motivation. Socioeconomic challenges including food insecurity, transport costs and unstable housing may create barriers, particularly in resource-limited settings. Digital interventions, habit-formation strategies and conditional incentives have emerged to reinforce pill-taking routines. National monitoring systems employing electronic prescription records enable large-scale assessment of adherence dynamics and identification of at-risk groups. A holistic approach that integrates regimen optimisation, psychosocial support and structural enablers is essential for global HIV/AIDS management.

Research from Nature Portfolio

A nationwide study leveraging health insurance claims data found that approximately 70% of newly diagnosed individuals achieved a medication possession ratio (MPR) of 95% or higher. Factors associated with lower adherence included concurrent prophylactic antibiotic use, extremes of age, female gender, lower socioeconomic status, treatment outside tertiary centres and earlier years of diagnosis. The analysis highlighted both modifiable barriers—such as access to specialised care and financial constraints—and unmodifiable patient characteristics, underscoring the need for sustainable national monitoring systems and targeted adherence support strategies.

Antiretroviral Therapy Adherence in HIV/AIDS Management publication trend

The graph below shows the total number of articles in antiretroviral therapy adherence in hiv/aids management across all publications each year (not limited to Nature Index journals).

Technical terms

Viral suppression: A sustained reduction of HIV RNA in the blood to levels below laboratory detection, indicating effective therapy.

Medication possession ratio (MPR): The proportion of time a patient has medication available over a defined period, used as a proxy for adherence.

Pill burden: The total number of pills a patient must take in a given time frame, affecting regimen simplicity and convenience.

Adherence self-efficacy: A patient’s confidence in their ability to follow the prescribed ART regimen under various circumstances.

References

1. Adherence to antiretroviral therapy and factors affecting low medication adherence among incident HIV-infected individuals during 2009–2016: A nationwide study. Scientific Reports (2018).
2. INcentives and ReMINDers to Improve Long‐Term Medication Adherence (INMIND): impact of a pilot randomized controlled trial in a large HIV clinic in Uganda. Journal of the International AIDS Society (2024).
3. Adherence to antiretroviral therapy and viral suppression: Analysis of three periods between 2011 and 2017 at an HIV-AIDS center, Brazil. Frontiers in Pharmacology (2023).
4. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Medicine (2014).