Factors Associated with Non-Adherence to Antiretroviral Therapy: A Health-Facility-Based Cross-Sectional Study in the Amahlathi Sub-District of the Eastern Cape, South Africa.

INTRODUCTION: The Joint United Nations Programme on HIV and AIDS (UNAIDS) aims for 95% ART adherence to achieve global viral suppression against HIV/AIDS, which is a major health issue worldwide, especially in southern Africa. This study investigated ART non-adherence among adult HIV-positive clients in the Amahlathi sub-district of the Eastern Cape, South Africa. METHODS: A cross-sectional study of 400 HIV/AIDS-positive persons (PLWHA) was undertaken at multiple facilities. A Survey was used to collect data, while medical records were used to ascertain the viral load. Responses were captured on an ordinal adherence scale and triangulated with viral load records from patient files. Univariate, bivariate, and multiple logistic regression analyses were performed to determine factors associated with ART non-adherence, and 95% CIs reported. RESULTS: The ART non-adherence rate was 28%. In the bivariate analysis (odds ratio [OR]), living with children (OR = 2.59), living with parents (OR = 4.12), alcohol use (OR = 2.08), HIV non-disclosure to family (OR = 0.31), non-sharing of HIV status to partner (OR = 0.41), staying with partners (OR = 0.41), taking treatment regimen II (OR = 5.74), taking ART doses twice a day (OR = 4.80), use of traditional medicine (OR = 2.83), and missed dosage (OR = 3.98) were associated with non-ART adherence. Multivariate analysis revealed that young age (<30-40 years) (AOR = 0.95; 95% CI: 0.93-0.98), female sex (AOR = 0.41; 95% CI: 0.21-0.77), partner HIV disclosure (AOR = 0.49; 95% CI: 0.26-0.92), and use of traditional medicine (AOR = 2.45; 95% CI: 1.05-5.68) were independent predictors of ART adherence. CONCLUSION: ART adherence remains below UNAIDS targets in the study area. Tailored interventions that address traditional medicine use, strengthen partner disclosure support, and provide adherence counseling for young adults and men are urgently needed. Future programs could integrate digital adherence monitoring and reminder systems as practical tools to enhance treatment outcomes.