Factors Associated with Adherence to Antiretroviral Therapy Among Individuals Living with HIV/AIDS at Chawama Level One Hospital in Lusaka, Zambia: A Cross-Sectional Study
This cross-sectional study of 372 patients at Chawama Level One Hospital in Zambia reveals that ART non-adherence is primarily driven by behavioral factors like forgetfulness and skipping doses when feeling better, as well as relational challenges such as divorce and stigma, rather than structural barriers or side effects.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the fight against HIV, the medicine itself is only half the battle. The other half is the daily, often difficult, act of taking that medicine exactly as prescribed. This practice, known as adherence, is the key that turns a life-saving drug into a shield that keeps the virus dormant and prevents it from spreading to others. When people miss doses, the virus can wake up, multiply, and eventually become resistant to the drugs, rendering the treatment useless. For decades, public health experts have known that keeping patients on track is a complex challenge, influenced not just by the availability of pills, but by the messy realities of human life: relationships, mental health, the fear of being judged by neighbors, and the simple fatigue of managing a chronic condition every single day.
In a densely populated township in Lusaka, Zambia, researchers recently set out to understand exactly what helps or hinders this daily routine. They focused on Chawama Level One Hospital, a facility serving a community where economic struggles and crowded living conditions often make life difficult. The team wanted to move beyond general assumptions and find out what was actually happening inside the minds and lives of the people walking through those clinic doors. They asked a straightforward question: among the many things that could go wrong, which specific factors are truly stopping people from taking their medication?
The study, conducted over ten working days in July 2025, brought together 372 adults living with HIV who had been on treatment for at least six months. The researchers did not rely on medical records or pill counts, which can sometimes be inaccurate. Instead, they sat down with each participant for a private conversation, using a structured questionnaire to ask about their lives, their feelings, and their habits over the past month. They asked about their marriages, their jobs, their fears of being stigmatized, and their interactions with the nurses and doctors who cared for them. They also asked direct questions about whether they had ever forgotten a dose or stopped taking the medicine because they felt better.
The results painted a clear picture of a community where the medicine is available, but the path to taking it is paved with personal and social hurdles. Overall, about 81 percent of the participants were taking their medication correctly. However, nearly one in five people had missed doses recently. When the researchers dug into the reasons why, they found that the biggest obstacles were not the usual suspects like poverty or lack of transport, but rather behaviors and relationships. The most common reason for missing a dose was simply forgetting. The second most common was a dangerous misconception: stopping the medicine when feeling healthy. Many patients believed that if they felt fine, they no longer needed the drugs, not realizing that the medication was the very reason they felt well.
Surprisingly, the study found that traditional markers of hardship, such as having no job, earning very little money, or having less education, did not independently predict who would miss their doses. In this specific setting, where the government provides the medication for free, these structural barriers seemed less critical than the immediate social environment. The only major life event that stood out as a risk factor was divorce or separation. People who were divorced or separated were significantly more likely to miss their medication than those who were single, married, or widowed. The researchers suggest that the loss of a partner often means the loss of a daily reminder, emotional support, and a shared routine, leaving the individual to manage the complex task of treatment alone.
Another powerful finding was the role of the people who work at the clinic. The study showed that patients who felt they had a good, respectful, and supportive relationship with their healthcare workers were far less likely to miss doses. When a doctor or nurse listened well and treated a patient with dignity, it acted as a powerful motivator to stay on track. Conversely, while many patients reported experiencing stigma from their communities or fearing that others would judge them for taking the pills, these fears did not statistically predict non-adherence in the final analysis, even though they were widespread. This suggests that while stigma is a heavy burden, the immediate support of a trusted partner or a caring nurse can sometimes override it.
The researchers also looked at the practical side of the clinic experience. They found that long waiting times and occasional shortages of medicine were common frustrations. Yet, unlike the personal factors, these system issues did not show a strong independent link to missing doses in the data. This does not mean the problems didn't exist; rather, it suggests that when a patient feels supported and understands the importance of the treatment, they are more likely to persevere through long lines or supply hiccups. The study concluded that the most effective way to improve adherence in this community is not just to build better clinics or distribute more pills, but to address the human elements. This means helping patients who have lost their partners find new support systems, correcting the belief that feeling healthy means stopping treatment, and training healthcare workers to build stronger, more trusting connections with the people they serve.
The study serves as a reminder that in the fight against HIV, the science of the drug is only part of the story. The success of the treatment ultimately depends on the daily choices of the people taking it, choices that are deeply influenced by who they love, who they trust, and how they feel about themselves. By focusing on these human connections and correcting simple misunderstandings, health workers can help ensure that the medicine reaches its full potential, keeping individuals healthy and communities safe.
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