Impact of multi-level factors and partner characteristics on antiretroviral therapy adherence and access to HIV care during the COVID-19 pandemic

BackgroundAdherence to antiretroviral therapy (ART) remains a challenge for many people with HIV and was exacerbated during the COVID-19 pandemic. This paper examines factors associated with ART adherence among people with HIV who inject drugs (PWHWID) in Almaty, Kazakhstan during the COVID-19 pandemic.MethodsA cross-sectional survey was conducted from October 2020 to August 2022 with 66 PWHWID and their treatment support partners (<i>n</i> = 66) to assess associations between ART adherence and sociodemographic, COVID-19 related, social support, and other factors. Multilevel generalized linear mixed models were used to examine factors associated with optimal (≥90%) and standard (≥80%) adherence levels.ResultsWe found low medication adherence rates: only 55.8% took ≥80% of their doses, and just 14.7% took ≥90%. People were more likely to take their medication consistently if they had a partner with HIV, experienced less household conflict during COVID-19, or met with addiction professionals. Poor mental health and negative emotional impacts from COVID-19 were associated with low adherence.ConclusionThese findings suggest that HIV treatment programs should consider the importance of patients' relationship factors, mental health, and home environment impacts during public health crises.