Poor adherence to second-line antiretroviral therapy and its contributing factors among people living with HIV in Addis Ababa, Ethiopia

Poor adherence to second-line Antiretroviral Therapy (ART) remains a major risk factor for virological failure among people living with HIV (PLHIV), posing a significant public health challenge. In Ethiopia, limited data exists on this issue, prompting a study to assess adherence levels and contributing factors among adults in Addis Ababa, Ethiopia. A concurrent design, both quantitative and qualitative data were collected and analyzed using SPSS v28 and Atlas.ti v24, respectively. Among 369 participants, 16.5% exhibited poor adherence, with varied progress over time. Following up, 89 (24%) of clients had high viral loads, and 34 (38%) of them achieved suppression after undergoing Enhanced Adherence Counseling (EAC). Key factors influencing poor adherence included the presence of opportunistic infections; clients with such conditions were over five times more likely to have poor adherence (5.186 [1.963–13.698], p = 0.001). Additionally, nondisclosure of HIV status was significantly associated with poor adherence (0.507 [95% CI: 0.265–0.971], p = 0.041). In contrast, literacy emerged as a protective factor; individuals with secondary education were 2.5 times more likely to maintain optimal adherence [95% CI: 1.061–5.925], p = 0.036). Supportive evidence was also generated from the qualitative data. While many participants demonstrated good adherence, variability persisted. EAC proved effective in improving viral suppression. The study underscores the importance of targeted interventions that address opportunistic infections, promote HIV status disclosure, and enhance health literacy to improve treatment outcomes.