Abstract:
Introduction: Human Immunodeficiency Virus (HIV) infection remains a major global
public health issue. Antiretroviral therapy (ART) has significantly improved the lives of
people living with HIV. However, its effectiveness depends heavily on strict adherence
ideally at levels of 95% or higher. In the current study area, there is limited data on
antiretroviral therapy adherence levels and associated factors among people with HIV.
Objective: This study aimed to assess the level of adherence to antiretroviral therapy and its
associated factors among people living with HIV attending Burao General Hospital,
Somaliland, from January 1st to March 31st, 2025.
Method: A cross-sectional study was conducted among 303 HIV-positive individuals at
Burao General Hospital’s antiretroviral therapy clinic. Data on antiretroviral therapy
adherence, sociodemographics, and related factors were collected using structured
questionnaire through interviews and medical record reviews. Data was entered into Epi
Data 3.1, cleaned, and then, analyzed using STATA 17. Descriptive statistics were
summarized using mean, median, and percentage. Bivariate, and multivariable logistic
regression were used to identify factors associated with antiretroviral therapy adherence.
Statistical significance was declared at p-value <0.05with 95% confidence intervals.
Results: The range: 14–68, with 26–37 years as the median age group; 59.1% were female
and 40.9% male. Overall antiretroviral therapy adherence was 74.9% (95% CI: 70.0%
79.8%). Multivariable analysis showed reduced adherence across several factors. Rural
residents had 88% lower odds of adherence than urban residents (AOR = 0.12). Participants
traveling ≥1 hour were 75% less likely to adhere than those traveling <1 hour (AOR = 0.25).
Medication side effects reduced adherence by 55% (AOR = 0.45). Stigma had the strongest
social effect, reducing adherence by 92% (AOR = 0.08). Detectable viral load showed the
strongest overall association, with individuals 97% less likely to adhere than those with
undetectable viral load (AOR = 0.03).
Conclusion: Antiretroviral therapy adherence in the study population remains poor and
below the UNAIDS global target, posing a serious challenge to achieving optimal treatment
outcomes. Key barriers—such as rural residence, long travel distances, side effects, and
stigma—significantly undermine adherence. Addressing these challenges through targeted,
context-specific interventions is critical to improving treatment outcomes and advancing
national HIV control efforts in Somaliland.
