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

Neuenschwander P. Norcini Pala A. Altice F.L. Remien R.H. Mergenova G. Rozental E. Gulyayev V. Davis A.
June 2025 SAGE Publications Ltd

International Journal of STD and AIDS
2025 #36 Issue 7 568 - 576 pp.

Background: Adherence 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. Methods: A cross-sectional survey was conducted from October 2020 to August 2022 with 66 PWHWID and their treatment support partners (n = 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. Results: We 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. Conclusion: These findings suggest that HIV treatment programs should consider the importance of patients’ relationship factors, mental health, and home environment impacts during public health crises.

adherence , antiretroviral therapy , COVID-19 , HIV , Kazakhstan , people who inject drugs

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School of Public Health, State University of New York-Downstate Health Science University, Brooklyn, NY, United States
Section of Infectious Diseases, Department of Medicine, Yale University, New Haven, CT, United States
Division of Gender, Sexuality & Health, HIV Center, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, United States
Global Health Research Center of Central Asia, Almaty, Kazakhstan
School of Social Work, Columbia University, New York, NY, United States

School of Public Health
Section of Infectious Diseases
Division of Gender
Global Health Research Center of Central Asia
School of Social Work

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