Abstract: Background: Antiretroviral therapy (ART) adherence is the cornerstone of effective HIV management; suboptimal adherence undermines viral suppression, increases transmission risk, and accelerates disease progression. Rwanda reports a 3% adult HIV prevalence, yet determinants of non-adherence at facility level, particularly in western district hospitals, remain insufficiently characterized. This study determined the prevalence and multidimensional determinants of antiretroviral drug (ARD) non-adherence among people living with HIV (PLHIV) at Kirinda District Hospital, Karongi District, Rwanda.
Methods: A cross-sectional analytical mixed-methods study was conducted among 196 adult PLHIV on ART for at least six months at Kirinda District Hospital. Participants were selected through a finite-population-adjusted sample size (Fisher formula). Data were collected via structured questionnaires and five focus group discussions (n=42). Quantitative analysis used IBM SPSS v28; bivariate chi-square and multivariate logistic regression (95% CI; p<0.05) identified independent predictors of non-adherence. Qualitative data were analyzed thematically using NVivo.
Results: The overall non-adherence prevalence was 23.0% (n=45). Among non-adherent participants, 72.4% reported missing doses at least weekly; principal self-reported barriers were HIV-related stigma (16.3%), fear of status disclosure (13.3%), and drug side effects (12.8%). Knowledge gaps were prominent: 27.6% were unaware of ARV effectiveness and 41.3% did not know the risks of non-adherence. Social support was inadequate, with 51.6% uncomfortable discussing HIV status with family. Multivariate analysis identified six independent predictors of non-adherence: widowhood (aOR=2.82, 95% CI: 1.39–12.88, p=0.043), no formal education (aOR=2.61, 95% CI: 2.37–17.24, p=0.002), less than one year on ART (aOR=0.42, 95% CI: 0.05–1.68, p=0.024), experiencing drug side effects (aOR=2.56, 95% CI: 2.30–19.86, p=0.012), lacking knowledge of non-adherence consequences (aOR=2.12, 95% CI: 1.50–8.56, p=0.012), and absence of reminder tools (aOR=1.92, 95% CI: 2.92–20.67, p=0.041). Qualitative findings corroborated these determinants, revealing four major thematic domains: biomedical challenges and side-effect burden, structural and stigma-related barriers, sociocultural dynamics, and treatment literacy gaps.
Conclusion: Non-adherence at Kirinda District Hospital is driven by intersecting biomedical, structural, sociocultural, and knowledge-related determinants. Effective responses require multilevel, patient-centered interventions including enhanced side-effect management, targeted psychosocial support for widowed PLHIV, culturally adapted treatment literacy programmes, universal reminder-tool provision, and strengthened community stigma-reduction initiatives.
Keywords: antiretroviral therapy; ART adherence; non-adherence; PLHIV; HIV; Rwanda; stigma; treatment literacy; mixed methods; district hospital.
Title: Prevalence of non-adherence to antiretroviral therapy among people living with HIV and mitigation used to control in Kirinda District Hospital
Author: Donatien Mbonyintwari, Emile Sebera, Leonisse Uwajeneza, Jerome Mfitumukiza, Larissa Mukire, Jean Damascene Dusabimana, Daniel Ukwishatse, Thierry Patrick Ishimwe, Denyse Umuhoza, Maurice Silari
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
Vol. 14, Issue 1, April 2026 - September 2026
Page No: 464-475
Research Publish Journals
Website: www.researchpublish.com
Published Date: 09-July-2026
