Modeling antiretroviral therapy adherence among people living with HIV: a cross-sectional study at Pantang Hospital,...

Poor adherence to antiretroviral therapy (ART) continues to undermine HIV treatment outcomes in sub-Saharan Africa, including Ghana.

This study aimed to quantify ART treatment adherence among people living with HIV (PLHIV) at Pantang Hospital in Ghana.

This study took place from July to October 2025 among people living with HIV who receive care at Pantang Hospital in Accra, Ghana. Using random sampling, data were collected from 151 participants through interviewer-administered questionnaires assessing sociodemographic characteristics and ART adherence behaviors. A hold-back validation method was used to split the final dataset, allocating 80% to training and 20% to validation. Six machine learning models were applied to identify and rank key adherence predictors, and model performance was compared.

In all, 151 participants were recruited. Participants had a median age of 42 years; 75.5% were female, and 39.7% were older than 45 years. Most participants were Christian (88.7%), lived in peri-urban areas (70.9%), and were self-employed (72.2%). Non-adherence behaviors were common: 66.9% reported forgetting to take medication, 64.2% reported carelessness, and 85.4% reported stopping medication when feeling worse. Among the six models, Elastic Net regression demonstrated the best overall performance. The strongest predictors of non-adherence were not taking medication over the past weekend (utility estimate 0.3471, 95% confidence interval 0.2292-0.4650) and missing medication 6-10 times in the past week (utility estimate 0.2693, 95% confidence interval 0.1538-0.3848).

The study showed poor adherence to ART among this cohort of PLHIV which increases the risk of community-level transmission. This study provides quantitative data to help develop effective interventions to address poor adherence to improve health outcomes of PLHIV.