article · AIDS Research and Therapy
Suboptimal adherence to antiretroviral therapy among people living with HIV increases morbidity and mortality, with mental health challenges and alcohol misuse acting as major obstacles. A cross-sectional analytical study conducted in Moshi Municipality, Tanzania, examined 532 participants to evaluate how alcohol use and alcohol use disorders mediate the link between common mental disorders and medication non-adherence. Depression was observed in 14.8 percent of participants, anxiety in 12.4 percent, and treatment non-adherence in 10.7 percent. Depression was linked to poor medication adherence across genders, while anxiety was significantly associated with non-adherence only in men. Alcohol use disorder significantly mediated the relationship between depression and non-adherence, accounting for up to 45.5 percent of the effect. These findings indicate the need to integrate mental health and substance use care into routine HIV treatment services, accounting for gender differences.
Proper adherence to antiretroviral therapy is essential to prevent severe illness and death among people living with HIV. By demonstrating that alcohol use disorders strongly drive the link between psychological distress and missed medication, particularly in men, this research highlights clear targets for integrated healthcare interventions designed to improve long-term treatment outcomes.
The findings can inform the design of integrated clinical care pathways, screening protocols, and psychosocial support programmes for healthcare providers and public health organisations managing HIV services. Because this is observational epidemiological research, it represents an early evidence-gathering stage rather than a commercial product or near-market tool.
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BACKGROUND: Common mental disorders (CMDs) and alcohol use disorder (AUD) are significant barriers to effective antiretroviral therapy (ART) adherence among people living with HIV (PLHIV), especially in sub-Saharan Africa. Suboptimal adherence to ART contributes to increased morbidity and mortality in this population. CMD and AUD frequently co-occur, with alcohol often serving as a maladaptive coping mechanism for psychological distress, thereby compounding the negative impact on treatment outcomes. Understanding the mediating role of AUD in the relationship between CMD and ART adherence is essential for designing targeted interventions aimed at improving HIV treatment success. METHODS: A hospital-based cross-sectional analytical study was conducted between August and October 2023 in Moshi Municipality, Kilimanjaro. A multistage systematic sampling technique was used to recruit participants. Data were collected using structured sociodemographic and interviewer-administered, validated assessment tools. Statistical analyses included one-way ANOVA for continuous variables, chi-square tests for categorical variables, and logistic regression to estimate odds ratios (ORs) with 95% confidence intervals. Mediation analysis was conducted using R version 4.4.2, with significance set at p < 0.05. RESULTS: The study involved 532 participants, with an average age of 46.6 ± 13.3 years; 71.4% were female. The prevalence of depression, anxiety, and ART non-adherence was 14.8%, 12.4%, and 10.7%, respectively. Among men, depression and anxiety were both significantly associated with ART non-adherence in model1 and 2 respectively (depression OR = 5.38, 95% CI: 1.80-16.08; OR = 5.10, 95% CI: 1.55-16.82. Anxiety OR = 5.12, 95% CI: 1.63-16.12; OR = 5.30, 95% CI: 1.48-18.92). Among women, only depression significantly increased ART non-adherence in all models, respectively (OR = 2.50, 95% CI: 1.16-5.36; OR = 2.51, 95% CI: 1.13-5.59; OR = 3.26, 95% CI: 1.34-7.95). Alcohol use disorder significantly mediated the relationship between depression and ART non-adherence more substantially than alcohol use alone, with mediation effects up to 45.5%. CONCLUSION: Depression is significantly associated with ART non-adherence in both genders, and AUD is a key mediator, especially among male participants. These data support the integration of mental health and substance use care into HIV services, with attention to gender-specific risk factors.
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DOI: 10.1186/s12981-025-00818-5
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