Published in PLOS One on 2026-05-11, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Victor Luckyboy Dzramado, Obed U. Lasim, Emmanuel Oduro
Source: PLOS One • DOI 10.1371/journal.pone.0344395
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Despite significant advances in antiretroviral therapy (ART) accessibility in Ghana, suboptimal adherence remains a critical challenge undermining treatment effectiveness. This article presents evidence-based policy hypotheses derived from a comprehensive mixed-methods investigation of ART adherence determinants among 2,000 people living with HIV in Ghana#39;s Ashanti Region. We hypothesize that multisectoral policy interventions addressing economic barriers, healthcare system deficiencies, and socio-cultural obstacles will significantly improve adherence rates beyond conventional clinical approaches. Specifically, we propose that: (1) integrated transportation support systems will substantially reduce missed appointments; (2) decentralized medication distribution networks incorporating community-based refill options will improve medication access; (3) restructured clinic operations emphasizing reduced waiting times and privacy protection will enhance engagement; and (4) formalized income protection and nutritional support policies will address critical economic barriers to consistent treatment. These policy hypotheses extend beyond individual-focused interventions to address structural determinants of adherence, offering testable frameworks for evidence-based policy development in resource-limited settings.
1. Introduction
Human Immunodeficiency Virus (HIV) remains a significant public health challenge in Ghana despite substantial improvements in treatment accessibility over the past decade [1]. The introduction of antiretroviral therapy (ART) has transformed HIV/AIDS from a fatal condition to a manageable chronic disease, significantly reducing mortality and improving quality of life for affected individuals [2]. However, the remarkable clinical potential of ART is continuously undermined by suboptimal adherence to treatment regimens [3,4]. Recent data indicates that approximately 354,927 people were living with HIV in Ghana at the end of 2022, yet only 159,344 (46.55%) were consistently engaged with ART [5]. A 2023 systematic review confirmed that the pooled estimate of adherence to ART in Ghana was 70%, substantially below the recommended threshold, with adolescents and young adults demonstrating even lower rates at 66% [6].
The critical importance of ART adherence for achieving viral suppression, preventing drug resistance development, and reducing transmission is well-established in the literature [7,8]. International guidelines consistently recommend adherence levels exceeding 95% to maximize treatment effectiveness and prevent adverse outcomes [9]. However, studies from Ghana and similar settings in sub-Saharan Africa indicate that actual adherence rates frequently fall substantially below this threshold, often ranging between 60–80% [10,11]. Recent facility-based studies in Ghana revealed that adherence rates remain concerningly low, with some settings reporting only 42.9% adherence [12]. A multi-facility study in the Tamale Metropolis found that employment status was the strongest predictor of adherence, underscoring how economic stability fundamentally enables consistent treatment engagement [13]. These findings reflect broader patterns where structural, societal, and healthcare system factors create compounding barriers that extend far beyond individual motivation [14].
Understanding and addressing the complex determinants of ART adherence is essential for developing effective policies that support consistent treatment engagement. While clinical research has extensively documented the biological efficacy of antiretroviral medications, translating this efficacy into real-world effectiveness requires deeper understanding of the behavioral, social, economic, and structural factors that enable or constrain adherence behaviors [15,16]. Research conducted in southern Ghana revealed that gaps in testing, delays in accessing treatment, and retention issues represent acknowledged weaknesses in the HIV prevention-care continuum, with barriers including medication stock-outs, long waiting times, negative staff attitudes, and differential pricing between private and public facilities [17]. Qualitative studies from the Ho Teaching Hospital demonstrated that while trust in medication and satisfaction with provider care facilitate adherence, fear of side effects and social stigma constitute major barriers that policy must address [18].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Victor Luckyboy Dzramado, Obed U. Lasim, Emmanuel Oduro. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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- Evidence brief: Pathways linking internalized HIV stigma to attitudes and beliefs toward ART through depression: Conditional indirect effects of food insecurity
- Evidence brief: Resilient in adversity: Innovative treatment support interventions in facilitating ART adherence among young adults living with HIV in the informal settlements of Kibera, Nairobi
- Evidence brief: Participant perspectives on a person-centred care model for mobile individuals in HIV care from the SEARCH Dynamic Choice Treatment trial in rural Kenya and Uganda
