Published in PLOS One on 2026-06-12, 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: Cosmas Zyambo, Paul Somwe, Mwiche Musukuma, Chomba Mandyata, Phoebe Bwembya, Henry Phiri, Malizgani Chavula, Hikabasa Halwindi, Joseph Zulu, Wilbroad Mutale
Source: PLOS One • DOI 10.1371/journal.pone.0345368
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
In order to achieve the 95-95-95 goals and obtain optimal benefits from ART, PLWH must adhere to prescribed medication.
Investigate factors associated with ART adherence in a clinical setting in Zambia.
National cross-sectional study involving 193 clinics across all 10 provinces of Zambia. The primary outcomes assessed were ART adherence status, associated behavioral factors, and clinical characteristics. Logistic regression analysis was conducted to evaluate associations between these factors and ART adherence. Both unadjusted odds ratios (UOR) and adjusted odds ratios (AOR) were calculated, with adjustments made for relevant covariates, and all estimates reported with 95% confidence intervals.
Of the 5,204 PLWH, 7.1% were non-adherent to ART (9.7% males vs 5.9% females). Of those who were non adherent, 60% and 22% consumed alcohol and smoked tobacco respectively. In adjusted analysis, age; 45–59 (AOR: 0.5, 95% CI:0.32–0.79), 60+ (AOR: 0.26, 95% CI: 0.12–0.59) and education; Primary (AOR: 0.6, 95% CI: 0.4–0.9), secondary (AOR: 0.57, 95% CI: 0.4–0.82), college/university (AOR: 0.5, 95% CI: 0.29–0.89) were associated with decreased odds of being non-adherence to ART. In contrast, being male (AOR: 1.45, 95% CI:1.07–1.98), being in informal employment (AOR:1.65, 95% CI:1.15–2.36), having average yearly income; > $160 (AOR: 1.55, 95% CI: 1.16–2.06), Alcohol consumption; healthy consumption (AOR: 2.72, 95% CI: 1.9–3.89), unhealthy consumption (AOR: 2.76, 95% CI: 1.8–4.22), indeterminant consumption (AOR: 3.03, 95% CI: 2.04–4.5) and tobacco smoking (AOR: 95% CI: 2.03 1.42–2.9) were associated with increased odds of being non-adherence to ART.
ART non-adherence among PLWH in Zambia is 7.1%, with higher rates in males. Substance use especially alcohol and tobacco are common among the non-adherent. The associations between alcohol consumption, tobacco smoking, and ART adherence highlight the potential value of targeted support strategies. These results can inform future longitudinal research and contribute to the development of evidence-based interventions
Background
The benefits of antiretroviral therapy (ART) in prolonging life expectancy and improving clinical outcomes of People Living with HIV (PLWH) near to those without HIV are well established [1–3]; however, the increasing risk for the chronic co-morbidities, including cardiovascular diseases [4], depression [5,6], cancer [7] and other cardiometabolic abnormalities such diabetes and lipodystrophy [8,9] might negate the gains achieved so far. The optimal benefits of ART can only be attained when a PLWH is adhering to the prescribed medication [10,11]. Adherence refers to a patient’s ability to follow a treatment plan, take medications at prescribed times and frequencies, and adhere to dietary and medication restrictions [12]. Non-adherence to ART is associated with poor viral suppression, decreased CD4 + count, increased risk of antiretroviral drug resistance, and accelerated disease progression [13–15]. It is, therefore, critical to identify factors that lead to non-adherence and develop strategies to improve long-term adherence.
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 research & evidence 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 Cosmas Zyambo, Paul Somwe, Mwiche Musukuma, Chomba Mandyata, Phoebe Bwembya, Henry Phiri, Malizgani Chavula, Hikabasa Halwindi, Joseph Zulu, Wilbroad Mutale. 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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