Conclusion
depressive, depressive symptoms
This study in a rural community of people with HIV found that PLHIV who were male, had low household income or experienced moderate or severe depressive symptoms were at increased risk of suboptimal adherence and/or virological failure, and may benefit from additional ART adherence support. Sex-specific risk factors that were identified included depressive symptoms in women and food insecurity in men. Task-oriented coping was protective against suboptimal adherence as indicated by pill count. While the rate of self-reported adherence difficulties was high, there was limited overlap between risk factors for non-adherence and virological failure. The high levels of self-reported adherence difficulties would point to a possible self-reporting bias resulting in an over-estimation of bias adherence problems. Our identification of socio-demographic and psychosocial risk factors can guide the targeting of adherence support interventions to rural populations, as well as highlight the factors underlying adherence problems that should be addressed in such interventions. Our findings contribute to the available knowledge on risk factors for adverse outcomes of ART in rural populations and may contribute to the ongoing development of ‘rural proof’ healthcare policies currently being introduced in South Africa, such as National Health Insurance and the new 2030 Human Resources for Health Strategy.