Determinants associated with non-adherence to antiretroviral therapy (ART) and viral load suppression in PLHIV in Meta, Colombia

Background Although antiretroviral therapy (ART) coverage has increased, significant gaps in adherence and viral suppression persist, particularly in vulnerable settings such as Meta (Colombia), where armed conflict and barriers to healthcare access exacerbate the epidemic. This study examined sociodemographic and clinical factors associated with ART adherence and viral suppression in this population. Methods An analytical cross-sectional study was conducted with 155 people living with HIV. The Simplified Medication Adherence Questionnaire was applied, and clinical data were extracted from medical records. Associations were analyzed using bivariate and multivariable logistic regression. Results Among participants, 73 (47.1%) were non-adherent to ART and 31 (20%) did not achieve viral suppression. Both non-adherence and viral non-suppression were associated with demographic, behavioral, clinical, and ART-related aspects. In the multivariable analysis, ART side effects [odds ratios (OR) = 0.360; P = .015] and PAS use (OR = 11.375; P = .032) were predictors of non-adherence. Likewise, participation in sex work (OR = 4.334; P = .029) and lack of dietary modifications (OR = 3.176; P = .046) predicted viral non-suppression. Conclusions Targeted interventions addressing both clinical and psychosocial determinants are essential to improve adherence, achieve sustained viral suppression, and reduce HIV transmission in highly vulnerable contexts.