Alcohol consumption and tobacco smoking associated with decreased antiretroviral therapy adherence among people living with HIV in Zambia: Evidence from a 2023 national NCDs/ HIV survey

Background In order to achieve the 95-95-95 goals and obtain optimal benefits from ART, PLWH must adhere to prescribed medication. Aim Investigate factors associated with ART adherence in a clinical setting in Zambia. Methods 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. Results 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. Conclusions 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