{
  "abstract": "Background Suboptimal adherence to antiretroviral therapy (ART) remains a key challenge in HIV care. We aimed to determine the prevalence of poor ART adherence and its independent predictors among people living with HIV (PLWH) attending a tertiary HIV clinic.Methods This observational, retrospective cohort study included PLWH followed at our outpatient HIV clinic between January 2024 and June 2025, who had been on ART for at least six months and had a follow-up of ≥ 60 days. Adherence was measured by the Proportion of Days Covered (PDC) from pharmacy refill records and poor adherence was defined as PDC <90%. Prevalence was estimated with exact Clopper-Pearson 95% CIs. Univariate comparisons used Mann-Whitney U or chi-square/Fisher’s exact tests, after assessing normality by Shapiro-Wilk test. Independent predictors were identified by multivariable logistic regression with multiple imputation by chained equations (MICE; m=20; Rubin’s rules), reported as adjusted odds ratios (aOR) with 95% CI.Results Among 1,485 PLWH included (median age 54.0 years [IQR 44.0–61.0]; 72.8% male) ( table 1), the prevalence of poor adherence was 46.9% (95% CI: 44.4%–49.5%) (figure 1). Median PDC was 82.0% (IQR 71.7–87.0%) in poorly adherent vs. 94.9% (92.1–97.5%) in adherent patients. On multivariable logistic regression with multiple imputation (table 2), independent predictors of poor adherence were: younger age (aOR 0.98 per year, 95% CI 0.97–0.99; p=0.001), African region of origin (aOR 1.91, 95% CI 1.08–3.40; p=0.027), lower educational attainment (p=0.002), NNRTI-based regimen (aOR 1.40, 95% CI 1.08–1.83; p=0.012) and PI-based regimen (aOR 2.06, 95% CI 1.27–3.36; p=0.004) vs. INSTI-based, and ART regimen switch during follow-up (aOR 1.76, 95% CI 1.34–2.30; p<0.001). Long-acting therapy was found to be protective (aOR 0.54, 95% CI 0.31–0.94; p=0.030). Sex, alcohol use, depression, anxiety disorder, comorbidities, and HIV transmission risk factors were not independently associated with poor adherence after adjustment.Conclusions Nearly half of PLWH followed at our large Italian center show suboptimal adherence. Younger age, female sex, African origin, lower education, PI-based regimens, treatment switching, and alcohol use are independent determinants of poor adherence. Our results call for renewed clinical prioritization of adherence monitoring and intervention. This focus remains essential despite the availability of simplified, better-tolerated modern regimens, as treatment advances alone cannot overcome adherence barriers without comprehensive patient support.Abstract SC36 Figure 1Abstract SC36 Table 1Baseline characteristies stratised by ART adherence groupAbstract SC36 Table 2Multivariable logistic regression: independent determinants of poor ART adherence (PDC< 90%)",
  "authors": [
    {
      "affiliations": [
        "Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy"
      ],
      "name": "E Vania"
    },
    {
      "affiliations": [
        "Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy"
      ],
      "name": "FV Segala"
    },
    {
      "affiliations": [
        "Hospital Pharmacy Unit, Azienda Ospedale-Università Padova, Padua, Italy"
      ],
      "name": "D Mengato"
    },
    {
      "affiliations": [
        "Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy"
      ],
      "name": "D Leoni"
    },
    {
      "affiliations": [
        "Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy"
      ],
      "name": "S Gardin"
    },
    {
      "affiliations": [
        "Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy"
      ],
      "name": "A Ferrari"
    },
    {
      "affiliations": [
        "Hospital Pharmacy Unit, Azienda Ospedale-Università Padova, Padua, Italy"
      ],
      "name": "G Berti"
    },
    {
      "affiliations": [
        "Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy"
      ],
      "name": "L Sasset"
    },
    {
      "affiliations": [
        "Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy",
        "Department of Molecular Medicine, University of Padua, Padua, Italy"
      ],
      "name": "A Cattelan"
    }
  ],
  "title": "SC36 Persisting adherence challenges in HIV treatment: insights from a tertiary HIV clinic",
  "uid": "3f1617ef-eacc-5622-bf68-f65fcfa40341"
}