Introduction
Antiretroviral Therapy (ART) has transformed HIV from a fatal infection into a manageable chronic condition for many people living with HIV. Yet, achieving and maintaining ART completion—consistently taking the prescribed medication until treatment goals are reached—remains a complex challenge. Completion depends on a mix of individual, clinical, and systemic factors that interact over time. Understanding these factors is essential for health professionals, policymakers, and communities aiming to optimize treatment outcomes and minimize HIV transmission.
Key Individual-Level Factors
Adherence and Pill Burden
Adherence to daily or multi-dose regimens is a cornerstone of ART success. Regimens with simpler dosing, once-daily pills, or long-acting formulations can reduce fatigue and improve completion rates. However, even with simplified regimens, forgetfulness, daily routines, and competing life priorities can disrupt adherence. Behavioral strategies—such as routine-building, reminder systems, and patient education—play a critical role in sustaining ART completion.
Side Effects and Tolerance
Adverse drug reactions and perceived toxicity can deter continued use. Common side effects like nausea, sleep disturbances, or metabolic changes may accumulate and erode motivation to stay on therapy. Managing side effects through clinician oversight, regimen adjustments, and patient-centered counseling is essential for preserving ART completion.
Mental Health and Substance Use
Depression, anxiety, and substance use disorders can hinder consistent medication-taking behavior. Integrated care models that address mental health and HIV treatment concurrently have shown promise in improving ART adherence and completion. Social support, counseling, and peer navigation can buffer these challenges.
Health System and Access-Related Factors
Health Care Access and Continuity of Care
Regular contact with HIV care providers, access to medication, and stable insurance or funding are pivotal. Barriers such as long travel times, stockouts, or complex appointment systems can disrupt ART completion. Building patient-centered clinics, community outreach, and telehealth options can improve continuity of care and adherence.
Clinic-Patient Communication
Trust and effective communication influence a patient’s willingness to disclose barriers to adherence. Clear explanations about how ART works, potential side effects, and realistic expectations promote engagement and sustained ART completion. Culturally sensitive care and non-judgmental approaches support ongoing treatment.
<h2Socioeconomic and Structural Determinants
Stigma, Discrimination, and Social Support
HIV-related stigma and discrimination can deter individuals from seeking care or disclosing adherence challenges. Strong social support networks, family involvement, and community-based programs can reduce barriers to ART completion. Peer mentors and support groups often provide practical tips for maintaining treatment over time.
Economic Stability and Housing
Stable housing and income enable better medication management. Food security, transportation costs, and competing life priorities influence the ability to attend appointments, pick up medications, and maintain daily dosing. Interventions that address these social determinants, such as income support or housing-assisted programs, can improve ART completion rates.
<h2Medication-Specific Considerations
Drug Resistance and Regimen Suitability
Previous treatment failures or resistance can complicate regimen selection, affecting confidence in ART and willingness to continue. Periodic resistance testing and personalized regimen planning help ensure that prescribed therapies remain effective, encouraging long-term completion.
Drug Interactions and Polypharmacy
Co-administration with other medications may require careful monitoring to avoid interactions that could compromise ART efficacy or tolerability. Clinician collaboration across specialties reduces risks and supports sustained ART adherence and completion.
Implications for Practice and Policy
Efforts to improve ART completion should combine patient-centered clinical care with strategies that address social determinants, reduce stigma, and streamline access. Programs that simplify regimens, provide mental health support, and remove logistical barriers can increase completion rates and improve health outcomes for people living with HIV.
Conclusion
ART completion is influenced by a constellation of personal, clinical, and structural factors. By adopting integrated care models, tailoring regimens to patient needs, and addressing the broader social context, health systems can enhance ART adherence, support sustained completion, and advance the goal of lasting viral suppression for people living with HIV.
