Laher, Abdullah E.Richards, G.A.Paruk, FathimaVenter, Willem Daniel Francois2022-10-192022-10-192021-08Laher, A.E., Richards, G.A., Paruk, F. et al. Antiretroviral therapy non-adherence among HIV-positive patients presenting to an emergency department in Johannesburg, South Africa: Associations and reasons. South African Medical Journal, vol. 111, no. 8, pp. 753-758, aug. 2021. doi:10.7196/SAMJ.2021.v111i8.15604.2078- 5135 (online)0256-9574 (print)10.7196/SAMJ.2021.v111i8.15604https://repository.up.ac.za/handle/2263/87813BACKGROUND. Suboptimal antiretroviral therapy (ART) adherence is associated with viral resistance, opportunistic infections and increased mortality. OBJECTIVES. To determine the rates of ART non-adherence and its associations, and also the reasons for ART non-adherence, among HIV-positive patients presenting to a major central hospital emergency department (ED). METHODS. Consecutive HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital adult ED between 7 July 2017 and 18 October 2018 were prospectively enrolled. Self-reported adherence was assessed using the AIDS Clinical Trials Group Adherence Questionnaire (ACTG-AQ). RESULTS. Of the 1 224 consecutive HIV-positive participants enrolled, 761 (75.2%) were on ART at the time of ED presentation. Of these, 245 (32.2%) were non-adherent as per the ACTG-AQ. Participants not yet on ART prior to ED presentation had significantly higher in-hospital mortality than participants on ART (odds ratio 1.69; 95% confidence interval 1.21 - 2.34; p=0.002). Younger age, male sex, CD4 count <100 cells/µL, lack of viral suppression, a high National Early Warning Score 2 (≥7 points) and length of hospital stay ≥7 days were significantly associated with ART non-adherence (p<0.05). Forgetfulness (13.9%) and lack of social support, depression/stress/mental illness, and lack of money for transport to collect medications (9.9% each) were the most common reasons given for ART non-adherence. CONCLUSIONS. Of HIV-positive patients presenting to the ED, a high proportion were either not yet initiated on ART or ART non-adherent. HIV programmes should focus on HIV-positive ED attendees with the aim of identifying high-risk patients and providing adequate ART adherence supportenThis open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.Antiretroviral therapy (ART)Human immunodeficiency virus (HIV)Emergency departmentHealth sciences articles SDG-03SDG-03: Good health and well-beingArticle