Marinda, EdmoreZungu, Nompumelelo PreciousChikovore, JeremiahMthembu, JacquelineMagampa, MmakotsediMathentamo, QaqambileNwosu, Chijioke O.Maoba, PhomoloRamlagan, ShandirZuma, KhangelaniMoyo, SizuluSimbayi, Leickness C.2023-05-252023-05-252022-05Marinda, E., Zungu, N., Chikovore, J. et al. Association Between ART Adherence and Mental Health: Results from a National HIV Sero-Behavioural Survey in South Africa. AIDS and Behavior 26, 1517–1529 (2022). https://doi.org/10.1007/s10461-021-03505-4.1090-7165 (print)1573-3254 (online)10.1007/s10461-021-03505-4http://hdl.handle.net/2263/90808This paper assesses the levels of antiretroviral treatment (ART) adherence and mental health distress among study participants in a national behavioural HIV-sero prevalence study South Africa. The study was a cross-sectional population-based multi-stage stratified cluster random survey, (SABSSM V, 2017). Structured questionnaires were used to collect information on socio-demographics, HIV knowledge, perceptions, HIV testing and HIV treatment history. Study participants were tested for HIV infection, antiretroviral use, viral suppression, and ART drug resistance. A total of 2155 PLHIV aged 15 years or older who were on ART were included in the study. Incidence of either moderate or severe mental health distress was 19.7%. Self-reported ART adherence among study participants with no, mild, moderate, or severe mental distress was 82%, 83%, 86% and 78%, respectively. The adjusted odds ratio for ART non-adherence was 0.58 (95% CI 0.24; 1.40) for mild mental distress, 0.82 (95% CI 0.35; 1.91) for moderate mental distress and 2.19 (95% CI 1.14; 4.19) for severe mental distress groups compared to the no mental health distress group. The other factors that were associated with ART non-adherence in adjusted models included education level, alcohol use and province/region of residence. The study revealed that mental health remains a challenge to ART adherence in South Africa. To improve ART adherence, HIV continuum of care programs should include screening for mental health among people living with HIV.en© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021. The original publication is available at : http://link.springer.comjournal/10461.Antiretroviral therapy (ART)Human immunodeficiency virus (HIV)People living with HIV (PLHIV)Low- and middle-income countries (LMICs)ART adherenceMental healthAlcohol useSouth Africa (SA)Postprint Article