Clinical and health system factors associated with antiretroviral therapy adherence among people living with HIV and AIDS: cross-sectional survey insights from three ART facilities in Tamale, Ghana

HIV and AIDS have attained a manageably chronic status as more infected people experience increases in their life quality and expectancy. Health system factors affect adherence to ART among persons living with HIV and AIDS(PLHIV). Nonetheless, literature on health-system factors and ART adherence among PLHIV is sparse. This study therefore, aimed to elucidate clinical and health system factors associated with antiretroviral therapy adherence among people living with HIV and AIDS in Tamale Metropolis. We conducted a facility-based cross-sectional survey of 418 PLHIV in the Tamale Metropolis, selected by consecutive sampling from three major antiretroviral therapy (ART) centres. Each factor associated with ART adherence, considered statistically significant at a p-value of <0.05 with a 95% confidence interval, was analysed using both binary and multivariate logistic regression. The ART adherence rate was 93%. Clinical and health system factors significantly associated with higher adherence included the absence of post-pill fatigue (AOR = 0.09; 95% CI: 0.02–0.37), absence of complaints regarding pill size (AOR = 3.71; 95% CI: 1.23–11.18), lower cost of accessing therapy (AOR = 0.27; 95% CI: 0.10–0.73), uninterrupted ART supply (AOR = 7.76; 95% CI: 1.02–59.30), and strong social support systems (AOR = 6.62; 95% CI: 1.18–37.21). In conclusion, a suboptimal adherence rate of 93% was obtained. Clinical factors promoting adherence included the absence of fatigue and concerns related to pill size, while health system related factors promoting adherence included reduced cost of access, consistent ART supply, and good social support. The Ghana AIDS Commission and its implementing partners are urged to strengthen community-based social support networks, expand ART distribution points, and develop targeted educational initiatives to improve therapy adherence and contribute to achieving epidemic control.