PREDICTORS OF ART ADHERENCE AND ITS IMPACT ON HEALTH OUTCOMES FOR OLDER ADULTS LIVING WITH HIV IN KAMPALA, UGANDA.

Abstract

ABSTRACT This study examined the predictors of antiretroviral therapy (ART) adherence and its impact on health outcomes among older adults living with HIV in Kampala, Uganda. Guided by the biopsychosocial model, the study was grounded in the understanding that ART adherence is a multidimensional construct influenced by biological, psychological, and social domains. The specific objectives were: (a) to evaluate biological factors influencing ART adherence; (b) to analyze psychological factors determining ART adherence; (c) to assess social factors affecting ART adherence; and (d) to examine the impact of ART adherence on health outcomes among older adults living with HIV. A cross-sectional quantitative research design was employed, targeting adults aged 50 years and above attending ART services across six purposively selected health centers in Kampala. Stratified random sampling ensured proportional representation across age, gender, and facility type, while purposive sampling was applied to capture diverse adherence experiences. Data were collected using structured questionnaires and analyzed using descriptive statistics, Pearson correlation, and multiple regression analysis. The findings revealed that biological factors had a positive but statistically non-significant relationship with ART adherence (β = 0.029, t = 0.738, p = 0.461). This suggests that while biological health plays a role in HIV care, it does not independently predict adherence behavior among older adults in this context. In contrast, psychological factors showed a significant and positive relationship with ART adherence (β = 0.227, t = 5.474, p = 0.000), indicating that emotional well-being is essential for maintaining consistent medication routines. Similarly, social factors were found to be significant positive predictors of ART adherence (β = 0.202, t = 4.897, p = 0.000), highlighting the role of interpersonal and societal dynamics in supporting treatment continuity. Furthermore, the study established that ART adherence has a significant positive impact on health outcomes (β = 0.271, t = 6.715, p = 0.000). Respondents with consistent adherence reported improved physical health, reduced frequency of opportunistic infections, and enhanced quality of life, reinforcing the central role of adherence in achieving favorable clinical and psychosocial outcomes. It was concluded that that psychological and social dimensions are critical determinants of ART adherence among older adults, while biological conditions alone do not predict adherence behavior when examined independently. Sustained adherence remains a cornerstone of improved health outcomes. The study recommends the integration of mental health services into HIV care, the strengthening of community-based support mechanisms, the adaptation of service delivery models for older adults, and the continued clinical management of biological vulnerabilities to support holistic adherence strategies in aging populations.