O-53 Factors influencing adherence to anti-retroviral therapy and engagement in HIV care at the National Care and Treatment Centre in Guyana: a retrospective chart review
Author(s):
D Shivdas , T Ferguson
Year of Presentation:
2026
Objective: Although antiretroviral therapy (ART) is widely
available in Guyana, viral suppression remains below targets. Understanding adherence and engagement in care is
essential. This study assessed ART and appointment adherence among adults at the National Care and Treatment
Centre (NCTC), Guyana’s largest treatment site.
Methods: A retrospective chart review included 335 randomly selected adults enrolled at NCTC on or before June 30, 2018, with follow-up through 2023. Adherence was assessed using routine clinic data recorded at each visit, including clinician-recorded self-reported missed ART doses over the preceding 30 days and appointment timelines based on scheduled visit dates. Participant-level cumulative scores were calculated by averaging visit measures across six years and dichotomized as “good” versus ”not good.” Multivariable logistic regression identified factors associated with adherence.
Results: Analysis included 180 men and 155 women, with mean age 51.5 years (SD=10.8). Good self-reported adherence was observed in 64.7% cumulatively over six years, and 85.5%–91.5% when assessed annually. Consistently on-time appointment adherence was lower (12.2% cumulatively; 44.0%–58.7% annually). In crosstabulations, selfreported adherence was associated with age, ART initiation timing, CD4 count, viral suppression, mental health conditions, and receipt of home visits and counselling (p<0.05). Appointment adherence was associated with viral suppression and fewer regimen changes (p<0.05). In multivariable models, viral suppression showed the strongest association with self-reported adherence. Participants with undetectable viral load (aOR 22.26, 95% CI 3.75–132.25) or lowlevel viremia (aOR 20.68, 95% CI 3.33–128.31) had higher odds of adherence. Each additional year from diagnosis to ART initiation reduced adherence (aOR 0.89, 95% CI 0.81–0.98), while home visits improved it (aOR 4.27, 95% CI 1.08–16.88). Each regimen change reduced appointment adherence (aOR 0.42, 95% CI 0.21–0.84).
Conclusion: Self-reported treatment adherence was generally high, but sustained appointment adherence remained suboptimal. Strengthening early ART initiation, treatment stability, and supportive services is critical for sustained engagement in care and virological suppression.