Abstract
BACKGROUND: Common mental disorders (CMDs) and alcohol use disorder (AUD) are significant barriers to effective antiretroviral therapy (ART) adherence among people living with HIV (PLHIV), especially in sub-Saharan Africa. Suboptimal adherence to ART contributes to increased morbidity and mortality in this population. CMD and AUD frequently co-occur, with alcohol often serving as a maladaptive coping mechanism for psychological distress, thereby compounding the negative impact on treatment outcomes. Understanding the mediating role of AUD in the relationship between CMD and ART adherence is essential for designing targeted interventions aimed at improving HIV treatment success. METHODS: A hospital-based cross-sectional analytical study was conducted between August and October 2023 in Moshi Municipality, Kilimanjaro. A multistage systematic sampling technique was used to recruit participants. Data were collected using structured sociodemographic and interviewer-administered, validated assessment tools. Statistical analyses included one-way ANOVA for continuous variables, chi-square tests for categorical variables, and logistic regression to estimate odds ratios (ORs) with 95% confidence intervals. Mediation analysis was conducted using R version 4.4.2, with significance set at p < 0.05. RESULTS: The study involved 532 participants, with an average age of 46.6 ± 13.3 years; 71.4% were female. The prevalence of depression, anxiety, and ART non-adherence was 14.8%, 12.4%, and 10.7%, respectively. Among men, depression and anxiety were both significantly associated with ART non-adherence in model1 and 2 respectively (depression OR = 5.38, 95% CI: 1.80-16.08; OR = 5.10, 95% CI: 1.55-16.82. Anxiety OR = 5.12, 95% CI: 1.63-16.12; OR = 5.30, 95% CI: 1.48-18.92). Among women, only depression significantly increased ART non-adherence in all models, respectively (OR = 2.50, 95% CI: 1.16-5.36; OR = 2.51, 95% CI: 1.13-5.59; OR = 3.26, 95% CI: 1.34-7.95). Alcohol use disorder significantly mediated the relationship between depression and ART non-adherence more substantially than alcohol use alone, with mediation effects up to 45.5%. CONCLUSION: Depression is significantly associated with ART non-adherence in both genders, and AUD is a key mediator, especially among male participants. These data support the integration of mental health and substance use care into HIV services, with attention to gender-specific risk factors.