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We examined associations between self\u2010reported ART adherence for the last 1 and 2 weeks; the Adherence Self\u2010Efficacy Scale (ASES) and symptoms of depression (Patient Health Questionnaire\u20109 [PHQ\u20109]), anxiety (Generalized Anxiety Disorder tool [GAD\u20107]), post\u2010traumatic stress disorder (PTSD Checklist [PTSD]); cognitive function (PROMIS v2.0 Adult Cognitive Function 8a short form) and forgetfulness (Forgetfulness Assessment Inventory). We used cut points of \u22655 for at least mild and \u226510 for at least moderate symptom severity for PHQ\u20109 and GAD\u20107 and of \u226544 for PTSD. Logistic and linear regression analyses were used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Participants\u2019 median age was 40.0 (IQR: 34\u221247) with 40.9% (<jats:italic>n<\/jats:italic> = 94) of females in the sample. Those who missed at least one pill for the last 2 weeks had higher odds of reporting at least mild depression (aOR = 3.34, 95% CI: 1.22\u20139.11, <jats:italic>p<\/jats:italic> &lt;\u00a00.05); mild anxiety (aOR = 3.27, 95% CI: 1.20\u20138.92, <jats:italic>p<\/jats:italic> &lt;\u00a00.05); and PTSD (aOR = 4.04, 95% CI: 1.15\u201314.21, <jats:italic>p<\/jats:italic> &lt;\u00a00.05) symptoms. Participants who missed at least one pill for the last week had higher odds of at least mild depression (aOR = 7.74, 95% CI: 1.31\u201345.7, <jats:italic>p<\/jats:italic> &lt;\u00a00.05), moderate anxiety (aOR = 21.33, 95% CI: 3.24\u2013140.33, <jats:italic>p<\/jats:italic> &lt;\u00a00.005) and PTSD (aOR = 13.81, 95% CI: 2.36\u201380.84, <jats:italic>p<\/jats:italic> &lt;\u00a00.005) symptoms. Participants with better cognitive function had lower odds of non\u2010adherence over the last week (aOR = 0.88, 95% CI: 0.81\u20130.96, <jats:italic>p<\/jats:italic> &lt;\u00a00.005) and higher ASES scores (\u03b2 = 0.26, 95% CI: 0.13\u20130.40, <jats:italic>p<\/jats:italic> &lt; 0.005). Poor memory was associated with higher odds of non\u2010adherence over the last week (aOR = 4.64, 95% CI: 1.76\u201312.24, <jats:italic>p<\/jats:italic> &lt;\u00a00.005) and lower ASES score (\u03b2 = \u22120.31, 95% CI: \u22120.45 to 0.16, <jats:italic>p<\/jats:italic> &lt; 0.005). Those who had at least mild depression (\u03b2 = \u22120.21, 95% CI: \u22120.35 to \u22120.07, <jats:italic>p<\/jats:italic> &lt; 0.005); moderate anxiety (\u03b2 = \u22120.21, 95% CI: \u22120.34 to \u22120.07, <jats:italic>p<\/jats:italic> &lt; 0.005) and PTSD (\u03b2 = \u22120.19, 95% CI: \u22120.33 to \u22120.05, <jats:italic>p<\/jats:italic> &lt; 0.005) symptoms had lower ASES scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Depression, anxiety and PTSD symptoms, poorer cognition, and forgetfulness were associated with poorer ART adherence and worse adherence self\u2010efficacy. It is crucial to assess and treat mental illness and provide support for PLWH with worsened cognition to enhance ART adherence.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26320","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T08:14:56Z","timestamp":1721376896000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Mental health and cognition in relation to adherence to antiretroviral therapy among people living with HIV in Kazakhstan: a cross\u2010sectional study"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4702-1944","authenticated-orcid":false,"given":"Gaukhar","family":"Mergenova","sequence":"first","affiliation":[{"name":"Global Health Research Center of Central Asia  Almaty Kazakhstan"},{"name":"Asfendiyarov Kazakh National Medical University  Almaty Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2084-9741","authenticated-orcid":false,"given":"Alissa","family":"Davis","sequence":"additional","affiliation":[{"name":"Columbia University School of Social Work Columbia University  New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Columbia University School of Social Work Columbia University  New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabila","family":"El\u2010Bassel","sequence":"additional","affiliation":[{"name":"Columbia University School of Social Work Columbia University  New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assel","family":"Terlikbayeva","sequence":"additional","affiliation":[{"name":"Global Health Research Center of Central Asia  Almaty Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sholpan","family":"Primbetova","sequence":"additional","affiliation":[{"name":"Global Health Research Center of Central Asia  Almaty Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhamilya","family":"Nugmanova","sequence":"additional","affiliation":[{"name":"Asfendiyarov Kazakh National Medical University  Almaty Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Norcini","family":"Pala","sequence":"additional","affiliation":[{"name":"Columbia University School of Social Work Columbia University  New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Gustafson","sequence":"additional","affiliation":[{"name":"State University of New York Downstate Health Sciences University  Brooklyn New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L.","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Psychiatry Vagelos College of Physicians and Surgeons Columbia University Irving Medical Center  New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfiya Y.","family":"Denebayeva","sequence":"additional","affiliation":[{"name":"Almaty City AIDS Center  Almaty Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"DeHovitz","sequence":"additional","affiliation":[{"name":"State University of New York Downstate Health Sciences University  Brooklyn New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,18]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"UNAIDS Data 2021 [Internet]","author":"UNAIDS","year":"2021"},{"key":"e_1_2_11_3_1","unstructured":"UNAIDS UNAIDS data 2022. 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