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Knowledge of enablers and barriers of adherence to antiretroviral treatment (ART) in these populations is limited. We conducted a cohort study of 501 adult PLHIV on ART at a rural South African treatment facility as a sub-study of a clinical trial (ClinicalTrials.gov NCT03357588). Socio-economic, psychosocial and behavioral characteristics were assessed as covariates of self-reported adherence difficulties, suboptimal pill count adherence and virological failure during 96\u00a0weeks of follow-up. Male gender was an independent risk factor for all outcomes. Food insecurity was associated with virological failure in males. Depressive symptoms were independently associated with virological failure in both males and females. Household income and task-oriented coping score were protective against suboptimal pill-count adherence. These results underscore the impact of low household income, food insecurity and depression on outcomes of ART in rural settings and confirm other previously described risk factors. Recognition of these factors and targeted adherence support strategies may improve patient health and treatment outcomes.<\/jats:p>","DOI":"10.1007\/s10461-023-04103-2","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T11:01:57Z","timestamp":1688036517000},"page":"3863-3885","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Predictors of Treatment Adherence and Virological Failure Among People Living with HIV Receiving Antiretroviral Therapy in a South African Rural Community: A Sub-study of the ITREMA Randomised Clinical Trial"],"prefix":"10.1007","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7870-1363","authenticated-orcid":false,"given":"Siphamandla B.","family":"Gumede","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annemarie M. 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AMJW Serves as a CEO for the European Society for Antiviral Research (ESAR) (unpaid), as governing Board member European AIDS Clinical Society, Chair of the European AIDS conference 2021 (unpaid, travel expenses paid to Institution), Member of the WHO Resnet (unpaid, travel expenses paid to Institution), Chair of the IAS-USA HIV drug resistance panel (unpaid), and as an Organizing Committee member of the European HIV and Hepatitis Meeting (unpaid, travel expenses paid to Institution). WDFV received funding for the ADVANCE RCT through his institution from UNITAID, USAID, and SAMRC, and received study drug from ViiV Healthcare and Gilead Sciences. WDFV also reports funding for his unit from the Bill and Melinda Gates, Foundation, National Institutes for Health, UNITAID, Foundation for Innovative New Diagnostics (FIND) and the Children\u2019s Investment Fund Foundation (CIFF), and received drug donations from Merck and J&J Sciences for investigator-led clinical studies. The unit leads investigator-led studies that receive financial support from Merck and ViiV and is involved in commercial drug studies for Merck. The unit performs evaluations of diagnostic devices for multiple biotech companies. WDFV. Also receives honoraria for educational talks and advisory board membership for Gilead, ViiV, Mylan, Merck, Adcock-Ingram, Aspen, Abbott, Roche, J&J, Sanofi and Virology Education; participates on DSMB for NIH International; is currently an unpaid board member for Dira Sengwe and was an unpaid board member for SAHCS. None of the ADVANCE RCT funders were involved in the design, execution, or analysis of this study. All other authors report no potential conflicts.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethics approval for the ITREMA trial was obtained from the University of Pretoria Human Research Ethics Committee (Ref Number: 69\/2015) and the Department of Health, Limpopo province (Ref No 4\/2\/2). Ethical clearance for this sub-study was obtained from the University of the Witwatersrand Human Research Ethics Committee (M190641), and approval was provided by the Johannesburg Health District (DRC Ref: 2019-10-005, National Health Research Database Reference Number: GP_201910_031).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}}]}}