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Newer antiretroviral therapy (ART) is now being increasingly prescribed and may be more forgiving of lower adherence. The lifelong nature of ART presents adherence challenges, particularly for women living with HIV. We aimed to describe ART use and examine the association between adherence and VS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Canadian HIV Women's Sexual and Reproductive Health Cohort, which included 1422 participants, was used. Data was collected three times, at 18\u2010month intervals, between 2013 and 2018. A Sankey diagram illustrated longitudinal ART trends among participants who reported their ART use. Cross\u2010sectional analysis using 2017\u20132018 data included participants who self\u2010reported their regimen, ART adherence, and viral load. Utilizing logistic regression models, self\u2010reported adherence (percentage of ART taken in the past month) and self\u2010reported VS (most recent &lt;50 copies\/mL) were investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among participants reporting ART use (<jats:italic>n<\/jats:italic>\u2009=\u20091187), integrase inhibitor use increased from 13.6% (<jats:italic>n<\/jats:italic>\u2009=\u2009162) to 30.6% (<jats:italic>n<\/jats:italic>\u2009=\u2009363), while other classes decreased. Among 617 participants assessed between 2017 and 2018, &lt;70% adherence levels (adjusted odds ratio [aOR]: 0.06, 95% confidence interval [CI]: 0.01\u20130.27), 70%\u201379% adherence (aOR: 0.29, 95% CI: 0.05\u20131.77) and 80%\u201389% (aOR: 0.21, 95% CI: 0.05\u20130.86) were associated with lower odds of reporting VS compared with \u226595% adherence, although statistically not significant for 70%\u201379% adherence. No difference was found for 90%\u201394% adherence (aOR: 1.04, 95% CI: 0.20\u20135.32) compared with \u226595%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings suggest that ART adherence levels lower than 90% are associated with a lower likelihood of VS among women living with HIV.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.70034","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T12:23:34Z","timestamp":1746188614000},"page":"1060-1073","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antiretroviral therapy use, self\u2010reported adherence, and viral suppression among women living with <scp>HIV<\/scp> in Canada"],"prefix":"10.1111","volume":"26","author":[{"given":"Maysaloun","family":"Mokaddam","sequence":"first","affiliation":[{"name":"Department of Family Medicine McGill University  Montreal Quebec Canada"},{"name":"Infectious Diseases and Immunity in Global Health Program Research Institute of the McGill University Health Centre  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2724-0496","authenticated-orcid":false,"given":"Nadine","family":"Kronfli","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Immunity in Global Health Program Research Institute of the McGill University Health Centre  Montreal Quebec Canada"},{"name":"Chronic Viral Illness Service McGill University Health Centre  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy L.","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Chronic Viral Illness Service McGill University Health Centre  Montreal Quebec Canada"},{"name":"Faculty of Pharmacy University of Montreal  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7102-4972","authenticated-orcid":false,"given":"Araceli","family":"Gonzalez Reyes","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Immunity in Global Health Program Research Institute of the McGill University Health Centre  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dani\u00e8le","family":"Dubuc","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Immunity in Global Health Program Research Institute of the McGill University Health Centre  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mona","family":"Loutfy","sequence":"additional","affiliation":[{"name":"Women and HIV Research Program Women's College Research Institute, Women's College Hospital  Toronto Ontario Canada"},{"name":"Department of medicine, Faculty of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Kaida","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences Simon Fraser University  Burnaby British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6809-1357","authenticated-orcid":false,"given":"Alexandra","family":"de Pokomandy","sequence":"additional","affiliation":[{"name":"Department of Family Medicine McGill University  Montreal Quebec Canada"},{"name":"Infectious Diseases and Immunity in Global Health Program Research Institute of the McGill University Health Centre  Montreal Quebec Canada"},{"name":"Chronic Viral Illness Service McGill University Health Centre  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the CHIWOS research team","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Joint United Nations Program on HIV\/AIDS.Understanding fast\u2010track: accelerating action to end the AIDS epidemic by 2023. 2015. 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