{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T01:34:08Z","timestamp":1768872848230,"version":"3.49.0"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:00:00Z","timestamp":1629936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"school of public health and health sciences, university of massachusetts amherst","award":["Dean\u2019s PhD Summer Fellowship"],"award-info":[{"award-number":["Dean\u2019s PhD Summer Fellowship"]}]},{"name":"The Graduate School, University of Massachusetts Amherst","award":["Dissertation Research and Fieldwork Grants"],"award-info":[{"award-number":["Dissertation Research and Fieldwork Grants"]}]},{"name":"center for research on families, umass amherst","award":["Dissertation Research Award"],"award-info":[{"award-number":["Dissertation Research Award"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Eswatini has the highest global prevalence of HIV despite decades of universal access to free antiretroviral therapy (ART). We conducted a mixed methods study to investigate barriers to ART adherence among women living with HIV (WLHIV) in rural communities of Eswatini. Qualitative findings were reported in our previous publication. This subsequent paper expands on our qualitative analysis to examine the magnitude to which identified barriers impacted ART adherence among WLHIV in the same communities.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We used an exploratory sequential design to collect data from WLHIV (n = 166) in rural Eswatini. Quantitative data were collected using interviewer-administered survey questionnaires between October and November 2017. ART adherence was measured using the CASE Adherence Index, with scores less than 10 indicating nonadherence. Log-binomial regression models were used to examine the extent to which critical barriers affected ART adherence among study participants.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A majority of the women in our study (56%) were nonadherent to ART. Of the barriers identified in our prior qualitative analysis, only eight were found to be significantly associated with ART nonadherence in our quantitative analysis. These include, with adjusted risk ratios (ARR) and 95% confidence intervals (95% CI): household food insecurity (ARR: 3.16, 95% CI: 1.33\u20137.52), maltreatment by clinic staff (ARR: 2.67, 95% CI: 1.94\u20133.66), forgetfulness (ARR: 1.80, 95% CI: 1.41\u20132.31), stress (ARR: 1.47, 95% CI: 1.14\u20131.88), gossip (ARR: 1.57, 95% CI: 1.21\u20132.04), mode of transport (ARR: 0.59, 95% CI: 0.44\u20130.79), age (ARR: 0.98, 95% CI: 0.97\u20130.99), and lack of community support (ARR: 0.55, 95% CI: 0.35\u20130.85).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Among numerous barriers identified in our study, food insecurity was found to be a significant contributor toward ART nonadherence among women living with HIV in rural Eswatini. Future strategies aimed at improving ART adherence in Eswatini should include programs which provide food and nutrition support for people living with HIV, particularly rural women living in poverty.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0256277","type":"journal-article","created":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T17:44:35Z","timestamp":1629999875000},"page":"e0256277","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["A quantitative analysis of food insecurity and other barriers associated with ART nonadherence among women in rural communities of Eswatini"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1780-7682","authenticated-orcid":true,"given":"Nozipho","family":"Becker","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krishna C.","family":"Poudel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorraine S.","family":"Cordeiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aline G.","family":"Sayer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thokozile E.","family":"Sibiya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindiwe N.","family":"Sibeko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,8,26]]},"reference":[{"issue":"9939","key":"pone.0256277.ref001","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/S0140-6736(14)60164-1","article-title":"HIV infection: epidemiology, pathogenesis, treatment, and prevention","volume":"384","author":"G Maartens","year":"2014","journal-title":"The Lancet"},{"issue":"9903","key":"pone.0256277.ref002","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1016\/S0140-6736(13)61809-7","article-title":"The end of AIDS: HIV infection as a chronic disease","volume":"382","author":"SG Deeks","year":"2013","journal-title":"The Lancet"},{"issue":"8","key":"pone.0256277.ref003","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1086\/339074","article-title":"The consistency of adherence to antiretroviral therapy predicts biologic outcomes for human immunodeficiency virus-infected persons in clinical trials","volume":"34","author":"S Mannheimer","year":"2002","journal-title":"Clin Infect Dis Off Publ Infect Dis Soc Am"},{"issue":"3","key":"pone.0256277.ref004","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/00126334-200403010-00006","article-title":"The impact of adherence on CD4 cell count responses among HIV-infected patients","volume":"35","author":"E Wood","year":"2004","journal-title":"JAIDS J Acquir Immune Defic Syndr"},{"issue":"2","key":"pone.0256277.ref005","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1097\/01.qai.0000179459.31562.16","article-title":"Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras","volume":"41","author":"NF Crum","year":"2006","journal-title":"JAIDS J Acquir Immune Defic Syndr"},{"issue":"10","key":"pone.0256277.ref006","doi-asserted-by":"crossref","first-page":"810","DOI":"10.7326\/0003-4819-139-10-200311180-00008","article-title":"Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4 cell count is 0.200 to 0.350\u00d7 109 cells\/L","volume":"139","author":"E Wood","year":"2003","journal-title":"Ann Intern Med"},{"issue":"7","key":"pone.0256277.ref007","doi-asserted-by":"crossref","first-page":"171","DOI":"10.4172\/2155-6113.1000171","article-title":"Clinic-Based Food Assistance is Associated with Increased Medication Adherence among HIV-Infected Adults on Long-Term Antiretroviral Therapy in Zambia","volume":"3","author":"N Tirivayi","year":"2012","journal-title":"J AIDS Clin Res"},{"key":"pone.0256277.ref008","unstructured":"WFP. 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