Prevalence and Factors Influencing Antiretroviral Therapy (ART) Nonadherence in Men During Different Stages of the Life Course: A Case Study in Greater Gaborone, Botswana.

Background: Adult men living with HIV are less likely than women to adhere to antiretroviral therapy (ART). This highlights the need to understand factors driving nonadherence and how adherence behaviors and barriers change with age. However, existing HIV surveillance data often collapse ages into broad groups, limiting life-course analysis. This study addresses this gap by examining the time from HIV diagnosis to ART initiation and subsequent adherence barriers among men, using women as a comparison group, in Greater Gaborone, Botswana. To explore these dynamics, we employed a cross-sectional survey design tailored to capture age-specific patterns of ART initiation and adherence. Methods: A cross-sectional survey was conducted with a stratified random sample of 239 men and 428 women attending 21 HIV treatment clinics. Semistructured questionnaires captured life-course characteristics, including the stage of HIV disease at ART initiation and individual-level factors affecting adherence. Results: The results showed that men (n = 239) initiated ART medication during Stage 1 (n = 165, 61.9%), early Stage 2 (n = 46, 19.2%), late Stage 2 (n = 17, 7.1%), and Stage 3 (n = 11, 4.6%). Most men (69.1%) were diagnosed in Stage 1 of HIV disease compared to early Stage 2 (19.2%), late Stage 2 (7.1%), and Stage 3 (4.6%). Majority of the men (n = 63, 38.2%) diagnosed in Stage 1 were aged 40-49 years, followed by those aged 30-39 years (n = 38, 23.0%). ART nonadherence rates were 46.0% for men and 29.1% for women. Men who were more likely to be ART nonadherent (compared to women) were aged 30-39 years (OR = 2.05, 1.06-3.56), 40-49 years (OR = 1.91, 1.06-3.45), and 50+ years (OR = 3.95, 1.73-8.97). Other risk factors for ART nonadherence were recently sick, comorbidities, and taking other medications. Conclusion: Despite free ART and medical care in Botswana, men face barriers related to comorbidities, highlighting the need for targeted gender-specific interventions to improve ART adherence.