Mental health disorders and substance use among people living with HIV in Nepal: their influence on non-adherence to anti-retroviral therapy.

People living with HIV often experience mental health disorders and engage in substance use. Evidence, however, is limited about the influence of mental health disorders and substance use on non-adherence to ART. We conducted a cross-sectional study among 682 HIV-positive people on ART in Nepal. We measured their depressive symptoms, anxiety, stress levels, substance use, and non-adherence to ART. We developed logistic regression models to examine the association of mental health disorders and substance use with non-adherence to ART. Experiencing depressive symptoms was positively associated with ART non-adherence among HIV-positive people (men: AOR = 2.77,  = .001; women: AOR = 3.69,  = .001). Additionally, both men and women were more likely to have non-adherence to ART when they had anxiety (men: AOR = 2.19,  = .022; women AOR = 2.83,  = .001) and higher stress scores (men: AOR = 1.11,  = .001; women: AOR = 1.08,  = .001). While substance use was associated with non-adherence only in HIV-positive men (AOR = 3.12,  < .001). Depressive symptoms, anxiety, and high level of stress had negative roles on adherence in HIV-positive men and women. While substance use had a negative role on ART adherence among men only. Results highlight that the HIV-positive people should be screened and provided treatment and psychosocial support while providing ART services to improve their medication adherence.