Magura Judie, Nhari Sibongile R, Nzimakwe Thokozani I
Africa Health Research Institute (AHRI), Durban, South Africa.
School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.
Front Public Health. 2025 Jun 10;13:1609743. doi: 10.3389/fpubh.2025.1609743. eCollection 2025.
With the 2025 UNAIDS 95-95-95 deadline upon us, significant gaps remain in achieving universal HIV care and treatment targets, particularly in Sub-Saharan Africa. Despite years of intensified global efforts, progress has lagged, partly driven by the multifaceted challenges of non-adherence to ART, shaped by social, economic, structural, and individual factors. These challenges have been compounded by the ever-changing landscape of global HIV funding, further undermining treatment outcomes. Addressing these interconnected barriers is essential to identify and implement targeted, evidence-based solutions.
To explore these challenges and potential interventions, a scoping review was conducted, searching through PubMed and Dimensions databases for peer-reviewed articles published from 2020 through February 2025. Eligible studies focused on barriers to ART adherence in adult men and women ≥ 18 years old living with HIV, aligning with the UNAIDS 95-95-95 framework in sub-Saharan Africa.
Of the 4,928 articles screened, 21 were included in this scoping review. Although the search period was extended to February 2025, no eligible studies published in 2025 were identified. Barriers to ART adherence were multifaceted, spanning individual-level issues such as mental health issues and substance abuse; social barriers including stigma and intimate partner violence; and economic factors, including food insecurity, transport costs, and income instability. Structural barriers such as health system fragmentation, clinic accessibility, and drug stockouts were also common and often worsened by the COVID-19 pandemic, which disrupted service delivery and exacerbated socioeconomic vulnerabilities. While only peer-reviewed articles were included in the analysis, recent UNAIDS reports and reputable media sources, such as The Guardian, were referenced to contextualize the emerging impact of the 2025 HIV funding cuts, which have not yet been reflected in the academic literature.
Our findings emphasize the urgent need for targeted, multi-level interventions to address persistent economic, social, psychological, and policy barriers to ART adherence. A sustainable funding framework, combined with financial support, mental health services, and community-based care models, is crucial for improving retention and long-term adherence. These insights are essential for shaping policies, strengthening HIV service delivery, and sustaining momentum toward the 95-95-95 targets amid systematic challenges.
随着2025年联合国艾滋病规划署（UNAIDS）设定的95-95-95目标期限临近，在实现普遍的艾滋病毒护理和治疗目标方面仍存在重大差距，特别是在撒哈拉以南非洲地区。尽管全球多年来加大了努力，但进展仍然滞后，部分原因是由社会、经济、结构和个人因素造成的不坚持抗逆转录病毒治疗（ART）这一多方面挑战。全球艾滋病毒资金格局的不断变化使这些挑战更加复杂，进一步损害了治疗效果。应对这些相互关联的障碍对于确定和实施有针对性的、基于证据的解决方案至关重要。
为了探讨这些挑战和潜在干预措施，我们进行了一项范围综述，通过PubMed和Dimensions数据库搜索2020年至2025年2月发表的同行评审文章。符合条件的研究聚焦于年龄≥18岁的成年艾滋病毒感染者中抗逆转录病毒治疗依从性的障碍，与撒哈拉以南非洲地区的UNAIDS 95-9-95框架一致。
在筛选的4928篇文章中，有21篇被纳入本范围综述。尽管搜索期延长至2025年2月，但未发现2025年发表的符合条件的研究。抗逆转录病毒治疗依从性的障碍是多方面的，包括个人层面的问题，如心理健康问题和药物滥用；社会障碍，包括耻辱感和亲密伴侣暴力；以及经济因素，包括粮食不安全、交通成本和收入不稳定。卫生系统碎片化、诊所可及性和药品短缺等结构障碍也很常见，并且往往因2019冠状病毒病疫情而恶化，疫情扰乱了服务提供并加剧了社会经济脆弱性。虽然分析中仅纳入了同行评审文章，但我们参考了UNAIDS最近的报告以及《卫报》等知名媒体来源，以了解2025年艾滋病毒资金削减的新影响，这些影响尚未在学术文献中得到反映。
我们的研究结果强调迫切需要采取有针对性的多层次干预措施，以应对抗逆转录病毒治疗依从性方面持续存在的经济、社会、心理和政策障碍。一个可持续的资金框架，再加上财政支持、心理健康服务和基于社区的护理模式，对于提高留存率和长期依从性至关重要。这些见解对于制定政策、加强艾滋病毒服务提供以及在系统性挑战下保持朝着95-95-95目标前进的势头至关重要。
