Background: ARV adherence is a strong predictor of biologic (virologic and immunologic) and clinical outcomes in HIV, including quality of life, HIV progression, hospitalizations, and death. Consistent adherence to antiretroviral therapy (ART) is the cornerstone of effective HIV treatment. This study explores the interrelationship between food insecurity and access and adherence to ARV treatment. Such studies will help inform policy maker in the study area on ways of improving or maintaining adherence to ARV and scale up the treatment level.

Objective: The main objective of the study is to assess the prevalence of ARV adherence and associated factors (with particular focus on household food insecurity) among urban PLHIV.

Method: PLHIV association based cross-sectional study was conducted from January, 2012 to May, 2012 in Hawassa city. Both quantitative and qualitative data were used to triangulate one with another. Adult PLWHA on ARV therapy for at least 3 months were the study participants. A purposive sampling method used to select the study participants. Bivariate and multivariate logistic regressions were computed to assess the factors associated with ARV therapy non- adherence among adult PLHIV in the study area.

Result: Data were collected using structured questionnaire with open and closed type questions where a total of 325 participants were interviewed. Two focus group discussions with 6- 8 members each were conducted. Key informant interviews for PLHIV association’s coordinator and healthcare providers at ART clinic were conducted. Data was presented using frequency tables and graphs. Data was analyzed using SPSS software version 16.0. Results show that that the prevalence of adherence to ART was 82.5 %( that is non –adherence level 17.5%), was sub-optimal(less than 95%).Both dietary diversity and meal frequency score were less than mean ( 48.6% and 60.6%) respectively. Based on household food insecurity access module (63.7%) were food in secured. Household food insecurity was associated with ART adherence. Factors significantly associated with non- adherence to ARV therapy were religious status, protestant and catholic (COR 3.74, 95% CI 1.43-9.78) and (COR 2.11, 95%CI 1.11-4.02) respectively; marital status, divorced (AOR 3.88(1.48-10.20). A significance relationship was also exist between level of education and adherence ARV therapies among study participants (read and write, COR 0.37, 95%CI 0.14-0.41 and Elementary level, AOR 0.43, 95%CI 0.22-0.85). The household food insecurity status of PLHIV on ARV therapy, specifically those moderately food insecure significantly associated with non-adherence to ARV therapy (AOR 2.40, 95%CI 1.04-5.54).From FGDs it was found that household food insecurity is one of the challenges for ART adherence.

Discussion: Study participants religious and marital status were significantly associated with non- adherence to ARV. Education level was significantly associated with adherence to ARV. The proxy indicator of household food insecurity showed that a significant number of PLHIV on ART consumed less than the mean the mean dietary diversity and meal frequency score in the study area. Household food insecurity was a serious problem among PLHIV on ART. Household food insecurity was significantly associated with ART adherence.

Conclusions and recommendations: Based on the findings, lack of food to take with medication is the main reason for those non-adherents. Food support as relief together with a sustainable income generating activities need to be included in ART scale-up program in the study area. To enhance ART adherence the study recommends to the government and other stakeholders to develop strategies to ensure food security in households with people living with HIV and AIDS. There is need for preparing and disseminating IEC material which focus on adherence to ARVs, stigma and disclosure to the community in general and PLHIV in particular. These materials should emphasize that PLHIV on ARVs need support to be fully adherent treatment.