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. 2025 Jul 9;22(1):66.
doi: 10.1186/s12981-025-00763-3.

Insights into medication adherence among HIV-positive patients: the integrated change model

Mehdi Mirzaei-Alavijeh  1 , Fatemeh Rahimi  2 , Behrooz Hamzeh  1 , Feizollah Mansouri  3 , Nastaran Shoukohi  4 , Farzad Jalilian  5
Affiliations

Insights into medication adherence among HIV-positive patients: the integrated change model

Mehdi Mirzaei-Alavijeh et al. AIDS Res Ther. .

Abstract

Background: HIV/AIDS continues to pose a significant global public health challenge, with millions affected worldwide. Despite advancements in antiretroviral therapy (ART), achieving optimal adherence remains critical for improving health outcomes and preventing transmission. This study aims to identify the key determinants influencing medication adherence among HIV-positive patients in western Iran, utilizing the integrated change model as a theoretical framework to inform effective intervention strategies.

Methods: This descriptive-analytical cross-sectional study involved 262 HIV-positive individuals from the Behavioral Diseases Counseling Centers (BDCCs) of Kermanshah University of Medical Sciences in 2021. Data were collected through structured interviews using a questionnaire based on the I-Change Model, with 255 completed responses analyzed using SPSS-16.

Results: The mean age of respondents was 39.04 years, with a majority being male (70.2%). The average medication adherence score was 21.09 [95% CI: 20.68, 21.50], indicating 84.36% adherence. In the adjusted regression model, significant determinants of medication adherence were job status (β = 0.133, P < 0.001) and behavioral skills (β = 0.296, P < 0.001), indicating their positive impact on adherence behavior. Conversely, perceived barriers (β = -0.418, P < 0.001) remained a strong negative correlate, highlighting the detrimental effect of barriers on adherence.

Conclusion: This study underscores the critical role of job status, behavioral skills, and perceived barriers in medication adherence. Clinically, healthcare providers must prioritize strategies to mitigate barriers and increasing behavioral skills. From a policy standpoint, expanding employment opportunities for individuals with HIV can support adherence and improve health outcomes.

Keywords: Behavioral skills; HIV/AIDS; Integrated change model; Medication adherence; Perceived barriers.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol (IR.KUMS.REC.1399.297) received approval from the research ethics committee of Kermanshah University of Medical Sciences. All procedures adhered to the ethical standards established by the institution and national research committees, in accordance with the 1964 Helsinki Declaration and its subsequent amendments. Prior to participation, individuals were given comprehensive information about the study’s procedures, confidentiality measures, and objectives. Participants received an information statement and provided written consent. Consent for publication: All participants granted written informed consent for their involvement in the study. The manuscript does not contain any personal information that could identify individuals. Competing interests: The authors declare no competing interests.

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