Medication adherence is a complex issue influenced by various factors, including patient factors, medication factors, provider-related factors, clinical settings, and other health system factors. Continued access to care is essential to adherence. For Black MSM from low-income backgrounds, additional factors such as poverty, limited access to medication (Fuchs et al., 2018), and other chronic diseases play a big role in influencing adherence and access to care. Patients have to continue their clinical visits for monitoring and viral load tests to determine if the medication is working. These visits can also help healthcare providers to find out if the patient is taking medication as required. 

Shah et al. (2016) used a cost-effective model to test the cost of non-adherence in the treatment of HIV. Their study revealed that new ways are needed to engage and retain patients in HIV care. As per their estimates, improved retention can help reduce HIV incidence by more than half and HIV-related mortality by two-thirds. Furthermore, it will lead to savings of up to $45,000 for every life-year gained due to proper medication.

Despite prescribing a simple regimen and other efforts to maintain patients on the HIV continuum of care, a multitude of patient-related factors can pose barriers to adherence:

• Inconsistent access to medications
• Depression and other mental illnesses
• Neurocognitive impairment
• Low levels of social support
• Low health literacy
• Stressful life events
• Alcohol/substance abuse
• Homelessness, poverty
• Nondisclosure of HIV status/denial
• Stigma
• Financial/insurance status
• Treatment fatigue

People who are not adherent risk becoming resistant to medications and they have fewer regimen options. Despite being on a regimen with simple administration, common barriers to adherence can prevent patients from maintaining virologic control.