# Knowledge, attitudes, perceptions, and practices toward antiretroviral therapy among people living with HIV in secondary healthcare facilities in Lagos State, Nigeria: a multicenter cross-sectional study

## TL;DR

This study explores how knowledge, attitudes, and perceptions of people living with HIV in Lagos affect their adherence to antiretroviral therapy.

## Contribution

The study identifies negative perceptions and stigma as barriers to ART adherence in Lagos, Nigeria.

## Key findings

- Participants showed satisfactory knowledge and attitudes toward ART but had poor perceptions of their medications.
- A significant negative correlation was found between knowledge and perception of ART.
- Medication concealment and nondisclosure of HIV status were linked to stigma.

## Abstract

Despite global progress against HIV/AIDS through widespread antiretroviral therapy (ART) access, treatment success still hinges on adherence, shaped by the knowledge, attitudes, perceptions, and practices of people living with HIV (PLHIV). In densely populated Lagos, Nigeria, where the HIV burden remains high, this study assessed factors influencing ART adherence to inform future strategies for improving treatment outcomes.

A multicenter, descriptive, cross-sectional study design was employed. Data were collected using a structured, self-administered questionnaire administered to consenting individuals living with HIV who had been receiving antiretroviral therapy for at least three months.

600 pre-tested questionnaires were administered. Of these, 513 were completed and analyzed, resulting in a response rate of 85.5%. Respondents are PLHIV attending antiretroviral clinics across six selected secondary healthcare facilities in Lagos. Data collection took place between February 2024 and April 2024. Descriptive statistics were generated using SPSS version 23. Pearson correlation and multiple linear regression were conducted to examine relationships among variables.

The mean age of respondents was 43 years, with 74.9% (384/513) being female. Approximately 94% of participants demonstrated satisfactory knowledge of ART. Additionally, 81.1% exhibited satisfactory attitudes toward treatment, while 68.4% had poor perceptions of their medications. Nearly half of the respondents (45.4%, 233/513) reported storing their medicines in a concealed location within their residence.

A significant but weak negative correlation was found between knowledge and perception of PLHIV towards ART (r(513) = -0.129, p = 0.003). No significant correlation was found between their knowledge and attitude towards ART (r(513) = 0.018, p = 0.683).

Multiple linear regression analysis revealed a statistically significant negative association between respondents' perception of ART and their knowledge of ART (β = –0.609, p = 0.003), indicating that less favorable perceptions were associated with lower levels of knowledge about ART.

People living with HIV in Lagos State demonstrate satisfactory knowledge and attitudes toward antiretroviral therapy; however, negative perceptions about their medications remain prevalent. HIV-related stigma continues to influence key behavioral practices, such as medication concealment and nondisclosure of HIV status. Strengthening patient-centered education and stigma-reduction efforts may enhance ART adherence and improve long-term treatment outcomes in this population.

The online version contains supplementary material available at 10.1186/s12889-025-25629-1.