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Background  Adherence to ART is the primary determinant of viral suppression and the risk of transmission, disease progression and death. Adherence of at least 95% is needed for optimal suppression. This study aimed at determining the adherence to Anti-Retroviral Therapy (ART) and its associated factors among People Living with HIV and AIDS in ART Center of Chitwan, Nepal.    Methods  A descriptive cross-sectional study was conducted among 231 clients aged 18 years to 49 years taking ART from Bharatpur Hospital of Chitwan and those who have been enrolled in ART for at least 6 months, were interviewed. Systematic Sampling technique was used. Semi-structured questionnaire was prepared by taking reference from the AIDS Clinical Trial group questionnaire (ACTG). Adherence was measured by patient self report. Data was entered Epi Data 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) software where the  P  value of < 0.05 was accepted as being statistically significant. The independent variables which were found significant at  p -value 0.10 in bivariate analysis were fitted in multivariable logistic regression model. Multivariable logistic regression model was performed to know the net effect of the independent variables on Adherence to ART medication.    Results  The overall adherence in the last month was found to be 87.4%. Wrist watch and mobiles were seen as a facilitating factor for taking ART on time as clients taking ART used to set alarm to get informed of the medication time. Adherence was associated with female sex (AOR = 10.550 CI: 1.854–60.046), family consisting only parents and their children (AOR = 4.877, CI: 1.246–19.079), having no habit of taking alcohol (AOR = 5.842 CI: 1.294–26.383), HIV duration of more than 3 years (AOR = 10.055 CI: 2.383–42.430), picking up ART medications on their own (AOR = 7.861, CI: 1.670–36.998) and not having side effects of ART (AOR = 8.832, CI: 2.059–37.890).    Conclusion  Identifying and evaluating the problems faced by ARV drug users can foster the achievement of ART related goals and addressing ART related problems in a rational way. Effective and appropriate monitoring of non adherence behaviors can help patients increase adherence level fostering improvement in treatment outcome.    Electronic supplementary material  The online version of this article (10.1186/s12889-019-7051-3) contains supplementary material, which is available to authorized users.

Adherence to antiretroviral treatment and associated factors among people living with HIV and AIDS in CHITWAN, Nepal