You have full access to this open access article. The role of health literacy on HIV outcomes has not been evaluated widely in Africa, in part because few appropriate literacy measures exist. Construct validity was assessed by a hypothetical model developed a priori.
Despite significant advances in antiretroviral therapy ART coverage, many patients still experience significant mortality after treatment initiation [ 2 ], and suboptimal adherence remains an important threat for opportunistic infections and HIV disease progression [ 3 , 4 ].
Low or inadequate health literacy is common even in high-income countries such as the United States, where 90 million people are estimated to be affected [ 8 ]. Studies have shown that limited health literacy is associated with suboptimal health outcomes, particularly in chronic conditions such as diabetes and HIV [ 8 , 11 β 13 ]. Evidence from the US has shown that health literacy skills are important mediators of HIV-related knowledge, behaviors and outcomes [ 21 β 28 ].
Studies suggest that individuals with HIV who have limited health literacy have less HIV knowledge [ 21 β 24 ], less ability to correctly manage HIV medication [ 25 , 29 ], and lower likelihood of achieving undetectable viral loads compared to those with adequate health literacy skills [ 21 , 27 ].
Most studies have demonstrated an association between limited health literacy and lower adherence to ART [ 26 , 27 , 30 β 33 ], but some did not find such a relationship [ 23 , 34 , 35 ]. In the few known studies examining the relationship between health literacy and HIV related behaviors and outcomes in sub-Saharan Africa, population literacy data and overall literacy skills have been used as surrogates for health literacy [ 19 , 20 ]. While these types of data may not require specialized testing, they do not measure the specific literacy skills needed to participate in health-related activities.
