Young, HIV-Positive, and Adherent? Insights into ART Adherence among HIV-Positive Young Adults in Eswatini

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DOI: 10.21522./TAJMHR.2016.05.02.Art025

Authors : Ntombifuthi Temalangeni Dlamini, Amitabye Luximon-Ramma, Abiodun Paul Olaiya

Abstract:

Antiretroviral therapy (ART) adherence is a cornerstone of HIV management, particularly among young adults, who often face unique psychosocial and structural challenges. In Eswatini, one of the countries with the highest HIV prevalence globally, understanding the determinants of adherence among youth is vital for epidemic control. This study employed a mixed-methods cross-sectional design, combining quantitative survey data with qualitative interviews among 161 participants enrolled from four regional hospitals in Eswatini. Data was extracted from clinic records and supplemented with structured questionnaires assessing socio-demographics, adherence behaviors, and barriers. ART adherence was classified as good (≥95%) or poor (<95%). Viral suppression was defined as <50 copies/mL. Data analysis in SPSS v28 included descriptive statistics, chi-square tests, and logistic regression to identify predictors of viral suppression. The mean adherence rate was 96.3% (±6.1 SD). Good adherence (≥95%) was achieved by 77.6% of participants, while 13.0% exhibited poor adherence. Viral suppression was observed in 85.7% of participants, although 17.4% reported treatment interruptions and 26.7% missed at least one clinic visit in the past six months. Forgetfulness (33.5%) and travel (18.0%) were the most cited reasons for missed doses. ART adherence and viral suppression among young adults in Eswatini fall short of the UNAIDS 95–95–95 targets. Behavioral barriers such as forgetfulness, structural barriers such as mobility, and health system challenges such as clinic attendance must be addressed through youth-friendly, innovative interventions.

References:

[1].   Zurbachew, H. S., Woreta, A. W., Alem, S. M., Wondie, T., & Walle, B. H., 2023, Adolescent’s and youth’s adherence to antiretroviral therapy for better treatment outcome and its determinants: multi-center study in public health facilities. AIDS Research and Therapy. https://aidsrestherapy.biomedcentral.com/articles/10.1186/s12981-023-00632-4.

[2].   UNAIDS, 2022, In Danger: UNAIDS Global AIDS Update 2022. https://www.unaids.org/en/resources/documents/2022/in-danger-global-aids-update.

[3].   Govender, K., Masebo, W., Nyamaruze, P., Cowden, R. G., Schunter, B. T., & Bains, A., 2018, HIV prevention in adolescents and young people in the Eastern and Southern African region: A review of key challenges impeding actions for an effective response. The Open AIDS Journal. https://openaidsjournal.com/VOLUME/12/PAGE/53/ABSTRACT/.

[4].   Dzinamarira, T., & Moyo, T., 2024, Adolescents and young people in sub-Saharan Africa: overcoming challenges and seizing opportunities to achieve HIV epidemic control. Frontiers in Public Health. https://www.frontiersin.org/articles/10.3389/fpubh.2024.1321068/full.

[5].   Ministry of Health, 2022, Integrated HIV Management Guidelines, 2nd Edition. Eswatini Ministry of Health. https://www.who.int/publications/m/item/eswatini-integrated-hiv-management-guidelines-2022.

[6].   Ashaba, S., Baguma, C., Tushemereirwe, P., Nansera, D., Maling, S., Zanon, B. C., & Tsai, A. C., 2024, Correction: Correlates of HIV treatment adherence self-efficacy among adolescents and young adults living with HIV in southwestern Uganda. PLOS Global Public Health, 4(10):e0003874. doi: 10.1371/journal.pgph.0003874. https://pubmed.ncbi.nlm.nih.gov/39405301/.

[7].   Creswell, J. W., & Plano Clark, V. L., 2018, Designing and Conducting Mixed Methods Research, 3rd ed., Sage Publications, Thousand Oaks, CA. https://us.sagepub.com/en-us/nam/designing-and-conducting-mixed-methods-research/book247952.

[8].   Chouraya, C., Ashburn, K., Khumalo, P., Mpango, L., Mthethwa, N., Machekano, R., Guay, L., & Mofenson, L., 2019, Association of antiretroviral drug regimen with viral suppression in HIV-positive children on antiretroviral therapy in Eswatini. The Pediatric Infectious Disease Journal. http://dx.doi.org/10.1097/INF.0000000000002347.

[9].   UNAIDS, 2023, The path that ends AIDS: UNAIDS Global AIDS Update 2023. https://www.unaids.org/en/resources/documents/2023/global-aids-update-2023-path-that-ends-aids.

[10].  ICAP at Columbia University, n.d., Eswatini HIV Incidence Measurement Survey (SHIMS3) 2021: Fact Sheet. ICAP at Columbia University. Retrieved September 16, 2025, from https://phia.icap.columbia.edu/eswatini-summary-sheet/.

[11].  Wilkinson, L. S., Skordis-Worrall, J., Ajose, O., & Ford, N., 2015, Self-transfer and mortality amongst adults lost to follow-up in ART programmes in low- and middle-income countries: systematic review and meta-analysis. Tropical Medicine & International Health, 20(3):365–379. doi: 10.1111/tmi.12434. https://pubmed.ncbi.nlm.nih.gov/25418366/.

[12].  Vreeman, R. C., McCoy, B. M., & Lee, S., 2017, Mental health challenges among adolescents living with HIV. Journal of the International AIDS Society, 20(S3):21497.

[13].  Villiera, J. B., et al., 2022, Factors associated with antiretroviral therapy adherence among adolescents living with HIV in the era of isoniazid preventive therapy as part of HIV care. PLOS Global Public Health, 2(6).

[14].  Ferrand, R. A., Briggs, D., & Penazzato, M., 2016, Viral suppression in adolescents on antiretroviral treatment: review of the literature and critical appraisal of methodological challenges. Tropical Medicine & International Health, 21(3):325–333.

[15].  Ritchwood, T. D., Malo, V., & Jones, C., 2020, Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review. BMC Public Health, 20(1):1195.

[16].  UNAIDS, 2024, Fact sheet – Latest global and regional statistics on the status of the AIDS epidemic.

[17].  UNAIDS, 2023, Global AIDS Strategy 2021–2026: End Inequalities. End AIDS. https://www.unaids.org/sites/default/files/media_asset/unaids-strategy-2021-2026_en.pdf.

[18].  Mphande, S., Namwera, R., Shambira, K., & Mutale, S., 2025, Barriers to ART adherence in sub-Saharan Africa: a scoping review toward achieving UNAIDS 95-95-95 targets. Frontiers in Public Health, 13. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1609743/full.

[19].  Motsa, T., Sibanda, N., Gwebu, P. M., & Nxumalo, R., 2023, Views of adolescents living with perinatally acquired HIV on HIV status disclosure in Eswatini. AIDS Care, 35(12):1787–1793. https://www.tandfonline.com/doi/full/10.1080/09540121.2023.2299334.

[20].  Madiba, S., & Josiah, S., 2019, The impact of a family-centered model of care for HIV-positive children on viral suppression and retention in care: a randomized controlled trial in Eswatini. PLOS ONE, 16(8):e0256256. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256256.