Psychosocial Determinants of Antiretroviral Therapy Adherence in Adolescents

Abstract

Adolescents living with HIV must sustain lifelong antiretroviral therapy (ART) during a developmental period already defined by identity formation and a shift toward autonomy, and psychosocial factors -- rather than regimen complexity alone -- are consistently the strongest predictors of whether they succeed. This article synthesizes the literature on the psychosocial determinants of adolescent ART adherence, organized around disclosure and HIV-related stigma, mental health, family and peer relationships, and the structural and economic stressors that interact with all three. Reported adherence prevalence across studies ranges from roughly 20% to 94%, and pooled meta-analytic estimates link good adherence positively to HIV-related knowledge and self-efficacy and negatively to stigma and depression. We review the intervention literature built on these findings, from Zimbabwe's peer-delivered Zvandiri differentiated care model and SMS reminder trials in Cameroon, both associated with large gains in viral suppression, to a peer support trial in Vietnam that found no benefit against an already strong standard of care, and we examine the pediatric-to-adult care transition as a point where psychosocial support most often lapses. The evidence argues for treating psychosocial support as a core, not optional, component of adolescent HIV care, while leaving the causal direction of several key associations, the process quality of disclosure, and the interaction between structural and psychosocial interventions as open questions for future research.