Factors influencing antiretroviral therapy adherence among youth living with HIV: a systematic review and meta-analysis

Abstract

Background: Adherence to antiretroviral therapy (ART) is vital for controlling the viral load and disease progression in people living with HIV. Previous reviews on ART adherence among youths living with HIV (YLHIV) are outdated and lack coverage of youth populations. Methods: A systematic review and meta-analysis were conducted using the WHO framework to identify factors influencing ART adherence among youth living with HIV (YLHIV). Nine electronic databases were used for studies published between January 2015 and November 2024. Eligible quantitative studies were included. A meta-analysis using a random-effects model was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Results: A systematic review of 45 studies revealed ART adherence rates ranging from 20% to 93.8% (mean: 69.34%), which were primarily assessed via self-reported measures with a 95% threshold for good adherence. The meta-analysis identified significant factors across WHO dimensions affecting adherence. Socioeconomically, older age is associated with poorer ART adherence (OR = 0.86, 95% CI: 0.79–0.95), and higher education improved adherence (OR = 3.68, 95% CI: 1.70–7.95), whereas parental death reduced it (OR = 0.32, 95% CI: 0.18–0.57). Patient-related factors positively associated with adherence included HIV knowledge (OR = 2.35, 95% CI: 1.82–3.03) and self-efficacy (OR = 2.81, 95% CI: 1.58–4.99), whereas HIV stigma (OR = 0.61, 95% CI: 0.47–0.79) and depression (OR = 2.01, 95% CI: 1.16–3.50 for nonadherence) had negative impacts. Clinical factors benefiting adherence included viral load suppression (OR = 4.28, 95% CI: 1.63–11.26), whereas comorbidities (OR = 0.43, 95% CI: 0.32–0.59) reduced it. Therapy-related barriers included increased pill burden (OR = 0.36, 95% CI: 0.29–0.45) and medication side effects (OR = 0.36, 95% CI: 0.20–0.65). Healthcare system facilitators included positive patient–provider relationships (OR = 1.76, 95% CI: 1.35–2.29) and adult accompaniment (OR = 1.75, 95% CI: 1.32–2.32), whereas barriers included longer travel times (OR = 0.58, 95% CI: 0.39–0.86) and missed appointments (OR = 0.44, 95% CI: 0.31–0.63). Conclusion: Optimal adherence to ART is crucial for achieving effective viral suppression and enhancing the quality of life of youths living with HIV. Understanding the facilitators of and obstacles to ART among YLHIVs could be beneficial in designing interventions to increase ART adherence. PROSPERO number: CRD42023441441.