Key determinants of antiretroviral therapy adherence among Thai youth living with HIV: the mediating role of HIV self-management behaviors

Information from the abstract

Thai youth living with HIV (YLHIV) aged 15–24 demonstrate poorer antiretroviral therapy (ART) adherence than adults; however, factors associated with self-management behaviors and adherence remain insufficiently understood. This study examined psychosocial, clinical, and relational factors associated with HIV self-management behaviors and ART adherence. A cross-sectional study recruited 210 participants (minimum 10 participants per estimated parameter), aged 15–24, from six tertiary hospitals in the Bangkok Metropolitan Region between May 1 and November 30, 2024. Participants completed self-administered questionnaires during routine clinic visits. Mediation analysis examined associations of depressive symptoms, comorbidities, family support, peer support, perceived public stigma, and patient-healthcare provider relationship with ART adherence (30-day Visual Analog Scale; good adherence ≥ 95%) through HIV self-management behaviors, adjusting for education, HIV disclosure status, and ART duration. Participants had a mean age of 21.65 years (SD = 2.15) with 90% aged between 19 and 24 years; 74.8% were male. The model explained 69.8% of the variance in ART adherence. HIV self-management behaviors were positively associated with adherence (β z = 0.237, p < 0.01). Depressive symptoms (β z = − 0.210, p < 0.01), comorbidities (β z = − 0.129, p < 0.05), and perceived public stigma (β z = − 0.224, p < 0.01) were negatively associated with HIV self-management behaviors, while family support (β z = 0.148, p < 0.05), and patient-healthcare provider relationship (βz = 0.153, p < 0.05) were positively associated. Depressive symptoms (β z = − 0.196, p < 0.01), comorbidities (β z = − 0.111, p < 0.05), and perceived public stigma (β z = − 0.169, p < 0.05) were negatively associated with ART adherence, while family support (β z = 0.155, p < 0.01) and patient-healthcare provider relationship (β z = 0.128, p < 0.05) were positively associated. All associations, except comorbidities, were partially mediated by HIV self-management behaviors. Peer support was not significantly associated with either outcome. Among Thai YLHIV receiving ART care in tertiary hospitals in the Bangkok Metropolitan Region, predominantly older adolescents and young adults, ART adherence was associated with psychosocial, relational, and clinical factors, with significant indirect associations observed through HIV self-management behaviors. Findings support multi-component, developmentally appropriate strategies integrating mental health screening, stigma reduction, family engagement, youth-sensitive communication, and coordinated management of comorbid conditions. Strengthening HIV self-management capacity represents an important target for comprehensive adherence support among this population. Not applicable.

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Related topics: HIV/AIDS Research and Interventions · HIV-related health complications and treatments · Mobile Health and mHealth Applications