Identifying the Latent Classes of Antiretroviral Therapy Adherence Among Adolescents Living with HIV

Background: Adolescents living with HIV (ALHIV) in sub-Saharan Africa face significant challenges in maintaining adherence to antiretroviral therapy (ART). This study aimed to identify distinct ART adherence profiles among ALHIV in Southern Uganda and explore the factors influencing membership in these profiles, providing a foundation for tailored interventions.

Methods: We analyzed baseline data from 702 ALHIV aged 10–16 years enrolled in the Suubi+Adherence Study, a cluster-randomized controlled trial in Southern Uganda. ART adherence was assessed using six self-reported items. We conducted latent profile analysis (LPA) using generalized structural equation modeling to identify adherence profiles. We also fitted multinomial logistic regression models to examine the predictors of profile membership, including age, gender, HIV knowledge, pill burden, depressive symptoms, and duration living with HIV.

Results: Three distinct adherence profiles emerged: High Adherence (13.8%), Moderate Adherence (15.4%), and Low Adherence (70.8%). Adolescents in the High Adherence Group reported minimal challenges, while those in the Low Adherence Group faced frequent medication misses and high perceived difficulty.

Multinomial logistic regression revealed that age (RRR = 1.32, 95% CI: 1.13–1.53, p < 0.001), being in school (RRR = 2.96, 95% CI: 1.03–8.50, p = 0.043), HIV knowledge (RRR = 1.13, 95% CI: 1.01–1.28, p = 0.037), taking >4 pills/day (RRR = 0.31, 95% CI: 0.11–0.89, p = 0.030), and depression (RRR = 1.10, 95% CI: 1.01–1.20, p = 0.039) were significant predictors of membership in Class 2 compared to Class 1.

On the other hand, being female (RRR = 1.82, 95% CI: 1.13–2.94, p = 0.014) and the number of years living with HIV (RRR = 0.92, 95% CI: 0.86–0.98, p = 0.016) were associated with membership in Class 3. Specifically, each additional year living with HIV reduced the relative risk of belonging to Class 3 (the low adherence group) by 8%.

Conclusion: This study identifies distinct adherence profiles among ALHIV, highlighting the need for tailored interventions that address specific barriers, such as mental health challenges and gender disparities. By moving beyond standardized approaches, these findings offer new insights into approaching adherence, while considering the different adherence profiles. Future research should evaluate the impact of targeted interventions on these adherence profiles.