ArticleInternational journal of environmental research and public health2026
Caregiver-Mediated Adherence and Perceived Health System Factors Associated with Viral Suppression Among Children Receiving Antiretroviral Therapy in Rural South Africa.
Article in International journal of environmental research and public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWhile caregiver and health system factors are known to influence paediatric ART outcomes, their roles within routine rural South African settings remain insufficiently characterised.
aimThe aim of this study is to assess the association between caregiver-mediated ART adherence, perceived healthcare access and service quality with viral suppression among children receiving ART in a rural South African province.
methodsA cross-sectional study was conducted among 86 children aged <15 years receiving ART in routine paediatric HIV care. Viral load suppression was defined as <1000 copies/mL. Predictor variables included caregiver-reported adherence (30-day recall; adherent vs. non-adherent), perceived healthcare access and perceived service quality. Associations were assessed using Chi-square or Fisher's exact tests, where appropriate. Effect sizes were estimated using risk differences.
resultsOverall, 77.9% of the child participants were virally suppressed. Caregiver-reported adherence was significantly associated with VLS (
conclusionsCaregiver-mediated adherence was strongly associated with viral suppression, whereas perceived health system factors were not independently associated with treatment outcomes in this cohort. These findings should be interpreted cautiously given the cross-sectional design and reliance on short-term adherence measures. Strengthening household-level adherence support is critical for improving paediatric HIV outcomes in rural settings.
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