ArticleAIDS and behavior2026
Barriers and facilitators to adherence of infants living with HIV in sub-Saharan Africa in an era of wide access to ART: a mixed-methods study.
Article in AIDS and behavior, 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
Infants and very young children with perinatally acquired HIV are solely dependent on caregivers for achieving high levels of adherence to antiretroviral therapy (ART). EARTH was a prospective study of infants from sites in South Africa, Mozambique, and Mali with perinatally-acquired HIV who started ART at ≤ 90 days after diagnosis. We implemented a mixed-methods social/behavioral substudy within the EARTH clinical study. Using data reported from caregivers of children in the EARTH study, this study explored caregivers' appraisals and coping regarding the child's HIV, caregiver-reported child adherence, and barriers and facilitators to adherence. Sixty of 78 participating caregivers (77%) reported that the child missed no ART doses in the previous week. Caregivers described improved child adherence and higher caregiver self-efficacy over time, and most perceived their children as adherent. Adherence was facilitated by caregiver education, psychosocial and practical support in giving ART, using incentives or consequences to encourage ART, and observing benefits to the child's health or development. Barriers included adverse medication characteristics, child resistance to ART, impacts of stigma, child feeling ill or experiencing side effects, and caregivers having trouble complying with timing. We note evidence for caregiver conceptualization of "good adherence" that includes tolerance for delayed doses. Even with EARTH-study and local supports, adherence was below the global target of 95%. We suggest interventions to improve outcomes in this vulnerable dyad-mothers who experienced a mother-to-child transmission and very young children living with HIV. Clinicians should attend to potential differences in interpretation of "good adherence" between clinicians and caregivers.
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