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Background <p>Adolescents living with HIV experience persistent challenges in achieving optimal adherence to antiretroviral therapy (ART), threatening viral suppression and long-term treatment success. In sub-Saharan Africa, including Ethiopia, developmental transitions, limited resources, and socio-cultural factors further complicate adherence. This study aims to develop and validate a model of antiretroviral therapy (ART) adherence determinants among Ethiopian adolescents living with HIV by extending the information-motivation-behavioral skills (IMB) model through the integration of HIV-related stigma as an additional construct, given its significant influence on adherence in this population.</p> Methods <p>A cross-sectional study was conducted from March to October 2024 among 219 adolescents living with HIV in ALERT hospital, Addis Ababa. The data were analyzed via SPSS and the lavaan 0.6–18 package in R. The pathways through which the study constructs influenced ART adherence were estimated via the diagonally weighted least squares (DWLS) method. Model fit was evaluated via the chi-square to degrees of freedom ratio (χ²/df), comparative fit index (CFI), Tucker–Lewis index (TLI), and root mean square error of approximation (RMSEA).</p> Results <p>A total of 210 adolescents were included in the final analysis, of whom 68.6% were adherent to ART. The proposed model demonstrated excellent fit to the data (χ²/df = 1.23, CFI = 0.99, TLI = 0.98, RMSEA = 0.033). Treatment self-efficacy mediated the effects of ART knowledge and ART attitude on ART adherence. While social support exerted both significant direct (β = 0.20, <i>p</i> = .029) and indirect effects via treatment self-efficacy, resulting in a significant total effect on ART adherence (β = 0.26, <i>p</i> = .004), HIV-related stigma did not demonstrate significant direct or indirect effects on ART adherence.</p> Conclusion <p>Interventions that strengthen ART-related knowledge, foster positive treatment attitudes, enhance social support, and build treatment self-efficacy may substantially improve ART adherence among adolescents living with HIV.</p>

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Factors associated with antiretroviral therapy adherence among adolescents living with HIV in Addis Ababa, Ethiopia: structural equation modeling

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月28日

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  • Gebre G. Gudisa,
  • Sangeun Jun

摘要

Background

Adolescents living with HIV experience persistent challenges in achieving optimal adherence to antiretroviral therapy (ART), threatening viral suppression and long-term treatment success. In sub-Saharan Africa, including Ethiopia, developmental transitions, limited resources, and socio-cultural factors further complicate adherence. This study aims to develop and validate a model of antiretroviral therapy (ART) adherence determinants among Ethiopian adolescents living with HIV by extending the information-motivation-behavioral skills (IMB) model through the integration of HIV-related stigma as an additional construct, given its significant influence on adherence in this population.

Methods

A cross-sectional study was conducted from March to October 2024 among 219 adolescents living with HIV in ALERT hospital, Addis Ababa. The data were analyzed via SPSS and the lavaan 0.6–18 package in R. The pathways through which the study constructs influenced ART adherence were estimated via the diagonally weighted least squares (DWLS) method. Model fit was evaluated via the chi-square to degrees of freedom ratio (χ²/df), comparative fit index (CFI), Tucker–Lewis index (TLI), and root mean square error of approximation (RMSEA).

Results

A total of 210 adolescents were included in the final analysis, of whom 68.6% were adherent to ART. The proposed model demonstrated excellent fit to the data (χ²/df = 1.23, CFI = 0.99, TLI = 0.98, RMSEA = 0.033). Treatment self-efficacy mediated the effects of ART knowledge and ART attitude on ART adherence. While social support exerted both significant direct (β = 0.20, p = .029) and indirect effects via treatment self-efficacy, resulting in a significant total effect on ART adherence (β = 0.26, p = .004), HIV-related stigma did not demonstrate significant direct or indirect effects on ART adherence.

Conclusion

Interventions that strengthen ART-related knowledge, foster positive treatment attitudes, enhance social support, and build treatment self-efficacy may substantially improve ART adherence among adolescents living with HIV.