Factors associated with adherence to HIV treatment among adolescent girls and young women in the Imagine pro- gramme in South Africa: A mixed-methods study protocol
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Background. Adherence to antiretroviral therapy (ART) is critical to achieving viral suppression and reducing HIV-related morbidity and transmission. However, consistent adherence remains a challenge, particularly among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA), an already vulnerable group disproportionately affected by HIV. In SSA, AGYW account for the majority of new infections, and despite widespread availability of ART and ambitious national targets, optimal adherence is not being consistently achieved.
Objectives. To identify factors associated with adherence to HIV treatment among AGYW enrolled in the Imagine programme, a school-based HIV and pregnancy prevention intervention implemented in 14 rural schools in North West and KwaZulu-Natal provinces, South Africa (SA).
Methods. Employing a mixed-methods design, the cross-sectional study will conduct secondary quantitative analysis of data collected in the Imagine programme. Additionally, primary data will be obtained from in-depth interviews conducted with a subset of participants to explore perceptions, barriers and experiences related to adherence. Quantitative data will be analysed using descriptive statistics and logistic regression to assess associations between adherence and sociodemographic, behavioural and structural factors. Qualitative data will be analysed thematically to provide contextual insights.
Conclusion. This study addresses a critical evidence gap by focusing on adherence in a rural AGYW population. The findings are expected to inform both programme implementation and broader adolescent HIV treatment strategies in SA.
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1. Stoner MCD, Kelly NK, Gomez-Olive FX, et al. Relationships between stress-responsive biomarkers, ART adherence, and viral suppression among adolescent girls and young women living with HIV in South Africa: An HPTN 068 analysis. J Acquir Immune Defic Syndr 2023;92(5):349-358. https://doi.org/10.1097/qai.0000000000003149
2. Altamirano J, Odero IA, Omollo M, et al. Understanding ART adherence among adolescent girls and young women in western Kenya: A cross-sectional study of barriers and facilitators. Int J Environ Res Public Health 2023;20(20):6922. https://doi.org/10.3390/ ijerph20206922
3. Joint United Nations Programme on HIV/AIDS (UNAIDS). Global HIV & AIDS statistics – fact sheet. 2024. https://www.unaids.org/en/resources/fact-sheet (accessed 30 January 2025).
4. Joint United Nations Programme on HIV/AIDS (UNAIDS). Understanding measures of progress towards the 95-95-95 HIV testing, treatment and viral suppression targets. 2024. https://www.unaids.org/en/resources/documents/2024/progress-towards-95-95-95
(accessed 16 April 2025).
5. International AIDS Society. Reaching the 95-95-95 targets: The importance of multi-
stakeholder collaboration – key considerations to reach the 95-95-95 targets. Geneva: IAS, 2021. https://www.iasociety.org/sites/default/files/CPP/IAS-CPP-Key-considerations. pdf (accessed 2 January 2026).
6. Minister Aaron Motsoaledi: Press statement about status of HIV/Aids and TB campaign in South Africa. Pretoria: Government Communications, 2025. https://www.gov.za/news/ media-statements/minister-aaron-motsoaledi-press-statement-about-status-hivaids- and-tb (accessed 2 January 2026).
7. Shisana O, Stoker D, Simbayi LC, et al. South African national household survey of HIV/AIDS prevalence, behavioural risks and mass media impact – detailed methodology and response rate results. S Afr Med J 2004;94(4):283-288.
8. Schaecher KL. The importance of treatment adherence in HIV. Am J Manag Care 2013;19(12 Suppl):s231-s237.
9. Mills EJ, Nachega JB, Bangsberg DR, Adherence to HAART: A systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med 2006;3(11):e438. https://doi.org/10.1371/journal.pmed.0030438
10. Almeida PRS, Rafael CAC, Pimentel V, Abecasis AB, Sebastião CS, Morais J. Adherence to antiretroviral therapy among HIV-1 patients from sub-Saharan Africa: A systematic review. AIDS Rev 2024;26(3):102-110. https://doi.org/10.24875/AIDSRev.24000004
11. Croome N, Ahluwalia M, Hughes LD, Abas M. Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa. AIDS 2017;31(7):995-1007. https://doi. org/10.1097/qad.0000000000001416
12. Boyer S, Clerc I, Bonono CR, Marcellin F, Bilé PC, Ventelou B. Non-adherence to antiretroviral treatment and unplanned treatment interruption among people living with HIV/AIDS in Cameroon: Individual and healthcare supply-related factors. Soc Sci Med 2011;72(8):1383-1392. https://doi.org/10.1016/j.socscimed.2011.02.030
13. Simelane PT, Simelane MS, Amoateng AY. Barriers and facilitators to adherence for antiretroviral therapy: The perspectives of patients from a wellness center in the Mpumalanga Province, South Africa. Afr Health Sci 2022;22(3):455-462. https://doi. org/10.4314/ahs.v22i3.49
14. Mashele V, Marincowitz GJO, Marincowitz C. Factors influencing adherence to antiretroviral therapy among young adults in Limpopo province. S Afr Fam Pract 2024;66(1):e1-e6. https://doi.org/10.4102/safp.v66i1.5973
15. Arnold EM, Kamal S, Rotheram-Borus MJ, et al. Factors associated with antiretroviral adherence among youth living with HIV. J Acquir Immune Defic Syndr 2024;95(3):215- 221. https://doi.org/10.1097/qai.0000000000003345
16. Bermudez LG, Jennings L, Ssewamala FM, Nabunya P, Mellins C, McKay M. Equity in adherence to antiretroviral therapy among economically vulnerable adolescents living with HIV in Uganda. AIDS Care 2016;28(Suppl 2):83-91. https://doi.org/10.1080/0954012 1.2016.1176681
17. Azmeraw D, Wasie B. Factors associated with adherence to highly active antiretroviral therapy among children in two referral hospitals, northwest Ethiopia. Ethiop Med J 2012;50(2):115-124.
18. Zhou S, Cluver L, Shenderovich Y, Toska E. Uncovering ART adherence inconsistencies: An assessment of sustained adherence among adolescents in South Africa. J Int AIDS Soc 2021;24(10):e25832. https://doi.org/10.1002/jia2.25832
19. Cluver LD, Hodes RJ, Toska E, et al. ‘HIV is like a tsotsi. ARVs are your guns’: Associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa. AIDS 2015;29(Suppl 1):S57-S65. https://doi.org/10.1097/ qad.0000000000000695
20. Nyasulu JCY, Maposa I. Progress towards 90-90-90 and 95-95-95 strategy implementations and HIV positivity trends in the City of Johannesburg. S Afr Med J 2023;114(1):51-55. https://doi.org/10.7196/SAMJ.2024.v114i1.862
21. Abdullah F, Naledi T, Nettleship E, et al. First social impact bond for the MRC: A novel financing strategy to address the health and social challenges facing adolescent girls and young women in South Africa. S Afr Med J 2019;109(11b):57-62. https://doi.org/10.7196/ SAMJ.2019.v109i11b.14254
22. Southern African HIV Clinicians Society. Guidelines for antiretroviral therapy in adults: 2023 update. 2023. https://sahivsoc.org/Files/SAHCS%20Adult%20ART%202023%20 Guidelines%20(1107).pdf (accessed 2 January 2026).