Determinants of Antiretroviral Treatment Adherence Among Young Mothers Living with HIV: The Role of Early Motherhood

Adolescent girls living with HIV are at higher risk of poor HIV treatment outcomes than older women living with HIV. However, little is known about how age at first birth influences their adherence to antiretroviral treatment (ART). Using South African data from a cross-sectional study of 311 young mothers living with HIV (N = 311, mean age 19.7 ± 1.92 years, follow-up = 2017-2018), we examined the association between age at first birth (< 18 versus 18+ years), all hypothesized factors and self-reported past-week ART adherence, adjusting for known covariates. We computed adjusted probability estimates conditional on the presence of none, one, or all factors significantly associated with ART adherence in the final regression model. Overall, 45% (N = 140) of participants had their first birth before the age of 18. ART adherence rates differed significantly by age at first birth (< 18 years: 67.9% vs. 18+ years: 80.1%, p = 0.013). Age-at-first birth (< 18 years) (aOR 0.45, 95% CI 0.26-0.78, p = 0.005) and internalized HIV stigma (aOR 0.33, 95% CI 0.17-0.62, p = 0.001) were associated with lower odds of past-week adherence, while psychosocial support (aOR 2.39, 95% CI 1.20-4.74, p = 0.013) and availability of a caregiver for the participant (aOR 2.74, 95% CI 1.37-5.52, p = 0.005) were associated with higher odds of past-week adherence. Combined psychosocial support and caregiver presence improved ART adherence among young mothers, with stronger effects in those reporting internalized HIV stigma. Efforts to support young mothers to improve their adherence to ART are urgently needed at scale, including strategies to reduce the impact of HIV-related stigma, including family psychosocial support.