Predictors and Interventions to Increase Adherence to Antiretroviral Therapy (Art) In Adolescents on HIV Treatment in Sub-Saharan Africa

Introduction Over the past ten years, access to adequate and affordable antiretroviral medications has expanded globally for people of all ages. Adolescents with HIV, however, have inferior treatment outcomes because of suboptimal adherence, which results in a high viral load and its associated effects, including higher mortality, morbidity, OIs, and HIV medication resistance mutation. This review aims to identify predictors and current strategies to promote ART adherence in adolescents and young people in Sub-Saharan Africa.  Method: We searched databases such as Pub Med and Google Scholar for articles published in English from 2000 to 2024 related to factors affecting ART adherence in adolescents (10-19 years) and interventions to mitigate the challenges and promote ART adherence and treatment outcomes in adolescents living with HIV. Only studies on ART adherence or strategies to enhance ART adherence in adolescents 10-19 years and young people 10-24 years living with HIV in Sub-Sahara Africa were included in the review.  Results: Factors linked to ART adherence and interventions to improve adherence in adolescents and youths were identified at individual client level, family level, health system delivery and healthcare provider level and medication level. Adherence interventions were tailored to mitigate specific level predictors. Individual-level interventions such as memory aids (SMS reminder) and therapeutic education counseling alone were not associated with significantly improved adherence in adolescents and adults. Health service delivery interventions such as age- adapted adolescent support group clinics over the weekend, after-school services in conjunction with peer support, and single-dose daily medication were associated with an increase in adherence to ART. Financial empowerment of family, adolescents, and HIV treatment literacy were linked to improved adherence. A combination of interventions cutting across multiple levels of interventions appears to be more effective in improving adherence in adolescents.  Conclusion: A combination of directly observed therapy engaging adolescent peer supporters and memory aides in a well- structured health service delivery system is an effective intervention to enhance ART adherence in adolescents. More studies are needed to determine the effects of combination interventions in achieving optimal adherence among adolescents on ART in Sub-Saharan Africa.