The Relationship Between Financial Well-Being and Antiretroviral Therapy Adherence in Youth with HIV in the United States

Youth and young adults experience high attrition across the HIV care continuum, including elevated risk of antiretroviral therapy (ART) nonadherence and virologic failure. This study examined how financial well-being relates to ART adherence among youth with HIV (YWH), including those using oral or LAI-based regimens. We analyzed baseline data from YWH aged 18-29 years in the United States enrolled between 2023 and 2025 in a randomized controlled trial addressing HIV care barriers, mental health, and substance use. Oral ART adherence was measured using a validated scale, with high adherence defined as a score ≥ 80%. For participants on LAI-ART, high adherence was defined as having no missed or delayed injection visits. We assessed the associations between financial well-being (i.e., unmet subsistence needs, overall financial situation, and mobile technology vulnerability) and adherence using descriptive statistics and adjusted prevalence ratios (PRs) estimated with log-Poisson models with robust standard errors. Among 201 participants, the median age was 27 years. Most (89.1%, n = 179) used oral ART, while 10.0% (n = 20) received LAI-ART. High adherence was achieved by 69.8% of oral ART users and 90% of LAI-ART users. Participants who reported they could "barely get by" financially had significantly lower adherence compared to those living comfortably (RR 0.70, 95% CI 0.52-0.95). Greater unmet subsistence needs were also associated with reduced adherence (RR 0.85, 95% CI 0.73-0.99). Financial well-being was linked to adherence among YWH using both oral and LAI-ART. Efforts to reduce financial hardship may support improved HIV treatment outcomes.