Background Thai youth living with HIV (YLHIV) aged 15–24 demonstrate poorer antiretroviral therapy (ART) adherence than adults; however, factors associated with self-management behaviors and adherence remain insufficiently understood. This study examined psychosocial, clinical, and relational factors associated with HIV self-management behaviors and ART adherence. Methods A cross-sectional study recruited 210 participants (minimum 10 participants per estimated parameter), aged 15–24, from six tertiary hospitals in the Bangkok Metropolitan Region between May 1 and November 30, 2024. Participants completed self-administered questionnaires during routine clinic visits. Mediation analysis examined associations of depressive symptoms, comorbidities, family support, peer support, perceived public stigma, and patient-healthcare provider relationship with ART adherence (30-day Visual Analog Scale; good adherence ≥ 95%) through HIV self-management behaviors, adjusting for education, HIV disclosure status, and ART duration. Results Participants had a mean age of 21.65 years (SD = 2.15) with 90% aged between 19 and 24 years; 74.8% were male. The model explained 69.8% of the variance in ART adherence. HIV self-management behaviors were positively associated with adherence (βz = 0.237, p < 0.01). Depressive symptoms (βz = − 0.210, p < 0.01), comorbidities (βz = − 0.129, p < 0.05), and perceived public stigma (βz = − 0.224, p < 0.01) were negatively associated with HIV self-management behaviors, while family support (βz = 0.148, p < 0.05), and patient-healthcare provider relationship (βz = 0.153, p < 0.05) were positively associated. Depressive symptoms (βz = − 0.196, p < 0.01), comorbidities (βz = − 0.111, p < 0.05), and perceived public stigma (βz = − 0.169, p < 0.05) were negatively associated with ART adherence, while family support (βz = 0.155, p < 0.01) and patient-healthcare provider relationship (βz = 0.128, p < 0.05) were positively associated. All associations, except comorbidities, were partially mediated by HIV self-management behaviors. Peer support was not significantly associated with either outcome. Conclusions Among Thai YLHIV receiving ART care in tertiary hospitals in the Bangkok Metropolitan Region, predominantly older adolescents and young adults, ART adherence was associated with psychosocial, relational, and clinical factors, with significant indirect associations observed through HIV self-management behaviors. Findings support multi-component, developmentally appropriate strategies integrating mental health screening, stigma reduction, family engagement, youth-sensitive communication, and coordinated management of comorbid conditions. Strengthening HIV self-management capacity represents an important target for comprehensive adherence support among this population. Clinical trial number Not applicable.

Key determinants of antiretroviral therapy adherence among Thai youth living with HIV: the mediating role of HIV self-management behaviors

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2026年8月5日

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Pairin Saenjun,
Tassanee Prasopkittikun,
Nopporn Vongsirimas,
Wantana Maneesriwongul,
Jutarat Mekmullica,
Joachim G. Voss

摘要

Background

Thai youth living with HIV (YLHIV) aged 15–24 demonstrate poorer antiretroviral therapy (ART) adherence than adults; however, factors associated with self-management behaviors and adherence remain insufficiently understood. This study examined psychosocial, clinical, and relational factors associated with HIV self-management behaviors and ART adherence.

Methods

A cross-sectional study recruited 210 participants (minimum 10 participants per estimated parameter), aged 15–24, from six tertiary hospitals in the Bangkok Metropolitan Region between May 1 and November 30, 2024. Participants completed self-administered questionnaires during routine clinic visits. Mediation analysis examined associations of depressive symptoms, comorbidities, family support, peer support, perceived public stigma, and patient-healthcare provider relationship with ART adherence (30-day Visual Analog Scale; good adherence ≥ 95%) through HIV self-management behaviors, adjusting for education, HIV disclosure status, and ART duration.

Results

Participants had a mean age of 21.65 years (SD = 2.15) with 90% aged between 19 and 24 years; 74.8% were male. The model explained 69.8% of the variance in ART adherence. HIV self-management behaviors were positively associated with adherence (β_z = 0.237, p < 0.01). Depressive symptoms (β_z = − 0.210, p < 0.01), comorbidities (β_z = − 0.129, p < 0.05), and perceived public stigma (β_z = − 0.224, p < 0.01) were negatively associated with HIV self-management behaviors, while family support (β_z = 0.148, p < 0.05), and patient-healthcare provider relationship (βz = 0.153, p < 0.05) were positively associated. Depressive symptoms (β_z = − 0.196, p < 0.01), comorbidities (β_z = − 0.111, p < 0.05), and perceived public stigma (β_z = − 0.169, p < 0.05) were negatively associated with ART adherence, while family support (β_z = 0.155, p < 0.01) and patient-healthcare provider relationship (β_z = 0.128, p < 0.05) were positively associated. All associations, except comorbidities, were partially mediated by HIV self-management behaviors. Peer support was not significantly associated with either outcome.

Conclusions

Among Thai YLHIV receiving ART care in tertiary hospitals in the Bangkok Metropolitan Region, predominantly older adolescents and young adults, ART adherence was associated with psychosocial, relational, and clinical factors, with significant indirect associations observed through HIV self-management behaviors. Findings support multi-component, developmentally appropriate strategies integrating mental health screening, stigma reduction, family engagement, youth-sensitive communication, and coordinated management of comorbid conditions. Strengthening HIV self-management capacity represents an important target for comprehensive adherence support among this population.

Clinical trial number

Not applicable.