Understanding Antiretroviral Therapy Adherence in Children With HIV: A Review of Barriers and Strategies

Abstract

Introduction: Despite advancements in antiretroviral therapy (ART) availability, maintaining optimal adherence remains difficult, especially in low- and middle-income countries (LMICs). This literature review synthesized evidence on barriers and interventions influencing adherence to ART among children and adolescents with HIV, focusing on studies conducted in LMICs, particularly in Africa and Asia, where adherence and challenges are more prevalent. Methods: This narrative review draws on peer-reviewed studies to identify barriers to ART adherence, such as medication complexity, caregiver-related issues, socioeconomic factors, and healthcare infrastructure limitations. A thorough search was conducted using electronic databases like PubMed, Google Scholar, and Scopus, covering relevant primary and secondary literature from 2010 to 2023 in LMICs in Africa and Asia. It also evaluates the effectiveness of digital tools and psychosocial interventions in enhancing adherence to ART among children with HIV. Results and Discussion: Findings reveal that adherence remains suboptimal, with rates ranging from 62% to 95% across settings. Major barriers include regimen complexity, psychosocial stressors, and limited healthcare access, while interventions such as digital adherence tools, caregiver education, and community-based programs demonstrate measurable improvements. Evidence highlights that targeted interventions can improve outcomes. Family support programs in Uganda increased adherence from 66% to 83%, and SMS reminder systems improved adherence by up to 5.5% among adolescents. Nevertheless, recent reductions in international funding pose a substantial threat to the sustainability of these gains in resource-limited settings. Conclusion: Improving adherence among children and adolescents requires not only simplified regimens and psychosocial support but also sustainable financing mechanisms. Future strategies must anticipate barriers related to funding cuts, drug resistance, and the transition from pediatric to adult care.