Identifying Latent Profiles of Adolescent ART adherence and the Factors influencing Membership

Background: Adolescents living with HIV (ALHIV) in sub-Saharan Africa (SSA) face significant challenges in maintaining adherence to antiretroviral therapy (ART). We aimed to identify ART adherence latent profiles among ALHIV in Uganda, and explore the factors associated with profile membership. Methods: We analyzed baseline data from 702 ALHIV aged 10–16 years enrolled in the Suubi + Adherence Study, a cluster-randomized controlled trial in Southern Uganda. ART adherence was assessed using six self-reported items, which were linearized and analyzed using latent profile analysis (LPA) to identify adherence profiles. The relationship between factors including age, gender, HIV knowledge, pill burden, depressive symptoms, and duration of living with HIV, and profile membership was examined using multinomial logistic regression—with high adherence group being the reference profile. Model fit was evaluated using Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and entropy. Results: Three adherence profiles emerged including High (comprising 13.8% of the sample), Moderate (15.4%), and Low Adherence (70.8%). Adolescents in the High Adherence Profile reported minimal challenges, while those in the Low Adherence Profile faced frequent medication misses and high perceived difficulty. Key predictors for belonging to the Moderate Adherence Profile included older age, being in school, and depressive symptoms, while being female and shorter duration living with HIV predicted membership to the Low Adherence Profile. Notably, higher pill burden was associated with better adherence, suggesting the role of structured support for complex regimens. Conclusion: This study identified three distinct adherence profiles among ALHIV, suggesting the need for tailored interventions that target the different profiles. By moving beyond standardized approaches, these findings offer new insights into understanding adherence. Future research should evaluate the impact of targeted interventions for these adherence profiles.