. 2025 Aug 18;59:e20250026. doi: 10.1590/1980-220X-REEUSP-2025-0026en

Chart 2. Summary of determinants identified in the studies included (n = 39) in the scoping review. Maringa, PR, Brazil, 2024.

Dimension of the determinants	Social determinants of adherence to antiretroviral therapy among adolescents and young people living with HIV
Dimension of the determinants	Promoters	Limiting factors
Dimension 1: Individual Characteristics	1. Understanding health and treatment: Increased health literacy⁽²³⁾ Knowledge of serological status^(25,48) Understanding the disease⁽²⁶⁾ Understanding the relevance of medication⁽³¹⁾ Knowledge of the effectiveness of ART⁽³⁶⁾ Perceived usefulness of HIV medications⁽⁴⁵⁾ 2. Motivation and self-efficacy: They hope to extend their life by at least 10 years⁽¹²⁾ Personal goal-oriented motivators⁽³¹⁾ I wish to be healthy and live⁽³⁷⁾ Motivational readiness for ART⁽³⁸⁾ Greater self-efficacy^{(38, 40)} Ways to self-motivate to achieve adherence⁽⁴³⁾ 3. Treatment management strategies: Use of memory aids⁽³¹⁾ Use of reminders⁽⁴³⁾ Concealment strategies⁽⁴³⁾ They instinctively know when it’s time to use their antiretrovirals⁽⁴³⁾ 4. Personal attitudes and beliefs: Fear of negative consequences of non-adherence⁽³⁴⁾ Life satisfaction⁽⁴⁶⁾	1. Age- and development-related factors: Young people with more advanced age^{(17,33,42,46)} Stunted growth⁽²⁵⁾ 2. Forgetfulness and lack of consistency: Forgetfulness^{(20,22,32–34,37)} Teenager never takes ART while away⁽²⁵⁾ Having lost doses of ART due to failure to collect them at the pharmacy⁽²¹⁾ 3. Lack of motivation and refusal of ART: Not feeling like taking medication⁽²⁰⁾ Not wanting to be reminded of HIV infection⁽²⁰⁾ Low self-efficacy in treatment⁽³²⁾ Teenager does not worry about ART⁽²⁵⁾ 4. Contextual factors: Male sex^(21,25,46) Female Sex⁽²⁵⁾ Being a double orphan⁽²⁵⁾ Lack of basic knowledge about HIV⁽³⁵⁾ Adolescents with horizontally acquired HIV⁽⁴²⁾
Dimension 2: Lifestyle and individual behaviors	1. Stability and routine of life: Stability of living situations⁽¹³⁾ Lifestyle and existence of a daily routine⁽³¹⁾ Adolescents on low-start and increasing adherence trajectories⁽⁵⁰⁾ 2. Mental health and well-being: Well-being and low psychological distress^(29,38,44) Less alcohol use^(17,29)	1. Mental health issues: Depression^{(14,16,17,19,24,35)} Psychological suffering^(20,29) Low mental health score⁽²⁵⁾ Unitary increase in psychological distress⁽²⁸⁾ Emotional problems⁽³¹⁾ Feeling depressed/overwhelmed⁽³²⁾ Self-reported unhappiness⁽³³⁾ 2. Substance Use: Substance use^(12,20,38) Marijuana use^(16,29) Alcohol use⁽³²⁾ 3. Distracting behaviors and activities: Being busy with other things⁽³²⁾ Having a boyfriend/girlfriend, frequent online chatting⁽³³⁾ 4. Non-adherence behaviors: Intentional refusal to take medication⁽⁴³⁾ Being sexually active⁽²⁵⁾
Dimension 3: Social and community networks	1. Family Support: Family support⁽¹⁸⁾ Administration of medication by parents⁽²⁵⁾ Family cohesion⁽³⁹⁾ Adolescent-caregiver communication⁽³⁹⁾ They disclosed their HIV status(mother)⁽¹²⁾ Having a caregiver with a partner⁽²⁵⁾ Have the person in charge present at each clinical meeting⁽²⁷⁾ 2. Support by the health professional: Support from the healthcare team⁽¹⁸⁾ Healthcare professionals providing support⁽²⁴⁾ Adolescents who were taught by a health professional how to take ART⁽²⁵⁾ Comfort in asking questions to the healthcare professional⁽²⁷⁾ 3. Peer and group social support: Peer support⁽²⁴⁾ Advice from healthcare professionals⁽²⁴⁾ Social and emotional support and peer group counseling⁽³³⁾ Support from treatment partners or family⁽⁴³⁾ Social support and counseling services⁽³⁶⁾ Community Resources for HIV⁽³⁶⁾ Greater social support^(38,45) 4. Coping Strategies and Resources: Coping (proactive coping strategies; turning to family; spiritual coping; professional help)⁽¹⁹⁾ Support in the home environment⁽³⁷⁾ Not taking medicine at school⁽¹⁷⁾ Teenager is unaware of caregiver’s health problems⁽²⁵⁾	1. Caregiver characteristics: Caregiver being widowed⁽²⁵⁾ Caregiver not having a religious practice⁽²⁵⁾ Low caregiver involvement⁽²⁵⁾ Low level of caregiver education⁽²⁵⁾ Low intellectual capacity assessed by the caregiver⁽³³⁾ Having grandparents or relatives as the primary caregiver⁽³³⁾ Having a grandparent as the primary caregiver⁽⁴⁶⁾ Caregiver being the only one who knows the child’s HIV status⁽²⁵⁾ 2. Impaired family and relational dynamics: Having a disorganized family and in loco parentis arrangements⁽²⁵⁾ Tense relationships with caregivers⁽³³⁾ Lack of care, support and love from the father⁽⁴³⁾ Blame whoever contaminated the mother⁽⁴³⁾ 3. Violence and trauma: Witnessing or experiencing violence at home⁽³²⁾ Loss of mother⁽³⁵⁾ 4. Communication and Collaboration: Poor communication with the doctor⁽³³⁾ Lack of collaboration between organizations and social norms⁽³⁶⁾
Dimension 4: Living and health conditions	1. Clinical aspects of treatment: CD4 level ≥ 500 cells/mm³⁽¹³⁾ Increased CD4+ counts⁽³⁴⁾ Viral loads <1000 copies/ml⁽⁴⁰⁾ Undetectable baseline viral load⁽⁴⁹⁾ Taking cotrimoxazole prophylaxis in conjunction with ART⁽²⁵⁾ Number of medications prescribed⁽¹³⁾ Absence of side effects and nutrition/diet⁽³¹⁾ Privacy to take the medicine⁽³¹⁾ Characteristics of the medicines (number and size of tablets, regimen)⁽³¹⁾ Once a day dosage⁽⁴⁰⁾ 2. Resources for living conditions and health: Participate in group sessions led by a professional facilitator⁽²⁷⁾ Food supply⁽²⁴⁾ Enough food to eat while taking the medication⁽⁴⁴⁾ Adequate supply of medicines⁽³⁶⁾ Those who received care for their concern within the unit⁽⁴⁷⁾ 3. Accessibility to health services: Short waiting time⁽²⁴⁾ Living closer to a clinic⁽³⁰⁾ Availability/accessibility (having transportation)^(24,31) Enough money to travel to the clinic⁽⁴⁴⁾ Travel close to home⁽³²⁾ Availability of free services⁽⁴⁵⁾	1. Poor housing and food conditions: Homelessness or lack of housing^(12,13) Lack of adequate nutrition⁽³⁶⁾ 2. Aspects related to treatment: Many pills^(12,24) Take 3 or more tablets per day⁽²⁵⁾ Difficulty in administering medication by the caregiver⁽²⁵⁾ Medication administered by the adolescent⁽²⁵⁾ Adolescents in the most advanced stage of HIV, presenting AIDS⁽¹⁷⁾ Previous history of opportunistic infection⁽⁴⁷⁾ RNA viral load ≥1000 copies/ml⁽³³⁾ Detectable baseline viral load⁽⁴⁹⁾ Not following the prescribed regimen⁽²⁸⁾ 3. Side effects and treatment burden: Medication-related adverse effects^{(15,24,35,41,43)} Medication intolerance⁽²⁵⁾ Drug fatigue^(24,31) Tired of taking medication every day for the rest of their lives⁽⁴³⁾ Perceived burden of treatment⁽⁴⁵⁾ Perceived effect of ART on physical appearance⁽⁴³⁾ 4. Low access and support from health services: Living far from work, whether in an urban or rural area⁽²⁵⁾ Living in remote areas⁽⁵⁰⁾ Low satisfaction with health care⁽¹⁹⁾ Lack of specific services for adolescents⁽³⁶⁾ Caregiver does not pay a fee for treatment⁽²⁵⁾ Complications in everyday routines⁽¹⁵⁾ Missing a doctor’s appointment in the last 6 months⁽³²⁾ Missing one or more doses of ART in the last week⁽³⁶⁾ Long waiting time at the clinic⁽³⁴⁾
Dimension 5: Socioeconomic, cultural and environmental conditions	1. Economic resources: Larger asset ownership, specifically family ownership of seven or more tangible assets⁽³⁰⁾ Greater economic advantage in household goods ownership, financial savings, and caregiver employment⁽³⁰⁾ Improvements in economic well-being ⁽⁴⁴⁾ within and between people 2. Stigma Reduction: Reducing internalized HIV stigma⁽⁴⁴⁾	1. Stigma and discrimination: Prejudice, discrimination and stigma^{(18,24,34,36,37)} Internalized stigma⁽⁴¹⁾ Feeling stigmatized by people outside and inside the home⁽³²⁾ Perceived resulting stigma and discrimination⁽⁴⁵⁾ 2. Fears related to disclosure: Fear of being seen taking antiretroviral medication^(22,24) Fear of disclosure^{(31,36,37,43)} Fear of disclosing HIV status to others, especially boys/girlfriends⁽³³⁾ 3. Socioeconomic conditions: Poverty^(24,36)

Source: Research data, 2024.