Table 1.

Summary of Factors Associated with Treatment Adherence and Health Outcomes among Youth Living with HIV

Category of Risk/Protective Factor	Factors Associated with Negative Outcome	Factors Associated with Positive Outcome
Demographic	Male gender	Female gender
Psychological, cognitive, and behavioral	Psychological distress Alcohol use Feeling like a burden on others Resentment for being infected Denial/anger of lifelong ART treatment Fear of HIV disclosure (family, school, clinic, peers, partner) Desire to not feel different Non-adherence as a tactic to hurt others Changing weekly routine Conflict with day-to-day activities Conflict with leisure activities (parties, alcohol use) Spending nights away from home Belief in traditional healing Forgetfulness	Having reasons to live Recognition of health benefits Personal agency Belief that HIV-negative peers also have health problems Motivation to stay in school Use of ARV concealment strategies Prayer Attendance at religious services Reminders to take medication and go to clinic Keeping a daily routine
Treatment/disease-related	High (> 350) or very low (<100) CD4 count Advanced disease (WHO State III/IV) First treated with efavirenz (compared to nevirapine) On cotrimoxazole prophylactic therapy Burden of ARV pill amount, size, smell, and taste Burden of daily ARV use ARV side effects Not knowing own HIV status ART initiation as an older adolescent (vs. at a younger age)	High CD4 count (> 350) Advanced disease (WHO Stage IV) On ART On TB treatment (pre-ART care only) Pill ARV delivery (compared to syrup) Once daily ARV regimen (vs. more frequent ARV use) Knowledge of HIV status
HIV clinic	Peer groups at clinic not age-specific Adolescent-specific clinic hours Clinic screens for STIs Attendance at HIV clinic alone Poor provider support Rushed clinic appointments Long clinic wait times Inadequate post HIV test counseling Lack of confidentiality and privacy at clinic Conflicting expectations for self-care from HIV clinic	Peer support groups at clinic Clinic has adolescent peer educators Clinic provides condoms Urban clinic setting (vs. semi-urban) Provider support HIV testing during hospitalization VCT entry into care (vs. other points of entry) Same day treatment following HIV diagnosis
Family and peers	Non-disclosure of HIV status at home Lack of family adherence support Discrimination at home Anti-ART family beliefs Death of parent or spouse due to HIV infection Stigma felt by caregivers who pick up ARVs Lack of privacy at home or foster care Avoidance by friends and colleagues in close relationships Conflict with time spent forming peer relationships	HIV disclosure to family and peers HIV treatment-related support from family Tangible support (money, food, rides) from family Emotional support from family Living with HIV-positive family member Parents bring ARVs to boarding school Parent present during HIV diagnosis HIV-negative peer support HIV treatment-related from peers and partners
School	Non-disclosure of HIV status to school staff Discrimination at school School policy on absenteeism Lack of privacy for taking ARVs at school	Supportive school staff Being in school (vs. out of school) HIV-negative peer support at school
Economic resources	Low access to food/water to take ARV pills Costs of transportation Costs of non-ARV medication