Young people with perinatally acquired human immunodeficiency viruses (HIV)

This mixed-methods study examines long-term treatment outcomes and adherence experiences among young people with perinatally acquired HIV receiving antiretroviral therapy (ART) in rural South Africa. Quantitative data from TIER.Net (n=583) were used to assess viral suppression, immunological recovery, and retention in care, while qualitative interviews explored barriers and facilitators to lifelong adherence. Viral suppression improved with ART duration, exceeding 80% after 11 years, alongside significant CD4 recovery, although outcomes varied by clinical stage at initiation and clinic of care. Retention was generally high but inconsistent across facilities. Qualitative findings indicate that adherence is shaped by delayed disclosure, psychosocial burden, food insecurity, transport barriers, and health system constraints, with missed doses reflecting routine disruptions rather than intentional non-adherence. Family support, healthcare worker engagement, and future aspirations emerged as key motivators. The findings highlight the need for integrated, youth-friendly interventions to support sustained ART adherence.