Abstract
We investigated how COVID-19-related disruptions influenced antiretroviral therapy (ART) adherence among young adults living with HIV (YALHIV) in Southern Uganda, a region with limited resources and high rates of HIV. Data were analyzed from 499 YALHIV aged 19 to 25, participating in the Suubi+Adherence-R2 COVID-19 Supplement study. The study measured COVID-19 disruptions using an 8-item Coronavirus Impact Scale and evaluated ART adherence through self-reported measures. Our analytical framework was informed by the Health Belief Model and generalized estimating equations were estimated. We find no statistically significant association between COVID-19 disruptions, as quantified by the COVID-19 Impact Score, and sub-optimal ART adherence (OR = 0.99, 95% CI [0.87-1.14]). However, findings revealed that being employed (OR = 1.99, 95% CI [1.07-3.71]) and older age (OR = 1.18, 95% CI [1.02-1.37]) was associated with higher likelihood of poor adherence highlighting the complex interplay between economic activity, working schedules, and health management. Other notable predictors included marital status, with cohabiting individuals showing decreased odds of poor adherence (OR = 0.25, 95% CI [0.08-0.74]) compared to single and separated YALHIV. These insights emphasize the need for multifaceted intervention strategies that consider both individual and systemic factors affecting ART adherence. Tailored interventions must address the socioeconomic challenges intensified by the pandemic and leverage the inherent resilience within this population to enhance ART adherence outcomes for YALHIV in challenging environments. Trial Registration ClinicalTrials.gov, ID: NCT01790373.