Factors Associated with Antiretroviral Therapy Adherence among Adolescents Living with HIV in Ethiopia: Structural Equation Modeling

Background This study aims to develop and validate a model of antiretroviral therapy (ART) adherence determinants among Ethiopian adolescents living with HIV by extending the information-motivation-behavioral skills (IMB) model through the integration of HIV-related stigma as an additional construct, given its significant influence on adherence in this population. Methods A cross-sectional study was conducted from March to October 2024 among 219 adolescents living with HIV in Addis Ababa. The data were analyzed via SPSS and the lavaan 0.6–18 package in R. The pathways through which the study constructs influenced ART adherence were estimated via the diagonally weighted least squares (DWLS) method. Model fit was evaluated via the chi-square to degrees of freedom ratio (χ²/df), comparative fit index (CFI), Tucker–Lewis index (TLI), and root mean square error of approximation (RMSEA). Results The findings of the study revealed that ART knowledge and ART attitudes had significant indirect effects on ART adherence (β = .12, p = .021 and β = .10, p = .021, respectively). Social support had direct (β = .18, p = .039) and indirect (β = .08, p = .012) effects on ART adherence. HIV stigma had no significant direct (β=-.21, p = .192) or indirect (β = .10, p = .082) effects on ART adherence. Treatment self-efficacy mediated the relationships among ART knowledge, ART attitudes, social support, and ART adherence. Conclusion Treatment self-efficacy mediated ART adherence among adolescents, with social support showing direct and indirect effects, whereas ART knowledge, attitudes, and stigma had no significant direct effects, highlighting the importance of treatment self-efficacy in ART adherence.