Determinants of Antiretroviral Therapy Interruption among Adolescents Living with HIV in Yirol West County, South Sudan

Abstract

Background: Adolescents living with HIV have poorer retention in care and higher rates of interruption in treatment than children and adults, especially in fragile settings. Evidence from South Sudan remains limited. This study examined determinants of antiretroviral therapy interruption among adolescents living with HIV in Yirol West County, South Sudan. Methods: A facility-based cross-sectional analytical study was conducted from February to March 2026 among 299 adolescents aged 10–19 years receiving antiretroviral therapy at six health facilities in Yirol West County. ART interruption was defined as missing ART for more than 28 consecutive days in the previous 12 months, based on self-report and verified with routine clinical or pharmacy records where available. Data was collected using interviewer-administered structured questionnaires and routine clinical records. Descriptive statistics summarized participant characteristics and treatment patterns. Bivariate associations were examined using chi-square and Fisher’s exact tests. Variables meeting the study inclusion criterion at bivariate level were entered into multivariable regression analysis to identify independent predictors of ART interruption. Statistical significance was considered at p < .05 Results: The prevalence of ART interruption in the previous 12 months was 57.5%, and 50.2% of participants reported missing medication for 28 days or more. Although knowledge about ART was almost universal, interruption remained common. Significant individual-level factors included feeling ashamed, shame related to HIV status, fear of being seen collecting ART, and non-disclosure of HIV status. Family-level factors included caregiver reminders and the availability of someone at home to talk to when facing problems; household emotional support remained statistically significant in multivariable analysis. Community-level factors included stigma or discrimination, fear of disclosure, peer support, and participation in cattle camp movement. Health-system factors included distance to the ART facility, appointment clashes with school or other activities, and prolonged medication gaps. Conclusion: ART interruption among adolescents in Yirol West County was common and associated with interconnected psychosocial, interpersonal, community, and structural factors. Despite widespread treatment knowledge, interruption persisted, suggesting that education alone is insufficient when adolescents face stigma, limited household support, mobility, and difficult access to care. Adolescent HIV programs in Yirol West County and similar fragile settings should strengthen caregiver engagement, stigma reduction, psychosocial support, and flexible service delivery approaches that respond to distance and mobility barriers.