Evaluating a Structured Disclosure Intervention for Perinatally Infected Adolescents in Botswana: A Mixed Methods Study of Antiretroviral Therapy Adherence and Viral Load Outcomes

Adolescents with perinatally acquired HIV in Botswana often experience non-disclosure of their status, a recognised barrier to optimal antiretroviral therapy adherence. Effective interventions to support disclosure for this group are needed. This study evaluated the effect of a structured, counsellor-facilitated disclosure intervention on antiretroviral therapy adherence and virological outcomes among perinatally infected adolescents. A concurrent mixed methods design was used. Quantitatively, a quasi-experimental cohort study compared viral load and self-reported adherence over 12 months between an intervention group (n=60) receiving the disclosure package and a standard-of-care control group (n=60). Qualitatively, post-intervention in-depth interviews were conducted with a purposively selected sub-sample of adolescents (n=25) and their caregivers to explore experiences and perceived impacts. Quantitatively, a significantly higher proportion of the intervention group achieved viral suppression (<1000 copies/mL) at 12 months (78%) compared to the control group (55%). Qualitative analysis identified key themes, including improved understanding of treatment, reduced internalised stigma, and enhanced caregiver communication, which participants associated with increased motivation for adherence. The structured disclosure intervention was associated with improved virological outcomes. Adolescents perceived it as a pivotal event enabling better HIV self-management, highlighting the value of formal, supported disclosure within adolescent care. Integration of structured, counsellor-led disclosure support into routine adolescent HIV services in Botswana is recommended. Further research should explore long-term sustainability and cost-effectiveness. HIV disclosure, perinatal infection, adolescents, antiretroviral therapy adherence, viral load, Botswana, mixed methods This study provides evidence for a structured disclosure intervention's potential to improve clinical and psychosocial outcomes for perinatally infected adolescents, informing service delivery in similar settings.