Maintaining control: challenges and facilitators to medication adherence among young adults with HIV and recent criminal legal system experience or high risk for system involvement

Non-adherence is of critical concern among youth with HIV (YWH). Socioeconomic and psychosocial determinants often prevent YWH’s consistent engagement in HIV antiretroviral therapy (ART). These barriers are further exacerbated among YWH with or at-risk for criminal-legal involvement; however, few studies have explored adherence in this population. The LINK2 intervention utilized Youth Service Navigators (YSNs) to engage participants (n = 35) and included weekly check-in calls to problem-solve barriers to and identify enablers of ART adherence. YSNs administered a standardized call script and systematically recorded summaries of participants’ responses. A qualitative analysis of these summaries identified themes related to ART adherence. When asked about factors contributing to missed doses, the most prevalent code was “forgot.” Other codes associated with poor adherence such as “going out,” “busy,” “slept through” and “routine change” contributed to participants’ not remembering medication doses; whereas external structural forces (“access to meds,” “unmet basic needs”) more directly interfered with adherence. The most prevalent codes related to adherence support were “established routine” and “used reminder tools” – options that YLWH have the opportunity to engage, regardless of external forces. Participants commonly described adherence factors that reflected their level of control over their daily lives, with influences from both internal and external forces.