Background: Identifying risk and protective factors for adolescent antiretroviral therapy (ART) adherence is a public health priority, given high HIV-related mortality in this population. An area that merits further investigation is the relationship between bullying victimization, mental health problems, and ART non-adherence among adolescents living with HIV (ALHIV). However, no known studies assess effects of bullying on adolescent non-adherence, or risk and protective factors that could moderate this relationship.
Setting: This study investigates a) the direct longitudinal relationship between bullying exposure and ART non-adherence, and the indirect relationship via psychological distress, and b) potential risk and modifiable protective factors moderating these pathways, among vertically and horizontally infected ALHIV who initiated treatment across 53 public healthcare facilities in a South African health district.
Methods: Survey data was collected at two-time points, between 2014 and 2017, with 1046 ALHIV (94% retention). Various mediation and moderated mediation models were run as part of a staged analysis approach.
Results: A significant longitudinal relationship was found between bullying victimization and non-adherence, operating indirectly via psychological distress (B= 0.07; 95%CI: [0.03, 0.13]). Moderation analyses indicated that older adolescents exposed to bullying are more at risk of non-adherence (B =0.52; 95%CI: [0.07, 0.97] p
