[Study on influencing factors of antiretroviral therapy medication adherence among adolescents living with HIV in Shandong Province: based on a structural equation model].

Objective: To explore the multidimensional influencing factors and their mechanisms on antiretroviral therapy medication adherence among HIV-infected adolescents aged 15-24 in Shandong Province, in order to promote treatment outcomes. Methods: A combination of stratified random sampling and convenience sampling was used to select HIV-infected adolescents aged 15-24 in Shandong Province for face-to-face questionnaire surveys. Data on demographic characteristics, medication adherence, depression, anxiety, AIDS awareness, and treatment self-efficacy were collected. Logistic regression models were employed to analyze the factors influencing medication adherence, and a structural equation model (SEM) was constructed to examine further the direct and indirect effects of these factors on adherence. Results: Among 546 HIV-infected adolescents, 43.77% had good medication adherence. Logistic regression analysis revealed that bisexuality (OR=0.62, 95%CI: 0.38-0.99), depression (OR=0.90, 95%CI: 0.84-0.95), AIDS awareness level (OR=1.15, 95%CI: 1.06-1.24), and treatment self-efficacy (OR=1.02, 95%CI: 1.01-1.03) were independent influencing factors of adherence. The SEM revealed that psychological distress had a direct negative effect on adherence (β=-0.16, P=0.010), while health adaptation and AIDS awareness positively enhanced adherence through direct effects (β=0.32 and 0.26, both P<0.001). Sexual behavior characteristics indirectly reduced adherence by exacerbating psychological distress (β=0.07, P=0.042). Conclusions: High level of psychological distress, insufficient health adaptation ability, and low AIDS awareness are core risk factors for poor medication adherence among HIV-infected adolescents in Shandong Province. Multidimensional strategies that integrate psychological interventions, health education, and risk behavior management are needed to improve medication adherence.