A qualitative exploration of psychosocial determinants influencing viral load suppression among adolescents living with HIV: Application of social action theory

Background: Adolescents living with HIV continue to experience poorer treatment outcomes than adults, with consistently lower rates of adherence and viral load (VL) suppression. This population faces unique developmental, social and emotional challenges that heighten their vulnerability. Aim: This study aimed to explore the psychosocial determinants influencing VL suppression among adolescents living with HIV (ALHIV) in Mpumalanga province, South Africa, by applying the Social Action Theory (SAT). Setting: The study was conducted at Mpumalanga province in South Africa. Method: An explorative, descriptive qualitative design was used, and data were collected from September to November 2023. Data were collected through in-depth interviews using a semi-structured interview guide in a local language. Nineteen participants were interviewed. Thematic analysis was employed, and the theory of social action; context influences, process of social and self-change and states of action were followed to orient the findings. Results: Six major themes, structured according to the SAT constructs, emerged, namely: Stigma and emotional distress hindering adherence and socio-environmental barriers to treatment consistency; Family and peer support promoting motivation for adherence and developing self-awareness and coping mechanisms; and lastly, Acceptance and responsibility towards treatment and formation of health-protective routines. Conclusion: Adolescents who understand HIV diagnosis and understand the benefit of antiretroviral treatment are actively engaged in targeted behaviour and are influenced by beliefs about their abilities and potential outcomes rather than passively driven by external forces. Contribution: There is a need for psychosocial support and monitoring from family members to help adolescents achieve the suppression of VL and to ensure adherence with antiretroviral therapy.