{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T09:11:07Z","timestamp":1790327467754,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MC_UU_00004\/03andMC_UU_00004\/04"],"award-info":[{"award-number":["MC_UU_00004\/03andMC_UU_00004\/04"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["227167\/A\/23\/Zand224310\/Z\/21\/Z"],"award-info":[{"award-number":["227167\/A\/23\/Zand224310\/Z\/21\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The BREATHER\u2010Plus trial was an open\u2010label, randomized non\u2010inferiority trial comparing weekends off antiretroviral therapy (ART) (short cycle therapy [SCT]) with daily oral ART (continuous therapy [CT]) for adolescents aged 12\u201319 years. We present findings from the qualitative sub\u2010study on the factors influencing trial participants\u2019 decisions to take\/not take ART in accordance with their randomized arm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Qualitative data collection was conducted in South Africa and Uganda from December 2022 to July 2024 using in\u2010depth interviews (IDIs) and focus group discussions (FGDs). We purposively recruited 29 trial participants (14 SCT\/15 CT arm) to take part in IDIs in South Africa. From the trial sites in both countries, 47 trial participants, 17 non\u2010trial participants, 15 caregivers and 16 healthcare providers took part in FGDs. Data collection with trial participants focused on adherence to SCT compared to daily ART; the acceptability of SCT and the experience of taking part in the trial. All FGDs explored the feasibility of SCT and preferences for alternative approaches to accessing therapy. Data were analysed thematically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both IDI and FGD data showed that the opportunity to have weekends off from treatment was welcomed by participants, caregivers and healthcare providers. However, the understanding of \u201c2 days off\u201d treatment was interpreted flexibly by some participants. Trial participants in both arms described their fluctuating adherence practices both prior to and during the trial. The introduction of SCT as a possibility through the trial prompted some to talk about previously concealed missed doses. Participants reported that they only mentioned missed doses in the clinic if they had a raised viral load result or had returned to the clinic with too many pills. Many participants relied on their viral load result to confirm that non\u2010adherent behaviour was not problematic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings offer insights into the factors that shape ART adherence among adolescents living with HIV. Adherence is not a static behaviour but a socially embedded and relational practice, shaped by adolescents\u2019 interpretations of treatment, interpersonal relationships and the structure of care environments. Regimen modification alone does not resolve the broader social and emotional challenges adolescents face.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70207","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:00:33Z","timestamp":1790100033000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding Adolescent Anti\u2010Retroviral Therapy Use in the BREATHER\u2010Plus Trial: Qualitative Findings From South Africa and Uganda"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7787-1401","authenticated-orcid":false,"given":"Londiwe","family":"Shandu","sequence":"first","affiliation":[{"name":"Africa Health Research Institute  KwaZulu\u2010Natal South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9217-3418","authenticated-orcid":false,"given":"Stella","family":"Namukwaya","sequence":"additional","affiliation":[{"name":"MRC\/UVRI and LSHTM Uganda Research Unit  Entebbe Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8803-3696","authenticated-orcid":false,"given":"Tamlyn Carmin","family":"Seunanden","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute  KwaZulu\u2010Natal South Africa"},{"name":"School of Nursing and Public Health University of KwaZulu\u2010Natal  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5630-6389","authenticated-orcid":false,"given":"Nothando","family":"Ngwenya","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute  KwaZulu\u2010Natal South Africa"},{"name":"School of Nursing and Public Health University of KwaZulu\u2010Natal  Durban South Africa"},{"name":"Department of Psychiatry University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3082-9234","authenticated-orcid":false,"given":"Moherndran","family":"Archary","sequence":"additional","affiliation":[{"name":"MRC\/UVRI and LSHTM Uganda Research Unit  Entebbe Uganda"},{"name":"Enhancing Care Foundation, Department of Paediatrics and Children Health Victoria Mxenge Hospital University of KwaZulu\u2010Natal  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9286-7052","authenticated-orcid":false,"given":"Cissy","family":"Kityo","sequence":"additional","affiliation":[{"name":"Joint Clinical Research Centre  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1713-6302","authenticated-orcid":false,"given":"Deborah","family":"Ford","sequence":"additional","affiliation":[{"name":"Medical Research Council Clinical Trials Unit at University College London (UCL)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4851-4727","authenticated-orcid":false,"given":"Sarah L.","family":"Pett","sequence":"additional","affiliation":[{"name":"Medical Research Council Clinical Trials Unit at University College London (UCL)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8240-1796","authenticated-orcid":false,"given":"Adeodata R.","family":"Kekitiinwa","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children's Foundation  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7628-8408","authenticated-orcid":false,"given":"Sarah","family":"Bernays","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Global Health and Development London School of Hygiene &amp; Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0583-5272","authenticated-orcid":false,"given":"Janet","family":"Seeley","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute  KwaZulu\u2010Natal South Africa"},{"name":"MRC\/UVRI and LSHTM Uganda Research Unit  Entebbe Uganda"},{"name":"School of Nursing and Public Health University of KwaZulu\u2010Natal  Durban South Africa"},{"name":"Department of Global Health and Development London School of Hygiene &amp; Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the BREATHER\u2010Plus trial team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0010307"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.261568398"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1310\/hct0801\u201019"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkx434"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2018.0320"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103018(16)30054\u20106"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta20490"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0196239"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102016\u2010012934"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103018(21)00300\u20103"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkab442"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idnow.2025.105164"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103018(25)00326\u20101"},{"issue":"1","key":"e_1_2_10_15_1","first-page":"1","article-title":"Challenges to HIV Treatment Adherence Amongst Adolescents in a Low Socio\u2010Economic Setting in Cape Town","volume":"20","author":"Wyk B. E.","year":"2019","journal-title":"Southern African Journal of HIV Medicine"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.2989\/16085906.2018.1534748"},{"issue":"2","key":"e_1_2_10_17_1","first-page":"93","article-title":"Adherence to HIV Care and Associated Health Functioning Among Youth Living With HIV in Sub\u2010Saharan Africa","volume":"22","author":"Tarantino N.","year":"2020","journal-title":"AIDS Review"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000003473"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473\u20103099(13)70363\u20103"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889\u2010018\u20106048\u20107"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26153"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmqr.2025.100560"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/JNC.0000000000000089"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40262\u2010013\u20100093\u20102"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742\u20101241.1999.tb11662.x"},{"key":"e_1_2_10_26_1","volume-title":"WHO Recommends Dolutegravir as Preferred HIV Treatment Option in all Populations","year":"2019"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000004212"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.70207","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.70207","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.70207","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T08:41:26Z","timestamp":1790325686000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.70207"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":26,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/jia2.70207"],"URL":"https:\/\/doi.org\/10.1002\/jia2.70207","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-03-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70207"}}