{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:07:40Z","timestamp":1777853260764,"version":"3.51.4"},"reference-count":76,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Assoc Provid AIDS Care"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>Adherence to antiretroviral therapy (ART) is lower in adolescents with HIV (AWH) than in any other age group, partly due to self-regulatory challenges during development. Mindfulness and acceptance training have been shown to support psychological flexibility, a self-regulatory skill that potentially improves adolescent adherence to medication. We assessed the effect of weekly group-based mindfulness and acceptance training sessions on ART adherence among older adolescents (15\u201319 years) in Kampala, Uganda. One hundred and twenty-two AWH (median age 17, range 15\u201319 years, 57% female) receiving care at a public health facility in Kampala were randomized 1:1 to receive 4 weekly 90-min group sessions facilitated by experienced trainers or standard-of-care ART services. The training involved (Session 1) clarifying values, (Session 2) skillfully relating to thoughts, (Session 3) allowing and becoming aware of experiences non-judgmentally, and (Session 4) exploring life through trial and error. At baseline, postintervention, and 3-month follow-up, psychological flexibility was measured using the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8), and self-reported ART adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). At baseline, the intervention and standard-of-care arms had similar psychological flexibility (AFQ-Y8 score:15.45\u2009\u00b1\u20090.82; 15.74\u2009\u00b1\u20090.84) and ART adherence (MMAS-8 score: 5.32\u2009\u00b1\u20090.24; 5.13\u2009\u00b1\u20090.23). Retention through the study was moderate (71%). Completion of mindfulness and acceptance training was associated with a significant reduction in psychological inflexibility at the 3-month follow-up (AFQ-Y8 score: 12.63\u2009\u00b1\u20091.06; 14.05\u2009\u00b1\u20091.07, P\u2009=\u2009.006). However, no significant differences were observed in self-reported adherence to ART at the 3-month follow-up (MMAS-8 score: 5.43\u2009\u00b1\u20090.23; 4.90\u2009\u00b1\u20090.33, P\u2009=\u2009.522). Group-based mindfulness and acceptance training improved psychological flexibility in this population of adolescents on ART in Uganda but did not significantly improve ART adherence. Future research should explore integrated approaches that combine behavioral management training with other empowerment aspects to improve ART adherence among AWH.<\/jats:p>","DOI":"10.1177\/23259582241236260","type":"journal-article","created":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T14:15:15Z","timestamp":1709734515000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["The Effect of a Group-Based Mindfulness and Acceptance Training on Psychological Flexibility and Adherence to Antiretroviral Therapy Among Adolescents in Uganda: An Open-Label Randomized Trial"],"prefix":"10.1177","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2825-9105","authenticated-orcid":false,"given":"Khamisi","family":"Musanje","sequence":"first","affiliation":[{"name":"Clinical Epidemiology Unit, Makerere University, Kampala, Uganda"},{"name":"Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moses R.","family":"Kamya","sequence":"additional","affiliation":[{"name":"Department of Medicine, Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosco","family":"Kasujja","sequence":"additional","affiliation":[{"name":"Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wouter","family":"Vanderplasschen","sequence":"additional","affiliation":[{"name":"Department of Special Needs Education, Ghent University, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah L.","family":"Sinclair","sequence":"additional","affiliation":[{"name":"Department of Special Needs Education, Ghent University, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin M.","family":"Baluku","sequence":"additional","affiliation":[{"name":"Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond F.","family":"Odokonyero","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles P.","family":"Namisi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Mukisa","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ross G.","family":"White","sequence":"additional","affiliation":[{"name":"School of Psychology, Queens University, Belfast, Northern Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol S.","family":"Camlin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,3,6]]},"reference":[{"key":"bibr1-23259582241236260","volume-title":"Global update on HIV treatment 2013: results, impact and opportunities","author":"WHO","year":"2013"},{"key":"bibr2-23259582241236260","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-020-09717-y"},{"key":"bibr3-23259582241236260","unstructured":"WHO.\n                      Global HIV program. 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