{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:52:59Z","timestamp":1789563179799,"version":"build-2803163510"},"reference-count":25,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Institutes of Health \/ National Institute of Child Health and Human Development","award":["UG3 HD96915-01"],"award-info":[{"award-number":["UG3 HD96915-01"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Assoc Provid AIDS Care"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While research has identified many associations between socioeconomic factors and human immunodeficiency virus (HIV) nonsuppression, few qualitative studies have defined the mechanisms by which these factors interrelate and lead to HIV nonsuppression. The development of interventions to achieve universal virologic suppression and eliminate transmission will require a deeper understanding of the individual and social processes that drive antiretroviral therapy (ART) nonadherence and consequent viral nonsuppression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used a semistructured interview-based case-study approach to characterize changes across 3 time points in the lived contexts of 11 adolescents and young adults (aged 15-24 years) from intervention and control arms of a longitudinal HIV intervention trial in rural Kenyan and Ugandan communities. We sought to determine commonalities among those who never virally suppressed, those who became nonsuppressed, and those who moved from nonsuppression to viral suppression, exploring social and behavioral micro-processes or causal chains observed among individuals who share these trajectories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We found that supportive family environments, high-quality service provision, and residential and partnership stability free of violence, or that permitted freedom to move and maintain extensive social ties both inside and outside one's immediate community, enabled ART adherence. We also found that several factors combine to have effects beyond each individual factor taken singly, for example, medication side effects were influenced by food insecurity; disclosure was most effective with individuals around whom one may potentially take medication, such as co-resident partners; and mobility compromised adherence when patients did not know how or where to access care in new places.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Recommendations<\/jats:title>\n                    <jats:p>Our findings suggest that to improve virologic suppression, clinical care and interventions should include assessment and strategies to address food insecurity, ART disclosure, and home-based violence from intimate partners or other family members. When such factors are present, we suggest referral for services, including violence prevention and protection services, and food provision for those patients who do not adhere because of medication side effects amplified by lack of food. We further recommend that clinics coordinate regionally to anticipate mobility, facilitate transfer of care to other areas, and ensure clients have access to information about care clinics elsewhere in the region.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259582251337202","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T20:37:43Z","timestamp":1747341463000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Trajectories to HIV Viral Suppression and Nonsuppression: Case Studies From Rural East African Adolescents and Young Adults in the SEARCH-Youth Trial"],"prefix":"10.1177","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9561-6366","authenticated-orcid":false,"given":"Jason","family":"Johnson-Peretz","sequence":"first","affiliation":[{"name":"University of California San Francisco (UCSF)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjeline","family":"Onyango","sequence":"additional","affiliation":[{"name":"RCTP-CMR-SEARCH, Kenya Medical Research Institute (KEMRI), Kisumu, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Akatukwasa","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9010-5953","authenticated-orcid":false,"given":"Fredrick","family":"Atwine","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3921-9280","authenticated-orcid":false,"given":"Titus M. O.","family":"Arunga","sequence":"additional","affiliation":[{"name":"RCTP-CMR-SEARCH, Kenya Medical Research Institute (KEMRI), Kisumu, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Owino","sequence":"additional","affiliation":[{"name":"RCTP-CMR-SEARCH, Kenya Medical Research Institute (KEMRI), Kisumu, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9467-0950","authenticated-orcid":false,"given":"Florence","family":"Mwangwa","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn","family":"Nyabuti","sequence":"additional","affiliation":[{"name":"RCTP-CMR-SEARCH, Kenya Medical Research Institute (KEMRI), Kisumu, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Kabami","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura B.","family":"Balzer","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of California Berkeley, Berkeley, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane V.","family":"Havlir","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Ayieko","sequence":"additional","affiliation":[{"name":"RCTP-CMR-SEARCH, Kenya Medical Research Institute (KEMRI), Kisumu, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore","family":"Ruel","sequence":"additional","affiliation":[{"name":"University of California San Francisco (UCSF)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Bukusi","sequence":"additional","affiliation":[{"name":"RCTP-CMR-SEARCH, Kenya Medical Research Institute (KEMRI), Kisumu, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin D.","family":"Charlebois","sequence":"additional","affiliation":[{"name":"University of California San Francisco (UCSF)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9106-4234","authenticated-orcid":false,"given":"Moses Robert","family":"Kamya","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration"},{"name":"Department of Medicine, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol S.","family":"Camlin","sequence":"additional","affiliation":[{"name":"University of California San Francisco (UCSF)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(23)00118-2"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19031085"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-016-0930-0"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1521\/aeap.2013.25.3.216"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2019.05.002"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-020-09121-6"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-023-15356-w"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.4.21528"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60072-5"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.19.232702"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0000000000000449"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0202990"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-019-4732-6"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.2147\/HIV.S376053"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-022-07428-w"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.4314\/rjmhs.v6i1.6"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0246140"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0196259"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.4.21591"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001369"},{"key":"e_1_3_3_22_2","unstructured":"Web application for managing analyzing and presenting qualitative and mixed method research data. 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