{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:27:09Z","timestamp":1785421629314,"version":"3.56.0"},"reference-count":49,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background: Tremendous efforts and resources have been outlaid for human immunodeficiency virus (HIV) prevention and treatment globally; however, HIV and\/or acquired immunodeficiency syndrome (AIDS) management for children appears to always lag behind the progress made for adults. South Africa operates the most extensive HIV treatment programme in sub-Saharan Africa. Even with greater availability of antiretroviral therapy (ART), controlling the infection continues to be difficult. To reduce HIV-related deaths, retention on ART and viral suppression are crucial. Although advances in ART medication development provide great hope, improvement in care is still needed. In this review, challenges related to ART for children and adolescents living with HIV are highlighted.\nAim: To review the challenges experienced in the drug management of children and adolescent patients on antiretroviral therapy globally.\nMethod: An extensive online database search was conducted using keywords on Google Scholar, PubMed, Medline, ISI Web and Embase in February 2025, for English language literature published between 2015 and 2024 in the public healthcare sector. All studies (N = 33) that met the inclusion criteria and reported on challenges experienced by children and adolescents living with HIV from prematurity to 15 years, their caregivers, and prescribers of HIV treatment were retrieved and reviewed.\nResults: Challenges found in the management of HIV in children and adolescents included adherence monitoring, medicine-related factors, psychological factors, social factors and health system-related factors.\nConclusion: Challenges still exist in the management of children and adolescents living with HIV, despite the great strides made. Addressing these challenges is imperative and necessitates a multifaceted approach involving various interventions.\nContribution: The findings of this study emphasise the need for a holistic approach to addressing the identified challenges in order to improve treatment outcomes.<\/jats:p>","DOI":"10.4102\/phcfm.v18i1.5121","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T07:46:00Z","timestamp":1782459960000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Challenges with drug management of children and adolescents living with human immunodeficiency virus on antiretroviral therapy: A narrative review"],"prefix":"10.4102","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1689-0186","authenticated-orcid":false,"given":"Phumelele P.","family":"Mthethwa","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6925-2834","authenticated-orcid":false,"given":"Panjasaram","family":"Naidoo","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3087-2240","authenticated-orcid":false,"given":"Myra","family":"Taylor","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"ref0","unstructured":"UNAIDS 2024 epidemiological estimates. 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Correlation of hair and plasma efavirenz concentrations in HIV-positive South Africans. S Afr J HIV Med. 2019;20(1):a881. https:\/\/doi.org\/10.4102\/sajhivmed.v20i1.881","DOI":"10.4102\/sajhivmed.v20i1.881"},{"key":"ref44","doi-asserted-by":"crossref","unstructured":"Kariminia A, Law M, Davies M-A, et al. Mortality and losses to follow-up among adolescents living with HIV in the IeDEA global cohort collaboration. J Int AIDS Soc. 2018;21(12):e25215. https:\/\/doi.org\/10.1002\/jia2.25215","DOI":"10.1002\/jia2.25215"},{"key":"ref45","doi-asserted-by":"crossref","unstructured":"Myburgh H, Reynolds L, Hoddinott G, et al. Implementing \u2018universal\u2019 access to antiretroviral treatment in South Africa: A scoping review on research priorities. Health Policy Plan. 2021;36(6):923\u2013938. https:\/\/doi.org\/10.1093\/heapol\/czaa094","DOI":"10.1093\/heapol\/czaa094"},{"key":"ref46","doi-asserted-by":"crossref","unstructured":"Turkova A, Waalewijn H, Chan MK, et al. Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: A pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial. Lancet HIV. 2022;9(9):e627\u2013e637. https:\/\/doi.org\/10.1016\/S2352-3018(22)00160-6","DOI":"10.1016\/S2352-3018(21)00292-7"},{"key":"ref47","doi-asserted-by":"crossref","unstructured":"Bamford A, Hamzah L, Turkova A. Paediatric antiretroviral therapy challenges with emerging integrase resistance. Curr Opin HIV AIDS. 2024;19(6):323\u2013329. https:\/\/doi.org\/10.1097\/COH.0000000000000876","DOI":"10.1097\/COH.0000000000000876"},{"key":"ref48","doi-asserted-by":"crossref","unstructured":"Gelaw B, Mulatu G, Tesfa G, et al. Magnitude and associated factors of virological failure among children on ART in Bahir Dar Town public health facilities, Northwest Ethiopia: A facility based cross-sectional study. 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