Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Adherence to antiretroviral therapy is crucial for thwarting disease progression and reducing secondary transmission, yet HIV+ youth struggle with adherence. The highest rates of new HIV infections occur in young African American men (YAAM), thus understanding reasons for non-adherence in this group is critical. Reasons for non-adherence can be complex and multifactorial, and innovative methods of exploration are needed for advancing prevention and treatment efforts. A sample of 387 HIV+ YAAM who reported currently taking HIV medications were selected from a cross-sectional assessment of 2,226 HIV+ youth from sites within the Adolescent Trials Network for HIV/AIDS Interventions (ATN) from 2009-2012 (12-24 years-old, Median = 22.00, SD 2.06). Participants completed self-reported adherence, demographic, health, and psychosocial measures. Seventy-two theoretically relevant predictors of adherence underwent Optimal Data Analysis (ODA) to construct a classification tree which hierarchically maximizes the classification accuracy of 100% adherence. Sixty-two percent reported 100% adherence (no missing doses) over the past seven days. Frequency of cannabis use was the strongest predictor of adherence, yielding moderate effect strength sensitivity, ESS = 27.1, p < 0.00. Among participants with infrequent cannabis use, 72% demonstrated full adherence, while only 45% of participants who used cannabis (monthly or more) demonstrated full adherence. Classification tree analysis (CTA) correctly classified 82.35% of those who were adherent and 64.85% of those who were non-adherent. The final CTA adherence model was strong (ESS = 49.12) identifying four pathways towards adherence and five pathways toward non-adherence. Participants most likely to be adherent were those less likely to have substance abuse issues and reported low levels of psychiatric distress (92.59% were adherent). This research demonstrates the impact of substance use and mental health on adherence among YAAM. Moreover, this analysis identifies complex and multiple profiles of adherence among HIV+ YAAM and suggests that targeted interventions may be most prudent.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.