Digital adherence tools for HIV management in young people living with HIV in Malawi

This thesis investigated the role of digital adherence tools (DATs) in improving antiretroviral therapy (ART) adherence and viral suppression among young people living with HIV (YPLHIV, aged 15–24 years) in Malawi. Despite the scale-up of ART across sub-Saharan Africa, viral suppression rates in adolescents and young adults remain suboptimal compared to older populations, highlighting the need for targeted interventions.
Therefore, using a mixed-methods approach across six chapters, this thesis first characterised the prevalence and determinants of viral suppression among YPLHIV using HIV survey data from five Southern African countries (Malawi, Eswatini, Zimbabwe, Mozambique, and Lesotho). It then synthesised global evidence on real-time medication monitoring (RTMM)-based DATs through a systematic review and meta-analysis. Finally, the thesis presented the protocol, qualitative acceptability findings, and results of a randomised controlled trial conducted in primary health facilities in Blantyre, Malawi, evaluating a customised DAT among non-adherent YPLHIV on ART.
In conclusion, the thesis demonstrates how digital health interventions can be rigorously evaluated through the integration of epidemiological analysis, evidence synthesis, trial methodology, and qualitative inquiry. The thesis contributes new evidence on the feasibility, acceptability, and effectiveness of DATs in a low-resource setting and offers insights to inform HIV care programming for young people in Malawi and similar contexts.