Executive Function and Adherence in Children and Adolescents Living With HIV: Evidence From the HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) Study
Restricted accessResearch articleFirst published online April, 2026
Executive Function and Adherence in Children and Adolescents Living With HIV: Evidence From the HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) Study
Executive function may be impaired in people with human immunodeficiency virus (HIV) infection, and poor executive function may affect medication adherence. However, there is little data on executive function in children and adolescents with perinatally acquired HIV in sub-Saharan Africa.
Methods
A total of 208 children/adolescents with perinatally acquired HIV and 208 HIV-exposed uninfected controls were recruited in Zambia for this prospective cohort study. Executive function was measured using performance-based, self-report, and parental report measures. Adherence over 1 year of follow-up was assessed through questionnaires and viral load measurement.
Results
Participants with HIV performed significantly worse on all 3 measures of executive function. Lower parental rating of executive function was associated with poorer antiretroviral therapy adherence (odds ratio 1.5, 95% confidence interval 1.02-2.2, P = .04).
Conclusion
Children and adolescents with perinatally acquired HIV have executive function impairments that may lead to consequences like poor medication adherence and treatment failure. Interventions to improve executive function or compensate for impaired executive function are needed in this population.
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