The role of parents and caregivers in motivating adolescents with HIV to participate in a long-acting injectable ART clinical trial in South Africa and Uganda.

ABSTRACTIn this paper, we describe the central role of caregivers in shaping adolescent engagement with long-acting injectable antiretroviral therapy (LAI-ART) within the Long-Acting Treatment for Adolescents (LATA) trial conducted in South Africa and Uganda. Adolescents' participation in HIV care is embedded within emotional, moral, and cultural relationships rather than individual decision-making. Drawing on the bioecological model of human development and the adolescent well-being framework, we conceptualise caregiver support as an evolving relational process that fosters adolescents' connectedness, competence, optimism, and autonomy - psychosocial attributes critical to sustained treatment adherence. Our findings reveal that caregivers provide emotional anchoring, interpretive guidance, and motivational reinforcement, while adolescents' growing agency reshapes caregiving dynamics toward collaborative partnership. By addressing disclosure-related guilt and emotional burdens among caregivers, we advance a relational model of adolescent-centred HIV care. We call for interventions that recognise caregivers as co-participants essential to improving treatment uptake, adherence, and long-term well-being.