School-level Barriers of Antiretroviral Therapy Adherence and Interventions to Overcome them Among Adolescents Living with HIV in Western Kenya: A Qualitative Study

Monica A Onyango,Lisa J Messersmith,Perez Akello,Lora L Sabin,Jane Oyombra,Houda Chergui,Natalya Sarkisova,Juliana Otieno,Daniel O Kwaro

doi:10.2174/1874613602115010093

Abstract

Background: Adolescents in Kenya spend the majority of their time in a school environment. However, research to understand Antiretroviral Therapy (ART) adherence among adolescents living with HIV (ALWHIV) in school settings is sparse. Objective: To improve the design of appropriate interventions to better support this vulnerable population, the study aimed to explore school-related barriers to ART adherence experienced by ALWHIV. Methods: Qualitative data were utilized from a larger mixed-methods study on ALWHIV conducted at a major teaching and referral hospital in Kisumu, Kenya. Participants encompassed ALWHIV, their caregivers, teachers, and health care providers. Transcripts from a total of 24 in-depth interviews and five focus group discussions were analyzed in NVivo using a thematic approach. Results: Four themes emerged as key barriers in a school setting: negative experiences following HIV status self-disclosure, a strong desire for secrecy, restrictive school policies, and health education focused on sexual transmission of HIV. Participants suggested a range of potential interventions to better support ART adherence for ALWHIV, including coaching ALWHIV on disclosure strategies, promoting empathy among teachers and students, transition-preparing for ALWHIV, changing the narrative about HIV transmission in schools, providing water in schools, and introducing adherence support programs in schools, including the use of mobile technology. Conclusion: ALWHIV in Kenya experience numerous important challenges while trying to maintain optimal ART adherence in the school environment. Interventions that create supportive school settings are critical for better health outcomes among ALWHIV.

Highlights

IntroductionSignificant advances have been achieved in HIV prevention, treatment, and care, progress for adolescents living
Interventions that create supportive school settings are critical for better health outcomes among adolescents living with HIV (ALWHIV)
We identified four key themes related to barriers to Antiretroviral Therapy (ART) adherence among ALWHIV within the school environment: 1) negative experiences following HIV status self-disclosure, 2) desire for secrecy, 3) restrictive school policies not supportive for students’ ART adherence, and 4) health education focused on HIV as a sexually transmitted disease

Summary

Introduction

Significant advances have been achieved in HIV prevention, treatment, and care, progress for adolescents living. Similar to other parts of the world, the incidence of HIV in Kenya is declining in all age groups except in people 15-24 years of age. 110,000 adolescents aged 10-19 years are living with HIV in Kenya [5], and according to the Kenyan Ministry of Health 2018 AIDS ResponseProgress Report, onethird of all new HIV infections were young women aged 15-24 years [6, 7]. ART adherence and retention in care among adolescents decline with increasing age [10, 11], leading to high mortality [11 - 13]. Research to understand Antiretroviral Therapy (ART) adherence among adolescents living with HIV (ALWHIV) in school settings is sparse

Methods

Results

Discussion

Conclusion