Socio-Cultural Factors Influencing Adherence Among Adolescents Living with HIV On Second-Line Antiretroviral Therapy in Gem Sub-County, Western Kenya
OWOKO, Lilian Adhiambo
MetadataShow full item record
The initiation of antiretroviral therapy (ART) was a major milestone in the care and management of HIV; however, ALHIV on ART was the only sub-population that registered a 50% increase in deaths even after initiating ART due to sub-optimal adherence. There isa dearth of information focusing on factors influencing adherence among ALHIV on 2nd line ART despite reduced therapeutic options, higher risk of repeated treatment failure and the cost implications for the healthcare system. Despite Gem sub-County being part of KEMRI/CDC HDSA, it is not known why ALHIV still exhibit sub-optimal adherence to ART. This study sought to examine socio-cultural and demographic factors influencing adherence among 15-19 year old ALHIV on 2nd line ART in Gem Sub-County. Specifically, the study sought to: find out the socio-demographic factors of 15-19 year old ALHIV and their influence on adherence; to determine the extent to which ART knowledgeinfluenced adherence among 15-19 year old ALHIV; to establish ways in which sexuality issues influenced adherence among 15-19 year old ALHIV and to describe how existing psychosocial support systems promoted adherence among 15-19 year old ALHIV. The study used social ecological theory which assumes that the effectiveness of health promotion efforts can be enhanced through an analysis of the interplay between environmental resources available in an area and particular health habits and life-styles of the people who occupy that area. The study used a focused ethnographic research design to collect data from37ALHIV on 2nd-line ARTenrolled in the sampled PSCs. For quantitative data, the study administered 37 semi-structured questionnaires whereas for qualitative data: direct observation, 10 in-depth and 13 key informant interviews and 3 FGDs were conducted. Quantitative data was analyzed using descriptive statistics with the aid of SPSS version 20 and presented in tables of frequencies and percentages. Qualitative data was exposed to thematic analysis and presented using descriptions and verbatim quotations. The study findings show that socio-demographic characteristics such as gender, household background and the relationship between ALHIV and primary caregiver coupled with access to reminder tools influenced adherence to ART. There was evidence of sufficient basic ART adherence-related knowledge among ALHIV yet this varied in its influence on adherence. Similarly, influence of sexual debut and ART status disclosure to sexual partner among ALHIV were inconclusive. Finally, psychosocial support systems were vital in promoting adherence among ALHIV. Thus, the study concluded that an understanding of the interplay between socio-cultural and demographic factors was important in order to tackle sub-optimal adherence among ALHIV as individual factors did not elicit significant conclusive explanations on ART adherence. The study, therefore, recommends that policy formulations, relevant treatment guidelines and intervention strategies should recognize the central role played by both socio-cultural and demographic factors in adherence-related activities among ALHIV and engage at that level.