Community perceptions affecting uptake & retention on antiretroviral therapy by PLHIV: a qualitative study among residents of an urban informal settlement in Kenya

Introduction: Lack of HIV treatment and loss of follow up measures is associated with high mortality among persons living with HIV (PLHIV) in sub-Saharan Africa. Especially in resource-limited populations. Respondents diagnosed with HIV through a home-based testing and counseling program in an informal settlement in Kenya, were referred to health facilities of their choice for antiretroviral therapy (ART). This qualitative study explored the community’s experiences and perceptions on factors associated with ART uptake and retention.Methodology: Using convenient purposive sampling, we recruited 46 adults (21 women and 25 men) among them HIV infected and non-infected residents of the Kibera informal settlement in Nairobi, Kenya. Using a standardized discussion guide, six focus group discussions of 6-9 individuals were conducted. Discussions were recorded verbatim and complimented by tape recording to ensure accuracy. Transcription was done and coding done using a Priori codes. Thematic content analysis was done using Atlas 3.0.Results: Availability of many health facilities offering HIV services in Kibera informal settlement facilitated access to and uptake of ART. Respondents preparation procedures that prevented same-day ART enrolment were often perceived as denial of treatment.“They talk too much of treatment and when you go you are turned away” Said one respondent. Reported perceived poor staff attitude, Rudeness, Judgmental behaviours and Delays, were often perceived as lack of respect for Participants were reported to hinder retention in ART services.“He will look at your physical appearance, put your card aside and ask his colleague whether tea is ready” Participants disliked adherence counseling with written commitments after missed appointments and often felt that these measures too reflected lack of respect by health care providers. They wanted to cancel treatment because they said we had to commit ourselves by signing….”Conclusion: Individuals diagnosed with HIV generally accessed HIV treatment facilities following referral after HBTC. Participants perceived some standard treatment procedures. Reckoning Staff behavior and Communication as barriers hindering retention on ART. Supportive interpersonal relationship strategies between Respondents, providers and innovative patientcentered treatment plans and adherence counseling models should be adopted in treatment programs. This will promote uptake and retention of ART in communities.Keywords: HIV infection, retention in ART, adherence counseling, psychosocial and communication barriers, Responded satisfactio