"I could miss lessons," Facilitators and Barriers to ART and Clinic Adherence in School Going Kenyan Adolescents

Thesis (Master's)--University of Washington, 2020Adolescents living with HIV (ALHIV) face unique barriers to adherence to antiretroviral therapy and clinical care that require unique health interventions. Adolescents spend the majority of their time in school, making it critical to understand the barriers to optimal health for ALHIV within the school environment. We conducted in-depth interviews and focus group discussions with adolescents, caregivers, and healthcare workers from 9 different facilities in Kenya. Analysis focused on identifying the barriers and facilitators to antiretroviral therapy and clinic adherence while attending school, using Anderson’s Model of Health Services Utilization to organize them into contextual and individual categories that either led to adherence or non-adherence. In the school context, the largest barrier adolescents faced in treatment adherence was inadvertent disclosure, due to school policies on drug storage and missed lessons, and lack of privacy. In both the school and clinic contexts, scheduling conflicts forced adolescent to choose between school or clinic adherence. Support at the individual level from caregivers was important in managing challenges faced in school and clinic adherence. Support from both the clinic and school also helped adolescents adhere to treatment and clinic visits. School policies around medication storage and inflexible clinic schedules negatively affected ALHIV adherence while in school. Participatory research is needed to engage school staff and collect positive experiences and strategies for developing interventions for schools aimed at reducing stigma and loss to follow-up