Exploring the Disparities between Health Knowledge and Adherence among Adolescents living with HIV on Second-line Antiretroviral Therapy in Rural Western Kenya

Document Type : Original Article


Department of Sociology and Anthropology, Maseno University, Kenya. Centre for the Advancement of Scholarship, University of Pretoria, South Africa


Background and Objectives: Adolescents living with HIV on medication have an additional duty to ensure adherence to antiretroviral therapy. There have been documented challenges in retaining adolescents in care and treatment programs, loss to follow-up, and poor adherence that have led to continued deaths. Adolescents on second-line antiretroviral therapy have reduced therapeutic options as they have resisted first-line drugs, and the third-line is not available in this resource-poor setting. Ensuring and upscaling adherence support is crucial. This study sought to find out the level of basic health literacy in terms of knowledge of one’s drugs, HIV re-infection, and HIV drug resistance and how this knowledge influenced adherence.

Materials and Methods: This was a longitudinal ethnographic research coupled with a mixed methods approach. Semi-structured questionnaires were administered to 37 participants. The study conducted ten in-depth and 13 key informant interviews, participant observation, and three focus group discussions. Quantitative data was analyzed using SPSS, and cross-tabulations were done to identify appropriate relationships. Qualitative data was analyzed thematically and presented using descriptive reports and verbatim quotations.

Results: Participants who had basic knowledge of the ARVs they were taking exhibited good adherence compared to those who did not know their ARVs. Among the participants, 72% knew what HIV re-infection was, yet 43% still had poor adherence. This was similar to basic knowledge of HIV Drug Resistance. 

Conclusion: There was sufficient health knowledge. However, the study observed a lack of ability to translate knowledge into practice. Other factors alongside health knowledge in determining health-promotive behaviour could be explored. 


Acknowledgment: I am grateful for the support from my PhD fieldwork supervisors, Dr. Charles Olang’o and Dr. Benson Nyambega of Maseno University. I am also thankful for the cooperation I received from my respondents.

Availability of data and materials: This will be available upon request from the author.

Conflict of interest: None.

Consent for publication: Not applicable.

Funding: I did not receive any financial support while conducting this study. This article was, however, prepared while part of the Re-imagining Reproduction: Making Babies, Making Kin and Citizens in Africa project funded by the Welcome Trust as a post-doctoral fellow, Centre for the Advancement of Scholarship, University of Pretoria, South Africa. I acknowledge its support.

Ethical approval and consent to participate: This study was carried out in accordance with the Helsinki Declaration. The Maseno University Ethics and Review Committee approved the study. Permissions were granted by the Centre for Health Solutions (CHS) as it has a supervisory role over all the public PSCs in Gem Sub-County and the PSC in charge of the six sampled PSCs. The study used adherence counselors and peer educators within the PSCs as points of initial contact with respondents and their caregivers. I got written informed consent from caregivers who accompanied the respondents to the PSC and assent from respondents. The study did not harm the respondents physically, psychologically, or otherwise. The study, however, ensured the data collection methods' comfort, confidentiality, and privacy. The study participants were assured that their responses would be kept confidential and not shared in a manner that could potentially jeopardize their privacy.

1- WHO (2016) Consolidated guidelines on the use of ARV drugs for treating and preventing HIV infection. Recommendations for a public health approach, 2nd edition 2016. Geneva: WHO
 2- Kim, M. H., Mazenga, A. C., Yu, X., Ahmed, S., Paul, M. E., Kazembe, P. N., & Abrams, E. J. (2017). High self-reported non-adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: barriers and associated factors. Journal of the International AIDS Society, 20(1), 21437. http://doi.org/10.7448/IAS.20.1.21437
PMid:28406275 PMCid:PMC5515061    
 3- Idele, P., Amaya, G., Porth, T., Suzuki, C., Mahy, M., Kasedde, S., & Luw, C (2014) Epidemiology of HIV & AIDS among adolescents: Current status, inequalities and data gaps. Journal of Acquired Immune Deficiency Syndrome, 66(2)
 4- UNAIDS. Ending AIDS: progress towards the 90-90-90 targets. 2017. Available at: htp://www.unaids.org/sites/default/fles/media_asset/Global_AIDS_update_2017_en.pdf    
 5- Kenya Demographic and Health Survey (KDHS) 2014. Kenya National Bureau of Statistics, 2014. Nairobi, KNBS    
 6- Odhiambo, F. O., Laserson, K., Sewe, M., Hamel, M. J., Feikin, D. R., Adazu, K. & Ombok, M. (2012) Profile: The KEMRI/CDC health and demographic surveillance system- Western Kenya. International Journal of Epidemiology, 41:977-987
 7- UNICEF, (2016). Parenting, family care and adolescence in East and Southern Africa: An evidence-focused literature review. Office of research-Innocenti. Discussion paper 2016-02    
 8-Yang, Yu., Dan, L., Xi, C., Zhulin, H., Min, W. & Shuiyuan, X. (2018). Medication adherence to antiretroviral therapy among newly treated people living with HIV. BMC Public Health; 18:825 https://doi.org/10.1186/s12889-018-5731-z Research Gate.
PMid:29973167 PMCid:PMC6030792    
 9-Birungi, H., Obare, F., Namwebya, H. J., Mohammed, M., Gitau, M., Makumi, M. (2011) Sexual and Reproductive Health Needs of Adolescents libing with HIV in Kenya. APHIA II OR Project in Kenya/Population Council: Nairobi Kenya
 9-Katko, E., Johnson, G., Flower, S. and Turner, R (2002). Assessment of adherence with medications in HIV-infected children. The Paediatric Infectious Disease Journal; 20(12):1174-6
 10- Wrubel, J., Moskowitz, J.,Stephens, E. & Mallory, J. (2011). Illness and medication appraisals in people with HIV: deciding to begin antiretroviral treatment. Psychology, 2(2):117-121
 11- Arika, L. (2011). Caregiver factors associated with adherence to antiretroviral therapy in HIV infected children: a case of Thika District Hospital, Kenya. Kenyatta University Institutional Repository    
 12- Hornschuh, S., Dietrich, J., Tshabalala, C. and Laher, F. (2017). Antiretroviral treatment adherence: knowledge and experiences among adolescents and young adults in Soweto, South Africa. AIDS Research and Treatment, eight pages https://doi.org/10.1155/2017/5192516
PMid:28409026 PMCid:PMC5376918    
 13- Stokol, D. (1992). Translating social ecology theory into guidelines for community health promotion. American Journal of Health Promotion, 10 (4):282-298
 14- Petersen, I., Bhana, A., Myeza, N., Alice, S., Holst, H. (2010) Psychosocial challenges and protective influences for socio-emotional coping of HIV+ adolescents in South Africa: a qualitative investigation. AIDS Care, 22: 970-8
PMid:20229370 PMCid:PMC3037257    
 15- Small, L., Mercado, M., Goplan, P., Pardo, G., Ann Mellins, C., Mckay, M. (2014). Enhancing the well-being of perinatally, HIV-infected youths across global contexts. Global Social Welfare Policy Practice, 1: 25-35
PMid:25364654 PMCid:PMC4213945    
 16- Adebola, A. A. (2005). Beyond knowledge and behaviour change: the social-structural context of HIV/AIDS risk perceptions and protective behaviour among young urban slum inhabitants in Nigeria. Havard School of Public Health, Boston    
 17- Gombachika, B. C., Heidi, F., Ellen, C., Johanne, S., Address, M. & Alfred, M. (2012). A social-ecological approach to exploring barriers to accessing sexual and reproductive health services among couples living with HIV in Southern Malawi. ISRN Public Health doi: 10.5402/2012/825459
 18- Guilamo-Ramos, V., Soletti, A. B., Burnette, D., Sharma, S., Leavitt, S. & McCarthy, K. (2014). Parent-adolescent communication about sex in rural India: U.S.-India Collaboration to prevent adolescent HIV. Qualitative Health Research; 22(6): 788- 800.
PMid:22232297 PMCid:PMC3343220    
 19- National AIDS and STI Control Programme (NASCOP), Kenya. Kenya AIDS Indicator Survey (KAIS), 2012: Final Report. Nairobi, NASCOP June 2014    
 20- Onywera, H., Maman, D., Inzaule, S., Auma, E., Were K., Fredrick, H., Zeh, C. (2017). Surveillance of HIV-1 pol transmitted drug resistance in acutely and recently infected antiretroviral drug-naïve persons in rural western Kenya. PloS One, 12(2), e0171124. doi:10.1371/journal.pone.0171124
PMid:28178281 PMCid:PMC5298248    
 21- Zanoni, B. and Meyer, K. (2014). The adolescent and young adult HIV cascade of care in the US: exaggerated health disparities. AIDS Patient Care STDs, March 1: 28 (3): 128-135 PMID 24601744.
PMid:24601734 PMCid:PMC3948479