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

Author

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

Abstract

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. 

Keywords


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.

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