Navigating socio-ecological and institutional barriers to antiretroviral therapy adherence: qualitative insights among young men and women from Nairobi's informal settlements.

IF 3.4 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Frontiers in Public Health Pub Date : 2025-09-25 eCollection Date: 2025-01-01 DOI:10.3389/fpubh.2025.1650966

O Muhenje, C O Olungah, D O Omia, R O Ondondo, P Waswa, A Lusambili

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引用次数: 0

Abstract

Background: The Human Immunodeficiency Virus (HIV) and acquired immunodeficiency syndrome (AIDS) pandemic remains a major global health issue, with 40.8 million people affected at the end of 2024. In Sub-Saharan Africa, Antiretroviral Therapy (ART) coverage reached 74%, though adherence remained challenging, particularly among youth due to poverty, stigma, and weak health systems.

Aim: This paper explored socio-ecological and institutional barriers to ART adherence among young men and women aged 18-24 living in Kibra, Nairobi's largest informal settlement.

Methods: The study utilized phenomenological research design to explore lived experiences within social contexts to uncover hidden structural barriers using qualitative methods. In-depth interviews (n = 25), key informant interviews (n = 10), participant diaries (n = 25), structured clinic and home observations (n = 25), and case narratives (n = 10). Participants were purposively selected. Data were analyzed thematically using deductive and inductive coding in NVIVO 14.

Results and discussion: Barriers emerged at individual, socioeconomic, and health system levels. These included limited ART knowledge, pill burden, comorbidities, food insecurity, stigma, violence, and negative healthcare provider attitudes. Addressing these requires multi-level interventions that go beyond medical treatment to tackle structural and social determinants of health.

查看原文本刊更多论文

克服抗逆转录病毒治疗依从性的社会生态和体制障碍：内罗毕非正规住区青年男女的定性见解。

背景：人类免疫缺陷病毒（HIV）和获得性免疫缺陷综合症（AIDS）大流行仍然是一个主要的全球健康问题，截至2024年底，有4080万人受到影响。在撒哈拉以南非洲，抗逆转录病毒治疗（ART）的覆盖率达到74%，但坚持治疗仍然具有挑战性，特别是在年轻人中，由于贫困、污名化和卫生系统薄弱。目的：本文探讨了生活在内罗毕最大的非正式定居点Kibra的18-24岁青年男女坚持抗逆转录病毒治疗的社会生态和制度障碍。方法：采用现象学研究设计，探索社会背景下的生活经验，采用定性方法揭示隐藏的结构性障碍。深度访谈(n = 25),关键线人采访(n = 10),参与者日记(n = 25)、结构化临床和家庭(n = 25),观察和案例叙述(n = 10)。参与者是有目的选择的。使用NVIVO 14中的演绎和归纳编码对数据进行主题分析。结果和讨论：障碍出现在个人、社会经济和卫生系统层面。这些因素包括抗逆转录病毒治疗知识有限、药物负担、合并症、粮食不安全、耻辱、暴力和卫生保健提供者的消极态度。要解决这些问题，需要采取多层次的干预措施，超越医疗，以解决健康的结构和社会决定因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Public Health Medicine-Public Health, Environmental and Occupational Health

CiteScore

4.80

自引率

7.70%

发文量

4469

审稿时长

14 weeks

期刊介绍： Frontiers in Public Health is a multidisciplinary open-access journal which publishes rigorously peer-reviewed research and is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians, policy makers and the public worldwide. The journal aims at overcoming current fragmentation in research and publication, promoting consistency in pursuing relevant scientific themes, and supporting finding dissemination and translation into practice. Frontiers in Public Health is organized into Specialty Sections that cover different areas of research in the field. Please refer to the author guidelines for details on article types and the submission process.