Navigating antiretroviral adherence in boarding secondary schools in Nairobi, Kenya: A qualitative study of adolescents living with HIV, their caregivers and school nurses.

Autor:	Kipkurui N; Impact Research Development Organization, Kisumu, Kenya., Owidi E; Kenya Medical Research Institute-Center for Clinical Research, Partners in Health Research and Development, Nairobi, Kenya., Ayieko J; Kenya Medical Research Institute-Center for Microbiology Research, Kisumu, Kenya., Owuor G; Impact Research Development Organization, Kisumu, Kenya., Mugenya I; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya., Agot K; Impact Research Development Organization, Kisumu, Kenya., Roxby AC; University of Washington, Departments of Medicine, Global Health, and Epidemiology, Seattle, WA, United States of America.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2023 Sep 25; Vol. 3 (9), pp. e0002418. Date of Electronic Publication: 2023 Sep 25 (Print Publication: 2023).
DOI:	10.1371/journal.pgph.0002418
Abstrakt:	In Kenya, adolescents spend much of their formative years in boarding secondary schools, which presents a challenging environment for antiretroviral (ART) adherence support among adolescents living with HIV (ALHIV). We examined the experiences of ALHIV, caregivers of adolescents, and school nurses regarding navigating ART adherence in boarding secondary schools. Between July and November 2022, we conducted focus group discussions (FGDs) among ALHIV attending boarding schools in Nairobi, Kenya, and caregivers of ALHIV, and in-depth interviews (IDIs) with school nurses. Clinic records were used to identify ALHIV and caregivers, who were invited to participate based on their availability. We categorized boarding schools into national, county, and sub-county levels and selected two schools from each category. We obtained permission from head teachers and invited school nurses to take part in virtual IDIs. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically. We conducted two FGDs with 11 caregivers, two FGDs with 18 adolescents, and 7 IDIs with school nurses. Most of the ALHIV reported having disclosed their HIV status to a school nurse or teacher during admission. School nurse friendliness, being understanding, fair, and confidential were qualities associated with ALHIV willingness to confide in them. Strategies ALHIV used to adhere to medication included: waiting until students were engaged in other activities, waking up early, stepping away from others, and stating their drugs were for different ailments. Caregivers were nervous about school-based adherence counseling, fearing it could lead to inadvertent disclosure of adolescents' HIV status and stigmatization by fellow students. All school nurses reported lacking appropriate training in HIV adherence counseling for adolescents. ALHIV have devised innovative strategies to navigate pill-taking and enlist quiet support while operating in stigmatized school environments. Establishment of a strong school nurse-adolescent rapport and building nurses' skills are key to improving school-based support for ALHIV. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2023 Kipkurui et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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