Kipkurui Nicholas, Owidi Emmah, Ayieko James, Owuor Gerald, Mugenya Irene, Agot Kawango, Roxby Alison C
Impact Research Development Organization, Kisumu, Kenya.
Kenya Medical Research Institute-Center for Clinical Research, Partners in Health Research and Development, Nairobi, Kenya.
PLOS Glob Public Health. 2023 Sep 25;3(9):e0002418. doi: 10.1371/journal.pgph.0002418. eCollection 2023.
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.
在肯尼亚，青少年的成长阶段大多是在寄宿制中学度过的，这给感染艾滋病毒的青少年（ALHIV）的抗逆转录病毒治疗（ART）依从性支持带来了具有挑战性的环境。我们调查了ALHIV、青少年照顾者以及学校护士在寄宿制中学应对ART依从性方面的经历。2022年7月至11月期间，我们在内罗毕就读于寄宿学校的ALHIV及其照顾者中进行了焦点小组讨论（FGD），并与学校护士进行了深入访谈（IDI）。利用诊所记录来确定ALHIV及其照顾者，根据他们的可及性邀请他们参与。我们将寄宿学校分为国家级、县级和次县级，并从每个类别中选择两所学校。我们获得了校长的许可，并邀请学校护士参加虚拟IDI。访谈进行了录音，逐字转录，并进行了主题分析。我们与11名照顾者进行了两次FGD，与18名青少年进行了两次FGD，与7名学校护士进行了7次IDI。大多数ALHIV报告称在入学时已向学校护士或教师透露了自己的艾滋病毒感染状况。学校护士的友好、善解人意、公平和保密是与ALHIV愿意向他们倾诉相关的品质。ALHIV用于坚持服药的策略包括：等到学生参与其他活动时、早起、避开他人以及声称他们的药物用于治疗不同疾病。照顾者对基于学校的依从性咨询感到紧张，担心这可能导致青少年的艾滋病毒感染状况被无意泄露以及受到同学的污名化。所有学校护士都报告称缺乏针对青少年艾滋病毒依从性咨询的适当培训。在充满污名的学校环境中，ALHIV已经想出了创新策略来应对服药问题并获得默默的支持。建立牢固的学校护士与青少年的融洽关系以及提升护士的技能是改善对ALHIV的学校支持的关键。
