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DC Field | Value | Language |
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dc.contributor.author | Braitstein, Paula | - |
dc.contributor.author | Nyandiko, Winstone M. | - |
dc.contributor.author | Myers, Courtney | - |
dc.contributor.author | Apondi, Edith | - |
dc.contributor.author | Toromo, Judith J. | - |
dc.contributor.author | Omollo, Mark | - |
dc.contributor.author | Aluoch, Josephine | - |
dc.date.accessioned | 2022-04-26T09:23:54Z | - |
dc.date.available | 2022-04-26T09:23:54Z | - |
dc.date.issued | 2022-02-01 | - |
dc.identifier.uri | http://ir.mu.ac.ke:8080/jspui/handle/123456789/6299 | - |
dc.description.abstract | Introduction:Adolescents living with HIV (ALHIV, ages 10–19) have developmentally specific needs in care, and have lowerretention compared to other age groups. Family-level contexts may be critical to adolescent HIV outcomes, but have oftenbeen overlooked. We investigated family-level factors underlying disengagement and supporting re-engagement among ado-lescentsdisengagedfromHIVcare.Methods:Semi-structured interviews were performed with 42 disengaged ALHIV, 32 of their caregivers and 28 healthcareworkers(HCW)intheAcademicModelProvidingAccesstoHealthcare(AMPATH)programinwesternKenya,from2018to2020. Disengaged ALHIV had≥1 visit within the 18 months prior to data collection at one of two sites and nonattendance≥60daysfollowingtheirlastscheduledappointment.HCWwererecruitedfrom10clinics.Transcriptswereanalysedthroughthematic analysis. A conceptual model for family-level domains influencing adolescent HIV care engagement was developedfromthesethemes.Results:Family-level factors emerged as central to disengagement. ALHIV-particularly those orphaned by the loss of one orboth parents-experienced challenges when new caregivers or unstable living situations limited support for HIV care. Thesechallenges were compounded by anticipated stigma; resultant non-disclosure of HIV status to household members; enactedstigmainthehousehold,withoverwhelmingeffectsonadolescents;orexperiencesofmultipleformsoftrauma,whichunder-minedHIVcareengagement.Somecaregiverslackedfinancesorsocialsupporttofacilitatecare.Othersdidnotfeelequippedto support adolescent engagement or adherence. Regarding facilitators to re-engagement, participants described roles forhousehold disclosure; and solidarity from caregivers, especially those also living with HIV. Family-level domains influencingHIV care engagement were conceptualized as follows: (1) adolescent living situation and contexts; (2) household materialresources or poverty; (3) caregiver capacities and skills to support adolescent HIV care; and (4) HIV stigma or solidarity atthehouseholdlevel.Conclusions:Family-level factors are integral to retention in care for ALHIV. The conceptual model developed in this studyforfamily-levelinfluencesoncareengagementmayinformholisticapproachestopromotehealthyoutcomesforALHIV.Devel-opmentally appropriate interventions targeting household relationships, disclosure, HIV stigma reduction, HIV care skills andresources,andeconomicempowermentmaypromoteadolescentengagementinHIVcare. | en_US |
dc.language.iso | en | en_US |
dc.subject | adherence | en_US |
dc.subject | adolescence | en_US |
dc.subject | HIV carecontinuum | en_US |
dc.subject | retention | en_US |
dc.subject | stigma | en_US |
dc.subject | structural drivers | en_US |
dc.title | “Who am I going to stay with? Who will accept me?”:family-leveldomainsinfluencingHIVcareengagementamongdisengagedadolescentsinKenya | en_US |
dc.type | Article | en_US |
Appears in Collections: | School of Medicine |
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File | Description | Size | Format | |
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MyersCetal..pdf | 400.36 kB | Adobe PDF | View/Open |
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