Abstract:
Background: Kaposi sarcoma is one of the most prevalent HIV-associated malignancies in sub-Saharan
Africa and is often diagnosed at advanced stage of disease. Only 50% of KS patients who qualify for
chemotherapy receive it and adherence is sub-optimal.
Methods: 57 patients >18 years with newly diagnosed KS within the AMPATH clinic network in Western
Kenya were purposively selected to participate in semi-structured interviews stratified by whether they had
completed or not completed chemotherapy for advanced stage KS. We based the interview guide and
coding framework on the situated Information, Motivation, Behavioral Skills (sIMB), in which the core
patient centered IMB constructs are situated into the socioecological context of receiving care.
Results: Of the 57 participants, the median age was 37 (IQR 32-41) and the majority were male (68%).
Notable barriers to chemotherapy initiation and adherence included lack of financial means, difficulty
with convenience of appointments such as distance to facility, appointment times, long lines, limited
appointments, intrapersonal barriers such as fear or hopelessness, and lack of proper or sufficient
information about chemotherapy. Factors that facilitated chemotherapy initiation and adherence
included health literacy, motivation to treat symptoms, improvement on chemotherapy, prioritization of
self-care, resilience while experiencing side effects, ability to carry out behavioral skills, obtaining national
health insurance, and free chemotherapy.
Conclusion: Our findings about the barriers and facilitators to chemotherapy initiation and adherence for
KS in Western Kenya support further work that promotes public health campaigns with reliable cancer
and chemotherapy information, improves education about the chemotherapy process and side effects,
increases oncology service ability, supports enrollment in national health insurance, and increases
incorporation of chronic disease care into existing HIV treatment networks.