School-level Barriers of Antiretroviral Therapy Adherence and Interventions to Overcome them Among Adolescents Living with HIV in Western Kenya: A Qualitative Study

Monica A. Onyango1, *, Houda Chergui2, Lora L. Sabin1, Lisa J. Messersmith1, Natalya Sarkisova1, Jane Oyombra3, Perez Akello4, Daniel O. Kwaro5, Juliana Otieno4
1 Department of Global Health, Boston University School of Public Health, Boston MA, USA
2 Last Mile. Boston, USA
3 Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
4 Uzima University, Kisumu, Kenya
5 Kenya Medical Research Institute, Kisumu, Kenya

© 2021 Onyango et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Floor, Boston MA 02118, USA; Tel: 6178171602; E-mail:



Adolescents in Kenya spend the majority of their time in a school environment. However, research to understand Antiretroviral Therapy (ART) adherence among adolescents living with HIV (ALWHIV) in school settings is sparse.


To improve the design of appropriate interventions to better support this vulnerable population, the study aimed to explore school-related barriers to ART adherence experienced by ALWHIV.


Qualitative data were utilized from a larger mixed-methods study on ALWHIV conducted at a major teaching and referral hospital in Kisumu, Kenya. Participants encompassed ALWHIV, their caregivers, teachers, and health care providers. Transcripts from a total of 24 in-depth interviews and five focus group discussions were analyzed in NVivo using a thematic approach.


Four themes emerged as key barriers in a school setting: negative experiences following HIV status self-disclosure, a strong desire for secrecy, restrictive school policies, and health education focused on sexual transmission of HIV. Participants suggested a range of potential interventions to better support ART adherence for ALWHIV, including coaching ALWHIV on disclosure strategies, promoting empathy among teachers and students, transition-preparing for ALWHIV, changing the narrative about HIV transmission in schools, providing water in schools, and introducing adherence support programs in schools, including the use of mobile technology.


ALWHIV in Kenya experience numerous important challenges while trying to maintain optimal ART adherence in the school environment. Interventions that create supportive school settings are critical for better health outcomes among ALWHIV.

Keywords: Adolescents, Barriers, Adherence, Antiretroviral therapy, Schools, Interventions.