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Table 2 Perceptions of barriers and facilitators to adolescent ART adherence by participant group

From: “Your status cannot hinder you”: the importance of resilience among adolescents engaged in HIV care in Kenya

Socio-ecological model level Barrier ALHIV AIC Peer leader Facilitator ALHIV AIC Peer leader
Individual ALHIV experience internalized stigma, which manifests in isolation and a lack of sense of belonging X X X Self-motivation and a positive attitude drive pro-health behaviors X   
Internalized stigma leads to low morale, negatively impacting ART use X X X The presence of future life goals (i.e., career goals, family goals) is a motivator for adherence X   
ALHIV constantly compare themselves to peers without HIV, negatively impacting mental health X    Knowledge is power, and accurate knowledge of ART can improve adherence X   X
Interpersonal Many parents/families will stigmatize, mistreat, or desert ALHIV when they find out their status   X X Family members offer support in the form of encouragement, reminders to take ART, and help picking up medication X   
Stigmatization within families often leads to community-wide stigma   X X Friends are generally supportive when disclosure occurs; support includes encouragement and reminders to take ART X   
ALHIV struggle with disclosing their status due to anticipated stigma X X X Support of an HIV-positive friend or family member encourages better adherence and improves mental health X   X
Lack of disclosure to others can lead to social withdrawal and mental health concerns (i.e., anxiety, depression) X    Having the support of even one person (family, friend) can motivate ALHIV to engage in pro-health behaviors X   X
ALHIV default on medication (skipping or delaying ART) due to fear of status disclosure while with friends or family X X X Disclosure is challenging, but the support received, as a result, is worth it X   X
Disclosure to friends causes friends to stigmatize/isolate ALHIV or become overly attentive   X   
Community School classmates and teachers stigmatize ALHIV and spread gossip X X X ALHIV who seek support from school staff (headteachers, matrons, nurses) are granted permission to attend clinic appointments X   
ART medication packaging is stigmatizing (i.e., seen as a symbol of HIV) and discourages ALHIV from carrying pill bottles at school X X X In school settings, creative solutions for carrying ART discreetly facilitate adherence (ex: carrying single pills in pocket rather than pill bottle) X   
Teachers separate students with HIV from other students, causing social isolation for ALHIV in school X X X Positive relationships with HCW generate trust and encourage care-seeking among ALHIV X   
Distrust of teachers causes challenges asking for permission to attend clinic during school hours; this can lead to missed appointments X    Peer leader encouragement and support is effective in motivating adherence, especially to attend clinic X   X
Fear of disclosure at school makes ART adherence difficult for those whose pill regimens overlap with school hours (especially boarding school students) X X X Adolescent support groups foster peer connection, support positive mental health, and improve adherence X   X
HCW are usually older, judgmental, cold, and unrelatable to ALHIV   X X  
HCW scold ALHIV who have missed appointments or have poor adherence, impacting their desire to attend clinic X   X
  1. This table outlines which participant groups discussed each of the above themes, to highlight each participant group’s perceptions of barriers and facilitators to ART adherence