Psychosocial And Health Systems Factors Associated with Antiretroviral Therapy Adherence Among HIV Positive Residents of Eastleigh, Nairobi City County, Kenya
DOI:
https://doi.org/10.53819/81018102t2613Abstract
Sustained adherence to antiretroviral therapy is essential for viral suppression, prevention of drug resistance, and improved survival among people living with HIV. Evidence on adherence among culturally distinct urban populations in Kenya remains limited, particularly in Eastleigh, Nairobi, where HIV related stigma, economic insecurity, and health service barriers may interact. This study assessed the prevalence of ART adherence and examined socio demographic, psychosocial, and health systems factors associated with adherence among HIV positive residents of Eastleigh. An analytical cross sectional design was used among adults attending Pumwani Level 4 Hospital, Eastleigh Health Centre, and Biafra/Eastleigh Lions Clinic. A sample of 272 participants was targeted and 263 completed questionnaires were analysed, giving a response rate of 96.7%. Participants were selected through systematic random sampling and data were analysed using descriptive statistics, chi square tests, and binary logistic regression in SPSS Version 26 at a 95% confidence level. Overall adherence was 81.1% and the mean three day dose recall was 8.7 ± 2.3. Adherence was significantly associated with sex, age, marital status, income, and duration on ART. Depression, HIV related stigma, intimate partner violence, disclosure, and social support were significant psychosocial correlates, while provider communication, waiting time, distance to facility, and medication accessibility were significant health systems correlates. Twelve variables significant at the bivariate level were entered into a binary logistic regression model, which was statistically significant (omnibus χ² = 89.64, df = 12, p < 0.001), well calibrated (Hosmer and Lemeshow χ² = 6.27, df = 8, p = 0.617), explained 48.2% of the variation in adherence and classified 86.3% of cases correctly. Low perceived stigma (AOR = 5.61, 95% CI 1.92–16.38, p = 0.002) and absence of moderate to severe depressive symptoms (AOR = 3.94, 95% CI 1.82–8.52, p < 0.001) were the strongest independent predictors, followed by monthly income above KES 10,000 (AOR = 3.62) and satisfaction with provider communication (AOR = 3.18), while distance to the facility did not retain significance after adjustment (AOR = 1.69, p = 0.115). The study recommends integrated mental health screening, culturally responsive counselling, reduced refill waiting times, reliable medicine supply, and targeted socioeconomic support for vulnerable ART clients in Eastleigh.
Keywords: antiretroviral therapy, adherence, psychosocial factors, health systems, HIV, Eastleigh, Nairobi
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