ORIGINAL RESEARCH article
Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1650966
Navigating Socio-Ecological and Institutional Barriers to Antiretroviral Therapy (ART) Adherence: Qualitative Insights among Young Men and Women from Nairobi's Informal Settlements
Provisionally accepted
Odylia Muhenje1*
Charles Owuor Olungah1
Dalmas Omia1Raphael O. Ondondo2Paul Waswa3
Adelaide M Lusambili4,5- 1Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
- 2School of Public Health, Biomedical Sciences & Technology, Masinde Muliro University of Science and Technology, Kakamega, Kenya
- 3Strathmore University Strathmore Business School, Nairobi, Kenya
- 4Environmental Health and Governance Centre, Africa International University, Nairobi, Kenya
- 5NextGen For Earth, Nairobi, Kenya
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
ABSTRACT Background: The Human Immunodeficiency Virus (HIV) and acquired immunodeficiency syndrome (AIDS) pandemic remains a major global health issue, with 40.8 million people affected at the end of 2024. In Sub-Saharan Africa, Antiretroviral Therapy (ART) coverage reached 74%, though adherence remained challenging, particularly among youth due to poverty, stigma, and weak health systems. Aim: This paper explored socio-ecological and institutional barriers to ART adherence among young men and women aged 18-24 living in Kibra, Nairobi's largest informal settlement. Methods: The study utilized phenomenological research design to explore lived experiences within social contexts to uncover hidden structural barriers using qualitative methods. In-depth interviews (n=25), key informant interviews (n=10), participant diaries (n=25), structured clinic and home observations (n=25), and case narratives (n=10). Participants were purposively selected. Data were analyzed thematically using deductive and inductive coding in NVIVO 14. Results and Discussion: Barriers emerged at individual, socioeconomic, and health system levels. These included limited ART knowledge, pill burden, comorbidities, food insecurity, stigma, violence, and negative healthcare provider attitudes. Addressing these requires multi-level interventions that go beyond medical treatment to tackle structural and social determinants of health.
Keywords: antiretroviral therapy, Young people, adherence, retention, HIV, Kenya
Received: 20 Jun 2025; Accepted: 08 Sep 2025.
Copyright: © 2025 Muhenje, Olungah, Omia, Ondondo, Waswa and Lusambili. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Odylia Muhenje, Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.