title: Changes in Health and Antiretroviral Adherence Among HIV-Infected Adults in Kenya: Qualitative Longitudinal Findings from a Livelihood Intervention.
abstract: This longitudinal qualitative study sought to understand how and why a livelihood intervention affected the health and health behaviors of HIV-infected Kenyan adults. The intervention included a microfinance loan, agricultural and financial training, and a human-powered water pump. In-depth interviews were conducted at two time points with intervention and control participants and program staff. We double coded interviews (n = 117) and used thematic content analysis of transcripts following an integrative inductive-deductive approach. Intervention participants described improvements in HIV health, including increased CD4 counts and energy, improved viral suppression, and fewer HIV-related symptoms. Better health was linked to improved clinic attendance and ART adherence through several mechanisms: (1) reductions in food insecurity and abject hunger; (2) improved financial stability; (3) improved productivity which enhanced social support; (4) better control over work situations; and, (5) renewed desire to prioritize their own health. Livelihood interventions may improve health by influencing upstream determinants of health behavior including food security and poverty.
authors.affiliation: Division of HIV, ID, and Global Medicine, Department of Medicine, University of California San Francisco (UCSF), Box 0874, 995 Potrero Avenue, San Francisco, CA, 94110, USA. Sheri.Weiser@ucsf.edu.|Center of Expertise in Women's Health & Empowerment, University of California Global Health Institute, San Francisco, CA, USA. Sheri.Weiser@ucsf.edu.
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
authors.affiliation: Division of HIV, ID, and Global Medicine, Department of Medicine, University of California San Francisco (UCSF), Box 0874, 995 Potrero Avenue, San Francisco, CA, 94110, USA.|Center of Expertise in Women's Health & Empowerment, University of California Global Health Institute, San Francisco, CA, USA.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Hatcher
authors.affiliation: Division of HIV, ID, and Global Medicine, Department of Medicine, University of California San Francisco (UCSF), Box 0874, 995 Potrero Avenue, San Francisco, CA, 94110, USA.
authors.forename: Lee L
authors.initials: LL
authors.lastname: Hufstedler
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
authors.forename: Elly
authors.initials: E
authors.lastname: Weke
authors.affiliation: Center of Expertise in Women's Health & Empowerment, University of California Global Health Institute, San Francisco, CA, USA.|Department of Social and Behavioral Sciences and Center for AIDS Prevention Studies (CAPS), UCSF, San Francisco, CA, USA.
authors.forename: Shari L
authors.initials: SL
authors.lastname: Dworkin
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.|Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, CA, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, CA, USA.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Burger
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kodish
authors.affiliation: World Food Program, San Salvador, El Salvador.
authors.forename: Nils
authors.initials: N
authors.lastname: Grede
authors.affiliation: Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Butler
authors.affiliation: Center of Expertise in Women's Health & Empowerment, University of California Global Health Institute, San Francisco, CA, USA.|Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, CA, USA.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000383:Agriculture; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004526:Efficiency; D005260:Female; D005378:Financial Support; D005523:Food Supply; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D006815:Hunger; D007630:Kenya; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D011203:Poverty; D036301:Qualitative Research; D012944:Social Support; D019562:Viral Load; D014829:Vocational Education; D014881:Water Supply
chemical_list: D019380:Anti-HIV Agents
keywords: Adherence; Food insecurity; HIV/AIDS; Kenya; Livelihood intervention; Qualitative research