title: Health Provider Views on Improving Antiretroviral Therapy Adherence Among Men Who Have Sex with Men in Coastal Kenya.
abstract: HIV-positive Kenyan men who have sex with men (MSM) are a highly stigmatized group facing barriers to care engagement and antiretroviral therapy (ART) adherence. Because care providers' views are important in improving outcomes, we sought the perspective of those serving MSM patients on how to optimize ART adherence in a setting where same-sex behavior is criminalized. We conducted 4 focus group discussions with a total of 29 healthcare workers (HCWs) experienced in providing HIV care to MSM. The semistructured, open-ended topic guide used was based on an access-information-motivation-proximal cues model of adherence, with added focus on trust in providers, stigma, and discrimination. Detailed facilitator notes and transcripts were translated into English and reviewed for common themes. The HCW identified adherence challenges of MSM patients that are similar to those of the general population, including HIV-related stigma and lack of disclosure. In addition, HCWs noted challenges specific to MSM, such as lack of access to MSM-friendly health services, economic and social challenges due to stigma, difficult relationships with care providers, and discrimination at the clinic and in the community. HCWs recommended clinic staff sensitivity training, use of trained MSM peer navigators, and stigma reduction in the community as interventions that might improve adherence and health outcomes for MSM. Despite noting MSM-specific barriers, HCWs recommended strategies for improving HIV care for MSM in rights-constrained settings that merit future research attention. Most likely, multilevel interventions incorporating both individual and structural factors will be necessary.
authors.affiliation: 1 Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute , Kilifi, Kenya .
authors.forename: Murugi
authors.initials: M
authors.lastname: Micheni
authors.affiliation: 1 Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute , Kilifi, Kenya .
authors.forename: Bernadette K
authors.initials: BK
authors.lastname: Kombo
authors.affiliation: 2 Innovations for Poverty Action , Lusaka, Zambia .
authors.forename: Andrew
authors.initials: A
authors.lastname: Secor
authors.affiliation: 3 Department of Psychology and Global Health, University of Washington , Seattle, Washington.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Simoni
authors.affiliation: 4 Department of Behavioral and Social Sciences, School of Public Health, Brown University , Providence, Rhode Island.
authors.forename: Don
authors.initials: D
authors.lastname: Operario
authors.affiliation: 1 Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute , Kilifi, Kenya .
authors.forename: Elise M
authors.initials: EM
authors.lastname: van der Elst
authors.affiliation: 1 Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute , Kilifi, Kenya .
authors.forename: Peter
authors.initials: P
authors.lastname: Mugo
authors.affiliation: 1 Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute , Kilifi, Kenya .
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kanungi
authors.affiliation: 1 Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute , Kilifi, Kenya .|5 Nuffield Department of Medicine, University of Oxford , Oxford, United Kingdom .
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.affiliation: 1 Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute , Kilifi, Kenya .|6 Departments of Medicine, Global Health, and Epidemiology, University of Washington , Seattle, Washington.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D018451:Homosexuality, Male / Q000208:ethnology / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care; D010379:Peer Group; D036301:Qualitative Research; D057545:Social Stigma; D013240:Stereotyping; D014342:Truth Disclosure; D055815:Young Adult
keywords: HIV-AIDS; Kenya; adherence; antiretroviral therapy; healthcare providers; men who have sex with men