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AIDS Behav. 2017 Feb;21(2):415-427. doi: 10.1007/s10461-016-1551-2.

Changes in Health and Antiretroviral Adherence Among HIV-Infected Adults in Kenya: Qualitative Longitudinal Findings from a Livelihood Intervention.

Author information

1
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.
2
Center of Expertise in Women's Health & Empowerment, University of California Global Health Institute, San Francisco, CA, USA. Sheri.Weiser@ucsf.edu.
3
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.
4
Center of Expertise in Women's Health & Empowerment, University of California Global Health Institute, San Francisco, CA, USA.
5
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
6
Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
7
Department of Social and Behavioral Sciences and Center for AIDS Prevention Studies (CAPS), UCSF, San Francisco, CA, USA.
8
Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, CA, USA.
9
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
10
World Food Program, San Salvador, El Salvador.
11
Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.

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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01548599.

KEYWORDS:

Adherence; Food insecurity; HIV/AIDS; Kenya; Livelihood intervention; Qualitative research

PMID:
27637497
PMCID:
PMC5953204
DOI:
10.1007/s10461-016-1551-2
[Indexed for MEDLINE]
Free PMC Article

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