Table 3: Barriers to VL suppression identified during EAC of adolescents at CHE.
|
Barriers (frequency, percentage) |
Intervention |
n (%) |
|
Knowledge deficit (126, 91.3%) |
Individual counseling for basic HIV/ARV education |
117 (92.9) |
|
Group counseling/ peer support group |
9 (6.5) |
|
|
Written instructions |
0 (0.0) |
|
|
Side effects (75, 54.3%) |
Nausea-take food, antiemetic |
39 (52.0) |
|
Diarrhea-rule out infection, medications where applicable, patient hydration |
9 (12.0) |
|
|
Anxiety/depression-counseling/medications |
6 (8.0) |
|
|
Headache-rule out OIs, medication |
15 (20.0) |
|
|
Fatigue-rule out anemia |
6 (8.0) |
|
|
Forgot (126, 91.3%) |
Medication organizer |
0 (0.0) |
|
Visual medication schedule-calendar, journal |
6 (4.8) |
|
|
Reminder devices-alarms, phone reminder |
117 (92.9) |
|
|
Treatment buddy/supporter |
0 (0.0) |
|
|
Directly Observed Therapy |
0 (0.0) |
|
|
Announced pill count at next visit |
3 (0.0) |
|
|
Feeling better (84, 60.9%) |
Basic HIV/ARV education |
84 (100) |
|
Physical illness (15, 10.9%) |
Clinical care to address comorbidities |
15 (100) |
|
Directly Observed Therapy |
0 (0.0) |
|
|
Treatment buddy |
0 (0.0) |
|
|
Alcohol or Drug use (12, 8.7%) |
Individual counseling |
12 (8.7) |
|
Peer support group |
0 (0.0) |
|
|
Referral to appropriate bodies to address specific issues if they check 3 or more on the CAGE score for alcohol and substance abuse |
0 (0.0) |
|
|
Depression and self-stigma (48, 34.8%) |
Individual counseling |
39 (81.3) |
|
Peer support group |
9 (18.8) |
|
|
Medication |
0 (0.0) |
|
|
Treatment buddy |
0 (0.0) |
|
|
Pill burden (12, 8.7%) |
Change to fixed dose combination if available |
12 (100) |
|
Transportation problems (63, 45.7%) |
Review by social worker |
63 (100) |
|
Clinic schedule |
0 (0.0) |
|
|
Incorrect health beliefs (72, 52.2%) |
HIV/ARV education |
30 (41.7) |
|
Individual counseling |
36 (50.0) |
|
|
Peer support group |
6 (8.3) |
|
|
Group counseling |
0 (0.0) |
|
|
Scheduling difficulty (57, 42.3%) |
Education (eg combine with daily routine such as bedtime or brushing the teeth |
39 (68.4) |
|
Reminder devices |
18 (31.6) |
|
|
Treatment buddy |
0 (0.0) |
|
|
Link with nearest health facility |
0 (0.0%) |
|
|
Fear of disclosure (42, 30.4%) |
Individual counseling on basic HIV education |
27 (64.3) |
|
Group counseling |
3 (7.1) |
|
|
Couple counseling |
0 (0.0) |
|
|
Facilitate enrolment into care of family members eg discordant couple, PrEP |
0 (0.0) |
|
|
Peer support groups |
12 (28.6) |
|
|
Treatment buddy |
0 (0.0) |
|
|
Unmarked pill bottle |
0 (0.0) |
|
|
Refer to social worker, nutritional services |
0 (0.0) |
|
|
Stigma and discrimination (66, 47.8%) |
Individual counseling |
60 (90.9) |
|
Group counseling |
0 (0.0) |
|
|
Peer counseling |
6 (9.1) |
|
|
Poor relationship with health care worker (27, 19.6%) |
Address HCP issues |
18 (66.7) |
|
Consider other HCP |
9 (33.3) |
|
|
Frequent visits to facility (78, 56.5%) |
Harmonize appointments for multiple services eg. FP, labs, immunization |
60 (100) |
|
Long wait times (66, 47.8%) |
Nurse led model |
0 (0.0) |
|
Fast track refill at pharmacy for patients with no complaints |
30 (45.5) |
|
|
Evening/early morning appointments |
0 (0.0) |
|
|
Three-month supply |
0 (0.0) |
|
|
Specific individualized appointment times |
36 (54.5) |