# Facilitators and barriers to the implementation of Community-Based Medication Adherence Support for Aging Individuals with HIV and Hypertension in western Kenya

## TL;DR

This study explores what helps or hinders community health workers from supporting older HIV-positive people with medication adherence in Kenya.

## Contribution

The study identifies novel facilitators and barriers specific to implementing community-based adherence programs for aging individuals with HIV and hypertension.

## Key findings

- Facilitators include adaptability of the intervention and collaboration between community and facility care providers.
- Barriers include increased workload for CHVs, limited hypertension knowledge, and unmet patient needs.
- Trust and empathy between CHVs and patients are critical for successful adherence support.

## Abstract

The advent of antiretroviral therapy (ART) remarkably improved the longevity and quality of life of people living with HIV (PLWH). However, as PLWH age, they often experience comorbidities, necessitating multiple medications, resulting in increased medication adherence challenges. Patient-tailored community-based medication adherence programs can improve adherence in this population. We explored facilitators of and barriers to the implementation of community health volunteer (CHV)-led medication adherence (CBA) support programs for older people living with HIV (OALWH).

This qualitative study involved 166 purposefully sampled participants. In-depth interviews (IDIs) were held with 27 healthcare providers (HCPs), 28 CHVs, and 25 older adults’ caregivers. Six focus group discussions (FGDs) were held with 86 OALWH affiliated with three health facilities in western Kenya. The IDIs and FGDs covered topics on perceived barriers and facilitators to having a CHV visit OALWH’s home to offer medication adherence support. The data were analyzed thematically and organized using the Consolidated Framework for Implementation Research (CFIR).

The findings revealed various factors that could influence the implementation of a CBA intervention for OALWH and hypertension. Facilitators included the relative advantage and adaptability of the intervention, the enhanced collaboration between facility and community care providers, and the potential to promote patient-centered care. However, participants voiced several factors that may impede the intervention, such as the complexity of the intervention, increased workload and costs for CHVs, limited knowledge of hypertension management, unmet patient needs, and limited health financing for NCD medications. Fears of decreased cognitive ability, low cardiovascular risk perception, and medication side effects among OALWH were perceived to pose challenges. Furthermore, trust and empathy between CHVs and patients were identified as critical personal attributes that foster patient empowerment.

This study identified barriers, highlighting the complexities of tailoring community support services to the needs of OALWH. The findings underscore the necessity for a holistic, multidimensional approach to addressing medication adherence by providing OALWH with the requisite hypertension management messaging, revisiting health system barriers (NCD care financing), and facilitating CHVs with knowledge, skills, and remuneration to enable them to efficiently support CBA intervention.