Makokha, Violet Nafula2024-09-262024-09-262024-06https://ir-library.ku.ac.ke/handle/123456789/28892A Thesis Submitted in Partial Fulfilment of the Requirements for the Award of the Degree of Master of Public Health (Epidemiology and Disease Control) in the School of Health Sciences, of Kenyatta University, June 2024. Supervisors 1. Justus O. S. Osero 2. Mary Wangui GitahiEnhanced adherence counselling (EAC) is a structured method of assessing current adherence levels, exploring barriers, and developing individualized adherence intervention plans to improve viral suppression. Adherence to treatment among adolescents has been reported to impede good treatment outcomes. WHO recommends EAC for patients with high Human Immunodeficiency Virus (HIV) viremia and suspected treatment failure and EAC has been associated with high re-suppression, yet limited information exists on the uptake of EACs among the adolescent population. In the UNAIDs goal of 95-95-95, the third ninety aims at achieving 95% viral suppression among those individuals who started on ART. The third ninety, especially among adolescents has remained a challenge. High HIV viremia is defined as individuals who have Viral Load (viral load less than one thousand copies of the virus in their blood. In 2017, only 66% of Adolescents living with HIV (ALHIV) had achieved viral load suppression. Nairobi City reported a viral load suppression of 56% among adolescents and young people. The study focused on assessing the uptake of enhanced adherence counseling among ALHIV on Antiretroviral Therapy (ART) with a documented high viremia in selected health facilities in Nairobi City County. The study investigated the knowledge of adolescents with high viremia, their compliance levels to enhanced adherence counseling, and the identification of factors that affect the uptake of enhanced adherence among adolescents with high viremia. The study used a cross-sectional analytical design and purposively sampled 379 respondents who were interviewed in the forty-five facilities. Data were collected utilizing questionnaires and key informant interview methods and conducted focus group discussions (FDG). Qualitative data were collected, coded, and categorized to come up with emerging themes. The Data analysis was done using Stata version 16. Continuous variables and categorical variables were described by measures of central tendencies and frequency tables, respectively. Calculation of inferential statistics was done using tests of Chi-Square tests at a confidence interval of 95% and an error of precision of 0.05 to show variable associations. According to this study's findings, only 41% of responders received satisfactory Enhanced adherence counseling (EAC). It was found that 55% were females and the median age was 14 years. The study observed high knowledge levels and level of compliance on enhanced adherence counseling at 73% and 80%, respectively. Respondents with adequate compliance ratings were more likely than those with inadequate compliance to take up EAC sessions (Odds ratio: 0.41, C.I 0.26 – 0.65) and respondents with adequate knowledge scoring were less likely to take up EAC successfully compared to those with inadequate knowledge (Odds ratio: 0.48, C.I: 0.29 – 0.8). Age, level of education and type of treatment supporter were among the factors associated with uptake of enhanced adherence counseling. The study concludes that ALHIV from selected facilities had low uptake of EAC and having adequate knowledge did not result in increased uptake similar to having high compliance ratings. Age and level of education influenced Knowledge levels while type of treatment supporter was found to be associated with uptake of enhanced adherence counseling. The study recommends structured EAC by age, reviewing the necessity of the 3 EAC sessions to define satisfactory EAC and necessity of treatment supporter for adolescents with high viremia.enThesis