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

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


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: NCT01548599.

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

MeSH terms

  • Adult
  • Agriculture
  • Anti-HIV Agents / therapeutic use*
  • CD4 Lymphocyte Count
  • Efficiency
  • Female
  • Financial Support*
  • Food Supply*
  • HIV Infections / drug therapy*
  • HIV Infections / immunology
  • Humans
  • Hunger
  • Kenya
  • Longitudinal Studies
  • Male
  • Medication Adherence*
  • Poverty*
  • Qualitative Research
  • Social Support
  • Viral Load
  • Vocational Education*
  • Water Supply


  • Anti-HIV Agents

Associated data