"We give them threatening advice…": expectations of adherence to antiretroviral therapy and their consequences among adolescents living with HIV in rural Malawi

摘要: INTRODUCTION Many adolescents living with HIV in sub-Saharan Africa struggle to achieve optimal adherence antiretroviral therapy (ART), but few studies have investigated how their treatment-taking decisions are influenced by social interactions providers, caregivers and community leaders. This study aims explore the narratives that define expectations of ART among a rural Malawian setting. METHODS Overall, 45 in-depth interviews were conducted 2016 HIV, caregivers, health workers leaders, four group sessions using participatory tools undertaken adolescents. Interviews audio-recorded, transcribed translated into English. Data coded inductively analysed thematically. RESULTS Adolescents given strict behavioural codes around treatment adherence, which often enforced through encouragement, persuasian threats. In clinics, some staff supported broader concerns relating other measures address sub-optimal clinics perceived patients as punitive, including pill-counts increased frequency clinic visits. Community leaders felt responsible for young peoples' health, sometimes attempting influence threatening withdraw services, or publically "out" those deemed be non-adherent. At home, discussions about limited dose reminders, caretakers resorted physical punishment ensure adherence. While complied strictly-enforced rules, others demonstrated resistance hiding missed doses, secretly throwing away drugs, openly refusing take them. CONCLUSIONS The potential people adhere may undermined restrictive messages punitive approaches enforce control engagement at wider community. Interventions should focus on creating safe spaces speak frankly challenges they face support home-based interventions.