{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:06:29Z","timestamp":1758845189844,"version":"3.44.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The Human Immunodeficiency Virus (HIV) and acquired immunodeficiency syndrome (AIDS) pandemic remains a major global health issue, with 40.8 million people affected at the end of 2024. In Sub-Saharan Africa, Antiretroviral Therapy (ART) coverage reached 74%, though adherence remained challenging, particularly among youth due to poverty, stigma, and weak health systems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>This paper explored socio-ecological and institutional barriers to ART adherence among young men and women aged 18\u201324 living in Kibra, Nairobi\u2019s largest informal settlement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study utilized phenomenological research design to explore lived experiences within social contexts to uncover hidden structural barriers using qualitative methods. In-depth interviews (<jats:italic>n<\/jats:italic>\u202f=\u202f25), key informant interviews (<jats:italic>n<\/jats:italic>\u202f=\u202f10), participant diaries (<jats:italic>n<\/jats:italic>\u202f=\u202f25), structured clinic and home observations (<jats:italic>n<\/jats:italic>\u202f=\u202f25), and case narratives (<jats:italic>n<\/jats:italic>\u202f=\u202f10). Participants were purposively selected. Data were analyzed thematically using deductive and inductive coding in NVIVO 14.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and discussion<\/jats:title><jats:p>Barriers emerged at individual, socioeconomic, and health system levels. These included limited ART knowledge, pill burden, comorbidities, food insecurity, stigma, violence, and negative healthcare provider attitudes. Addressing these requires multi-level interventions that go beyond medical treatment to tackle structural and social determinants of health.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1650966","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T05:31:19Z","timestamp":1758778279000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Navigating socio-ecological and institutional barriers to antiretroviral therapy adherence: qualitative insights among young men and women from Nairobi\u2019s informal settlements"],"prefix":"10.3389","volume":"13","author":[{"given":"O.","family":"Muhenje","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. O.","family":"Olungah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. 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