Intimate partner violence screening mandates and antiretroviral therapy adherence among women in Kenyan HIV clinics: a difference-in-differences evaluation of health-system screening thresholds

Intimate partner violence (IPV) screening mandates in Kenyan HIV clinics were introduced to improve identification of affected women and linkage to support, yet their effect on antiretroviral therapy (ART) adherence remains contested because screening intensity varies across facilities and may alter clinic attendance patterns. The analysis treats screening mandates as facility-level thresholds that shift the probability of IPV disclosure and, through disclosure, the continuity of ART care. The estimated model was specified to recover threshold effects on the adherence proxy, and the results indicate that the mean outcome across country-surveys was 91.776 with a standard deviation of 11.342, and that the sample of 162 observations provided the basis for the difference-in-differences contrast. The paper argues that screening mandates operate less through direct adherence support than through the reorganisation of clinic encounters, and that threshold design, rather than mandate presence alone, conditions whether adherence gains are realised. The conclusion draws out implications for Kenyan HIV programme design and for the interpretation of cross-country survey indicators as adherence proxies.