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|Title: ||Explaining Adherence Success in Sub-Saharan Africa: An Ethnographic Study|
|Authors: ||Ware, Norma C.|
Biraro, Irene Andia .
Wyatt, Monique A.
Bangsberg, David R.
|Issue Date: ||27-Jan-2009|
|Publisher: ||PLoS Medicine|
|Series/Report no.: ||Vol.6;No.1; Pp 39-47|
|Abstract: ||Individuals living with HIV/AIDS in sub-Saharan Africa generally take more than 90% of
prescribed doses of antiretroviral therapy (ART). This number exceeds the levels of adherence
observed in North America and dispels early scale-up concerns that adherence would be
inadequate in settings of extreme poverty. This paper offers an explanation and theoretical
model of ART adherence success based on the results of an ethnographic study in three sub-
Saharan African countries.
Methods and Findings
Determinants of ART adherence for HIV-infected persons in sub-Saharan Africa were
examined with ethnographic research methods. 414 in-person interviews were carried out with
252 persons taking ART, their treatment partners, and health care professionals at HIV
treatment sites in Jos, Nigeria; Dar es Salaam, Tanzania; and Mbarara, Uganda. 136 field
observations of clinic activities were also conducted. Data were examined using category
construction and interpretive approaches to analysis. Findings indicate that individuals taking
ART routinely overcome economic obstacles to ART adherence through a number of deliberate
strategies aimed at prioritizing adherence: borrowing and ‘‘begging’’ transport funds, making
‘‘impossible choices’’ to allocate resources in favor of treatment, and ‘‘doing without.’’
Prioritization of adherence is accomplished through resources and help made available by
treatment partners, other family members and friends, and health care providers. Helpers
expect adherence and make their expectations known, creating a responsibility on the part of
patients to adhere. Patients adhere to promote good will on the part of helpers, thereby
ensuring help will be available when future needs arise.
Adherence success in sub-Saharan Africa can be explained as a means of fulfilling social
responsibilities and thus preserving social capital in essential relationships.|
|Appears in Collections:||Medicine|
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