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Cited by 437HIV/AIDS Research and InterventionsMedication Adherence and ComplianceHIV/AIDS Impact and Responses

Explaining Adherence Success in Sub-Saharan Africa: An Ethnographic Study

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Ware, Norma C, Idoko, John, Kaaya, Sylvia, Biraro, Irene Andia, Wyatt, Monique A, Agbaji, Oche, Chalamilla, Guerino, Bangsberg, David R·2009·PLoS Medicine
DOI 10.1371/journal.pmed.1000011PMC PMC2631046
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Abstract

BACKGROUND: 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. CONCLUSION: Adherence success in sub-Saharan Africa can be explained as a means of fulfilling social responsibilities and thus preserving social capital in essential relationships.

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  • Studies on ART adherence showed that predictors and risk factors differ per region of the world.

    “Studies on ART adherence showed that predictors and risk factors differ per region of the world, necessitating context-specific development of non-adherence profiles.9 10”

    From Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review (2016) · cites this paper as [9]

    The Discussion contrasts economic obstacles and social relationships in sub-Saharan Africa with an individual-level account of adherence in North America, and describes a theory of differences between resource-poor and resource-rich settings. This supports context-dependent influences on adherence, but the paper does not establish that predictors and risk factors differ across regions of the world generally. The call for context-specific non-adherence profiles is the citing authors’ inference, not a finding reported in this paper. (LLM, conf=0.83)

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Authors
Ware, N. C., Idoko, J., Kaaya, S., Biraro, I. A., Wyatt, M. A., Agbaji, O., Chalamilla, G., & Bangsberg, D. R.
Affiliations
  • Harvard University (US)
  • University of Jos (NG)
  • Muhimbili University of Health and Allied Sciences (TZ)
  • Mbarara University of Science and Technology (UG)
Corresponding author
Ware, Norma C
ORCID
Venue
PLoS Medicine
Publisher
Public Library of Science (PLoS)
Published
2009-01-27
Volume
6
Issue
1
Pages
e1000011
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1000011
PMC
PMC2631046
OpenAlex
W2119740264
Cited by
437
References
6
Citations by year
2026: 29 · 2025: 9 · 2024: 12 · 2023: 7 · 2022: 14 · 2021: 14 · 2020: 17 · 2019: 21 · 2018: 29 · 2017: 22 · 2016: 37 · 2015: 16 · 2014: 33 · 2013: 50 · 2012: 35
FWCI
28.98
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • IHI Repository (acceptedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Harvard University
  • Muhimbili University of Health and Allied Sciences
  • University of Health and Allied Sciences
  • National Institutes of Health (5k24aa015287-03)
  • National Institute on Alcohol Abuse and Alcoholism (K-24 AA015287)
  • National Institute of Mental Health (R01MH054907, R21MH077539)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › HIV/AIDS Impact and Responses
Keywords
antiretroviral therapy adherence, HIV/AIDS, social capital, social responsibility, financial barriers to treatment, resource allocation, social support, social networks, poverty, sub-Saharan Africa
MeSH terms
Acquired Immunodeficiency Syndrome, Adult, Anthropology, Cultural, Female, Humans, Interviews as Topic, Male, Patient Compliance, Social Support, Socioeconomic Factors, Health Care Costs, Africa South of the Sahara, Anti-Retroviral Agents

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