Patient‐reported barriers and drivers of adherence to antiretrovirals in sub‐Saharan Africa: a meta‐ethnography

Abstract

This meta-ethnography aims at providing a synthesis and an interpretation of the findings of recent social science research on the questions of retention in antiretroviral therapy (ART) programmes in sub-Saharan Africa (SSA). The literature reviewed comprises ethnographic studies of the barriers to adherence to ART in various cultural settings. The results show that the quality of services, treatment-related costs, as well as the need to maintain social support networks - which can be negatively affected by HIV-related stigma - are important barriers to adherence. In addition, they show how African concepts of personhood are incompatible with the way services are conceived and delivered, targeting the individual. In SSA, individuals must balance physical health with social integrity, which is sometimes achieved by referring to traditional medicine. The ability of local concepts of illness to address social relations in addition to health, together with a historically grounded distrust in Western medicine, explains why traditional medicine is still widely used as an alternative to ART.

Personal barriers to antiretroviral therapy adherence: Case studies from a rural Uganda prospective clinical cohort

“…A systematic review identified fear of disclosure, forgetfulness, lack of understanding of treatment benefits and leaving behind medications, to be common barriers to ART adherence in developed and developing countries, while problems of access, including financial constraints and disruption in drug supplies were specific to developing countries 14 . Failure to disclose HIV serostatus, poor social and family support, concurrent use of other medications with ART have also been found to be associated with poor ART adherence [14][15][16][17][18] . Adolescents have been found to be less adherent to ART than adults and younger children, while orphanhood and lack of social support have also been reported to be associated with poor ART adherence 15,[19][20][21] .…”

“…Failure to disclose HIV serostatus, poor social and family support, concurrent use of other medications with ART have also been found to be associated with poor ART adherence [14][15][16][17][18] . Adolescents have been found to be less adherent to ART than adults and younger children, while orphanhood and lack of social support have also been reported to be associated with poor ART adherence 15,[19][20][21] . Standardised approaches are often used to enhance improvement in adherence to ART, however this may not be appropriate in all cases as this paper illustrates.…”

The biopolitics of engagement and the HIV cascade of care: a synthesis of the literature on patient citizenship and antiretroviral therapy

“…Discourses of the care cascade imply certain kinds of patient expectation and responsibility. An extensive body of extant literature accentuates how social and environmental factors shape HIV treatment provision and engagement (Gari et al, 2013;Merten et al, 2010;Underwood, Hendrickson, Van Lith, Kunda, and Mallalieu, 2014). Additionally, critical perspectives in the social sciences have reflected upon HIV and its care as constituted through situated health practices, identities and subjectivities, with implications for different social and political contexts Whyte, 2009).…”

Fatores intervenientes entre suporte social e autoeficácia em pessoas infectadas pelo HIV

“…A eficácia do tratamento está relacionada à sua adesão, no entanto, sua manutenção durante todo o tratamento é um problema [3][4][5]. A qualidade dos serviços de saúde, os custos relacionados com o TARV e a manutenção das redes de apoio social podem ser afetadas pelo estigma relacionado ao HIV, constituindo-se fatores que influenciam a adesão e tornando necessária a manutenção do equilíbrio entre a saúde física com a integridade social [6].…”