Explaining Adherence Success in Sub-Saharan Africa: An Ethnographic Study
Identifieur interne : 005407 ( Main/Merge ); précédent : 005406; suivant : 005408Explaining Adherence Success in Sub-Saharan Africa: An Ethnographic Study
Auteurs : Norma C. Ware [États-Unis] ; John Idoko [Nigeria] ; Sylvia Kaaya [Tanzanie] ; Irene Andia Biraro [Ouganda] ; Monique A. Wyatt [États-Unis] ; Oche Agbaji [Nigeria] ; Guerino Chalamilla [Tanzanie, États-Unis] ; David R. Bangsberg [États-Unis]Source :
- PLoS Medicine [ 1549-1277 ] ; 2009.
Descripteurs français
- KwdFr :
- Adulte, Afrique subsaharienne, Anthropologie culturelle, Antirétroviraux (usage thérapeutique), Coûts des soins de santé, Entretiens comme sujet, Facteurs socioéconomiques, Femelle, Humains, Mâle, Observance thérapeutique (ethnologie), Soutien social, Syndrome d'immunodéficience acquise (traitement médicamenteux).
- MESH :
- ethnologie : Observance thérapeutique.
- traitement médicamenteux : Syndrome d'immunodéficience acquise.
- usage thérapeutique : Antirétroviraux.
- Adulte, Afrique subsaharienne, Anthropologie culturelle, Coûts des soins de santé, Entretiens comme sujet, Facteurs socioéconomiques, Femelle, Humains, Mâle, Soutien social.
English descriptors
- KwdEn :
- MESH :
- chemical , therapeutic use : Anti-Retroviral Agents.
- geographic : Africa South of the Sahara.
- drug therapy : Acquired Immunodeficiency Syndrome.
- ethnology : Patient Compliance.
- Adult, Anthropology, Cultural, Female, Health Care Costs, Humans, Interviews as Topic, Male, Social Support, Socioeconomic Factors.
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.
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.
Url:
DOI: 10.1371/journal.pmed.1000011
PubMed: 19175285
PubMed Central: 2631046
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PMC:2631046Le document en format XML
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<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
<term>Observance thérapeutique (ethnologie)</term>
<term>Soutien social</term>
<term>Syndrome d'immunodéficience acquise (traitement médicamenteux)</term>
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<front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background</title>
<p>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.</p>
</sec>
<sec id="st2"><title>Methods and Findings</title>
<p>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.</p>
</sec>
<sec id="st3"><title>Conclusion</title>
<p>Adherence success in sub-Saharan Africa can be explained as a means of fulfilling social responsibilities and thus preserving social capital in essential relationships.</p>
</sec>
</div>
</front>
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