Explaining adherence success in sub-Saharan Africa: an ethnographic study

Area of Science:

• Global Health
• Social Sciences
• Medical Anthropology

Background:

• High adherence rates (>90%) to antiretroviral therapy (ART) in sub-Saharan Africa challenge early concerns about treatment scale-up in low-income settings.
• This study investigates the underlying factors contributing to successful ART adherence in the region.

Purpose of the Study:

• To explain the high rates of ART adherence observed in sub-Saharan Africa.
• To develop a theoretical model for ART adherence success in resource-limited environments.

Main Methods:

• An ethnographic study was conducted in Nigeria, Tanzania, and Uganda.
• Data collection involved 414 in-person interviews with patients on ART, their treatment partners, and healthcare professionals.
• 136 field observations of clinic activities were also performed.

Main Results:

• Individuals facing economic challenges employ deliberate strategies to prioritize ART adherence, such as securing transport funds and reallocating resources.
• Adherence is facilitated by support from treatment partners, family, friends, and healthcare providers who expect and communicate adherence expectations.
• Patients adhere to maintain goodwill with helpers, ensuring future support.

Conclusions:

• ART adherence success in sub-Saharan Africa is fundamentally linked to fulfilling social responsibilities.
• Adherence serves to preserve social capital within essential relationships, underscoring the importance of community and support systems in public health.
• The findings highlight a culturally embedded model of adherence driven by social obligations and mutual support.