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dc.contributor.authorIdoko, John
dc.contributor.authorKaaya, Sylvia
dc.contributor.authorBiraro, Irene Andia
dc.contributor.authorAgbaji, Oche
dc.contributor.authorBeyrer, Chris
dc.contributor.authorWare, Norma Clara
dc.contributor.authorWyatt, Monique A.
dc.contributor.authorChalamilla, Guerino E.
dc.contributor.authorBangsberg, David Roy
dc.date.accessioned2012-01-08T23:46:44Z
dc.date.issued2009
dc.identifier.citationWare, Norma C, John Idoko, Sylvia Kaaya, Irene Andia Biraro, Monique A Wyatt, Oche Agbaji, Guerino Chalamilla, and David R Bangsberg. 2009. Explaining adherence success in sub-Saharan Africa: an ethnographic study. PLoS Medicine 6(1): e1000011.en_US
dc.identifier.issn1549-1277en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:7349720
dc.description.abstractBackground: 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.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi://10.1371/journal.pmed.1000011en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631046/pdf/en_US
dash.licenseLAA
dc.subjectinfectious diseasesen_US
dc.titleExplaining Adherence Success in Sub-Saharan Africa: An Ethnographic Studyen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS Medicineen_US
dash.depositing.authorWare, Norma Clara
dc.date.available2012-01-08T23:46:44Z
dash.affiliation.otherSPH^Nutritionen_US
dash.affiliation.otherHMS^Medicine-Massachusetts General Hospitalen_US
dc.identifier.doi10.1371/journal.pmed.1000011*
dash.authorsorderedfalse
dash.contributor.affiliatedChalamilla, Guerino
dash.contributor.affiliatedWyatt, Monique
dash.contributor.affiliatedWare, Norma
dash.contributor.affiliatedBangsberg, David R.


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