Transcript Slide 1

A Social Model of Adherence for sub-Saharan Africa
Ware and Bangsberg PLoS Medicine (in press)
Improving Health
Individual:
HIV knowledge
Med side effects
Cognitive function
Mental health
Alcohol Use
Social Structural:
Patterns of Inequality,
e.g., stigma,
gender inequality
Resource
Scarcity
Relationships
as resources to
overcome
economic
obstacles to
adherence
Infrastructural:
Few treatment sites
Distance to care
Cost/Availability of
Transportation
Social
Capital
Adherence
fulfills
responsibility to
helpers and
preserve
relationships
as a resource
Resource
Scarcity
Cultural:
Religious Beliefs
Respect for Authority
Importance of
having children
How to improve adherence
Patient factors:
•Treatment preparedness; knowledge about HAART , encourage disclosure
•Treat depression
•Minimise alcohol / drug use
•Food security
Medication factors:
•Pregnancy
•No stock outs
•Adolescence
•Minimise no. of tablets and
doses
•Stigma
Provider factors:
•Minimise diet restrictions &
fluid requirements
•Maximise clinician experience
•Minimise adverse effects
•Supportive and caring programme
•Monitor adherence and act on problems early
•Clinics easily accessible (in place and time!) – cost to patient.