# \[e-med\] Expliquer la bonne observance aux traitements ARV en Afrique sub-saharienne : une étude ethnographique **URL:** \ **Category:** e-med\ **Created:** [February 3, 2009, 9:52am UTC](https://talk.edrugplus.org/t/e-med-expliquer-la-bonne-observance-aux-traitements-arv-en-afrique-sub-saharienne-une-etude-ethnographique/31235 "2009-02-03T09:52:28Z")\ **Posts on this page:** 1\ **Page:** 1
**Author:** ![remed9](https://avatars.discourse-cdn.com/v4/letter/r/22d042/32.png) [@remed9](https://talk.edrugplus.org/u/remed9)\ **Post date:** [February 3, 2009, 9:52am UTC](https://talk.edrugplus.org/t/e-med-expliquer-la-bonne-observance-aux-traitements-arv-en-afrique-sub-saharienne-une-etude-ethnographique/31235/1 "2009-02-03T09:52:28Z")
[article en entier disponible : [http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/](http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/) journal.pmed.1000011 CB] Résumé Explaining Adherence Success in Sub-Saharan Africa: An Ethnographic Study Norma C. Ware1\*, John Idoko2, Sylvia Kaaya3, Irene Andia Biraro4, Monique A. Wyatt1, Oche Agbaji2, Guerino Chalamilla5,6, David R. Bangsberg1,7,8 1 Harvard Medical School, Boston, Massachusetts, United States of America, 2 Jos University, Jos, Nigeria, 3 Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, 4 Mbarara University of Science and Technology, Mbarara, Uganda, 5 Muhimbili University/Dar es Salaam City Council/Harvard School of Public Health HIV/AIDS Care and Treatment Program, Dar es Salaam, Tanzania, 6 Harvard School of Public Health, Boston, Massachusetts, United States of America, 7 Massachusetts General Hospital, Boston, Massachusetts, United States of America, 8 Harvard Initiative for Global Health, Cambridge, Massachusetts, United States of America Background 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. Funding: This study was supported by grants from the U.S. National Institute of Mental Health (NIMH, R21 MH077539, MH54907) and the Harvard University Program on AIDS. DRB was funded by a grant from the National Institute of Alcohol and Alcoholism (K-24 AA 015287) and the NIMH (MH54907). The funders played no role in the design or conduct of the research, the decision to publish, or the preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Academic Editor: Chris Beyrer, Johns Hopkins University, United States of America Citation: Ware NC, Idoko J, Kaaya S, Biraro IA, Wyatt MA, et al. (2009) Explaining Adherence Success in Sub-Saharan Africa: An Ethnographic Study. PLoS Med 6(1): e1000011 doi:10.1371/journal.pmed.1000011 Received: June 3, 2008; Accepted: November 19, 2008; Published: January 27, 2009 Copyright: © 2009 Ware et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abbreviations: ART, antiretroviral therapy \* To whom correspondence should be addressed. E-mail: norma\_ware@hms.harvard.edu