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Social and Structural Determinants of Household Support for ART Adherence in Low- and Middle-Income Countries: A Systematic Review

Author

Listed:
  • Linda Campbell

    (Centre for Population, Family and Health, University of Antwerp, 2000 Antwerp, Belgium)

  • Caroline Masquillier

    (Centre for Population, Family and Health, University of Antwerp, 2000 Antwerp, Belgium)

  • Estrelle Thunnissen

    (Centre for Population, Family and Health, University of Antwerp, 2000 Antwerp, Belgium)

  • Esther Ariyo

    (Centre for Population, Family and Health, University of Antwerp, 2000 Antwerp, Belgium)

  • Hanani Tabana

    (School of Public Health, University of the Western Cape, Bellville 7535, South Africa)

  • Neo Sematlane

    (School of Public Health, University of the Western Cape, Bellville 7535, South Africa)

  • Anton Delport

    (School of Public Health, University of the Western Cape, Bellville 7535, South Africa)

  • Lorraine Tanyaradzwa Dube

    (School of Public Health, University of the Western Cape, Bellville 7535, South Africa)

  • Lucia Knight

    (School of Public Health, University of the Western Cape, Bellville 7535, South Africa)

  • Tair Kasztan Flechner

    (Centre for Population, Family and Health, University of Antwerp, 2000 Antwerp, Belgium)

  • Edwin Wouters

    (Centre for Population, Family and Health, University of Antwerp, 2000 Antwerp, Belgium)

Abstract

Adherence to HIV antiretroviral therapy (ART) is a crucial factor in health outcomes for people living with HIV (PLWH). Interventions to support ART adherence are increasingly focused on the household as a source of social support. This review aims to examine the social and structural determinants of support for ART adherence within households and families in low- and middle-income countries (LMICs). The review methodology followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seven databases were searched for peer-reviewed literature. The terms searched thematically covered (1) ART adherence, (2) household and family and (3) support and care. Thirty-three studies conducted in 15 LMICs were selected and a mixed methods synthesis was undertaken. Social and structural determinants affected the type, quality and amount of support for PLWH of all ages, which affected PLWH’s ART adherence. Gender norms affected the type of support that household members give to PLWH. Education moderated household support for ART adherence through literacy and language skills. Cultural context, religious beliefs, and social norms reinforced or undermined household support for ART adherence. Stigma affected disclosure, generated secrecy around giving medication and impeded access to support from the community. Supporting PLWH exacerbated economic hardship for household members. Health system dysfunction negatively impacted trust and communication between household members and health professionals. Intersecting social and structural determinants particularly affected the care given by household members who were older, female, with little education and low socioeconomic status. Household members were able to overcome some of these barriers when they received support themselves. Household interventions to support PLWH’s ART adherence should take structural factors into account to have maximum impact.

Suggested Citation

  • Linda Campbell & Caroline Masquillier & Estrelle Thunnissen & Esther Ariyo & Hanani Tabana & Neo Sematlane & Anton Delport & Lorraine Tanyaradzwa Dube & Lucia Knight & Tair Kasztan Flechner & Edwin Wo, 2020. "Social and Structural Determinants of Household Support for ART Adherence in Low- and Middle-Income Countries: A Systematic Review," IJERPH, MDPI, vol. 17(11), pages 1-28, May.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:11:p:3808-:d:363609
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    References listed on IDEAS

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    1. Wouters, Edwin & Masquillier, Caroline & Ponnet, Koen & le Roux Booysen, Frederik, 2014. "A peer adherence support intervention to improve the antiretroviral treatment outcomes of HIV patients in South Africa: The moderating role of family dynamics," Social Science & Medicine, Elsevier, vol. 113(C), pages 145-153.
    2. Conroy, Amy A. & McKenna, Stacey A. & Comfort, Megan L. & Darbes, Lynae A. & Tan, Judy Y. & Mkandawire, James, 2018. "Marital infidelity, food insecurity, and couple instability: A web of challenges for dyadic coordination around antiretroviral therapy," Social Science & Medicine, Elsevier, vol. 214(C), pages 110-117.
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    Cited by:

    1. Lucia Knight & Enid Schatz, 2022. "Social Support for Improved ART Adherence and Retention in Care among Older People Living with HIV in Urban South Africa: A Complex Balance between Disclosure and Stigma," IJERPH, MDPI, vol. 19(18), pages 1-16, September.
    2. Vicente F. Gil-Guillen & Alejandro Balsa & Beatriz Bernárdez & Carmen Valdés y Llorca & Emilio Márquez-Contreras & Juan de la Haba-Rodríguez & Jose M. Castellano & Jesús Gómez-Martínez, 2022. "Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions," IJERPH, MDPI, vol. 19(19), pages 1-23, September.

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