Understanding Patterns of Social Support and Their Relationship to an ART Adherence Intervention Among Adults in Rural Southwestern Uganda

Esther C Atukunda,Angella Musiimenta,Monique A Wyatt,Nicholas Musinguzi,Norma C Ware,Justus Ashaba,Jessica E Haberer

doi:10.1007/s10461-016-1559-7

Abstract

SMS is a widely used technology globally and may also improve ART adherence, yet SMS notifications to social supporters following real-time detection of missed doses showed no clear benefit in a recent pilot trial. We examine the demographic and social-cultural dynamics that may explain this finding. In the trial, 63 HIV-positive individuals initiating ART received a real-time adherence monitor and were randomized to two types of SMS reminder interventions versus a control (no SMS). SMS notifications were also sent to 45 patient-identified social supporters for sustained adherence lapses. Like participants, social supporters were interviewed at enrollment, following their matched participant’s adherence lapse and at exit. Social supporters with regular income (RR = 0.27, P = 0.001) were significantly associated with fewer adherence lapses. Instrumental support was associated with fewer adherence lapses only among social supporters who were food secure (RR = 0.58, P = 0.003). Qualitative interview data revealed diverse and complex economic and relationship dynamics, affecting social support. Resource availability in emotionally positive relationships seemingly facilitated helpful support, while limited resources prevented active provision of support for many. Effective social support appeared subject to social supporters’ food security, economic stability and a well-functioning social network dependent on trust and supportive disclosure.

Highlights

High levels of antiretroviral therapy (ART) adherence are critical for HIV viral suppression and general health outcomes
The dependent variable was computed for each participant as the number of 48-h interruptions in medication adherence compiled between study Months 4 and 9
In a pilot randomized controlled trial to assess the impact of SMS interventions on ART adherence in southwestern Uganda, SMS notifications of adherence lapses sent to social supporters showed no clear benefit for the adherence of the HIV-positive individuals taking ART

Summary

Introduction

High levels of antiretroviral therapy (ART) adherence are critical for HIV viral suppression and general health outcomes. Social support has been linked to improved medication adherence and quality of life among HIV-positive patients taking ART in many settings, noteworthy in subSaharan Africa, whose population accounts for [90 % of prescribed ART [1,2,3,4]. Multiple mechanisms may be involved in effective social support for medication adherence. For example, facilitates a positive state of mind and directly improves self-efficacy to adhere [5,6,7]. Instrumental support, especially after ART initiation, helps patients to sustainably overcome many other barriers to adherence. This support may involve income generating activities to overcome food insecurity, transportation challenges and other structural barriers to ART [1]

Methods

Results

Conclusion