title: In what ways do communities support optimal antiretroviral treatment in Zimbabwe?
abstract: Little research has been conducted on how pre-existing indigenous community resources, especially social networks, affect the success of externally imposed HIV interventions. Antiretroviral treatment (ART), an externally initiated biomedical intervention, is being rolled out across sub-Saharan Africa. Understanding the ways in which community networks are working to facilitate optimal ART access and adherence will enable policymakers to better engage with and bolster these pre-existing resources. We conducted 67 interviews and eight focus group discussions with 127 people from three key population groups in Manicaland, eastern Zimbabwe: healthcare workers, adults on ART and carers of children on ART. We also observed over 100 h of HIV treatment sites at local clinics and hospitals. Our research sought to determine how indigenous resources were enabling people to achieve optimal ART access and adherence. We analysed data transcripts using thematic network technique, coding references to supportive community networks that enable local people to achieve ART access and adherence. People on ART or carers of children on ART in Zimbabwe report drawing support from a variety of social networks that enable them to overcome many obstacles to adherence. Key support networks include: HIV groups; food and income support networks; home-based care, church and women's groups; family networks; and relationships with healthcare providers. More attention to the community context in which HIV initiatives occur will help ensure that interventions work with and benefit from pre-existing social capital.
authors.affiliation: Social and Behavioral Interventions, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room E5533, 615 North Wolfe Street, Baltimore, MD 21205, USA kerry.e.scott@gmail.com keescott@jhsph.edu.
authors.forename: K
authors.initials: K
authors.lastname: Scott
authors.affiliation: Institute of Social Psychology, London School of Economics and Political Science, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Campbell
authors.affiliation: Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: C
authors.initials: C
authors.lastname: Madanhire
authors.affiliation: The Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Skovdal
authors.affiliation: Biomedical Research and Training Institute, Harare, Zimbabwe School of Public Health, Imperial College, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Nyamukapa
authors.affiliation: Biomedical Research and Training Institute, Harare, Zimbabwe School of Public Health, Imperial College, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Gregson
mesh_terms: D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003150:Community Health Workers / Q000458:organization & administration; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006266:Health Education / Q000458:organization & administration; D006293:Health Promotion / Q000458:organization & administration; D006297:Health Services Accessibility; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D011203:Poverty; D011369:Professional-Patient Relations; D012067:Religion; D012657:Self-Help Groups; D066270:Social Capital; D057545:Social Stigma; D012944:Social Support; D015030:Zimbabwe
chemical_list: D044966:Anti-Retroviral Agents
keywords: Zimbabwe; antiretroviral treatment; community groups; social capital