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. 2017 Feb;21(2):428-440.
doi: 10.1007/s10461-016-1559-7.

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

Esther C Atukunda  1 , Angella Musiimenta  2 , Nicholas Musinguzi  2 , Monique A Wyatt  3 , Justus Ashaba  2 , Norma C Ware  3 , Jessica E Haberer  4
Affiliations

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

Esther C Atukunda et al. AIDS Behav. 2017 Feb.

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.

Keywords: ART; Adherence; Relation dynamics; Social support; Uganda.

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Conflict of interest statement

Compliance with Ethical Standards All human subjects’ approvals were obtained from all collaborating sites: Mbarara University of Science and Technology, Uganda National Council of Science and Technology, and Partners Healthcare. A research assistant trained in human participant research conducted informed consent procedures with eligible participants in the local language in a private area of the clinic. All consenting participants gave written informed consent individually, or for those who could not write, a thumbprint was made on the consent form. Conflict of Interest All authors declare no conflict of interest.

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