| dc.description.abstract | Timely initiation of and adherence to antiretroviral therapy (ART) is critical for improving HIV outcomes and
reducing HIV transmissibility. Social networks, or the social relationships individuals have with each other, have
been linked with positive health outcomes, but less is known about the extent to which social network
composition and structure are associated with improved ART adherence among people living with HIV (PLWH).
We conducted an ego-centric network study among 828 previously ART-naïve PLWH presenting for ART initiation at 11 clinics in Mbarara, Uganda (rural population) and Gugulethu, South Africa (peri-urban population).
We collected social network data using name generator and name interpreter questions. ART adherence was
monitored over 12 months using wireless monitors (Wisepill). Our primary outcome of interest was ART
adherence during the 12-month follow-up period. We used generalized linear models to estimate the associations
between network measures and ART adherence. PLWH at the Uganda site (compared with the South Africa site)
were less isolated, had larger social networks, and had more social ties providing sufficient social support; they
were also more likely to bridge different social groups whereby not all social ties were connected to each other. In
Uganda, social isolation was associated with a 5.5 percentage point reduction in ART adherence (95% confidence
interval [CI] − 9.95 to − 1.13; p =0.014), while having more same gender social ties was associated with higher
ART adherence (b =0.13, 95% CI 0.02–0.25, p =0.025). In South Africa, there was no association between
social isolation and ART adherence, and having more friendship ties (vs. family ties) was associated with lower
ART adherence (b =− 2.20, 95% CI − 3.56 to − 0.84; p =0.002). Identifying and supporting PLWH who are
isolated may facilitate optimal adherence, but understanding how networks differentially affect ART adherence
by country context is important. | en_US |
