TY - JOUR
T1 - Factors associated with HIV drug resistance in Dar es Salaam, Tanzania
T2 - Analysis of a complex adaptive system
AU - Kiekens, Anneleen
AU - Mosha, Idda H.
AU - Zlatić, Lara
AU - Bwire, George M.
AU - Mangara, Ally
AU - Dierckx de Casterlé, Bernadette
AU - Decouttere, Catherine
AU - Vandaele, Nico
AU - Sangeda, Raphael Z.
AU - Swalehe, Omary
AU - Cottone, Paolo
AU - Surian, Alessio
AU - Killewo, Japhet
AU - Vandamme, Anne Mieke
N1 - Funding Information:
Funding: This research and the APC were funded by VLIR-UOS, grant number TZ2019SIN263.
Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/11/24
Y1 - 2021/11/24
N2 - HIV drug resistance (HIVDR) is a complex problem with multiple interconnected and context dependent causes. Although the factors influencing HIVDR are known and well-studied, HIVDR remains a threat to the effectiveness of antiretroviral therapy. To understand the complexity of HIVDR, a comprehensive, systems approach is needed. Therefore, a local systems map was developed integrating all reported factors influencing HIVDR in the Dar es Salaam Urban Cohort Study area in Tanzania. The map was designed based on semi-structured interviews and workshops with people living with HIV and local actors who encounter people living with HIV during their daily activities. We visualized the feedback loops driving HIVDR, compared the local map with a systems map for Sub-Saharan Africa, previously constructed from interviews with international HIVDR experts, and suggest potential interventions to prevent HIVDR. We found several interconnected balancing and reinforcing feedback loops related to poverty, stigmatization, status disclosure, self-esteem, knowledge about HIVDR and healthcare system workload, among others, and identified three potential leverage points. Insights from this local systems map were complementary to the insights from the Sub-Saharan systems map showing that both viewpoints are needed to fully understand the system. This study provides a strong baseline for quantitative modelling, and for the identification of context-dependent, complexity-informed leverage points.
AB - HIV drug resistance (HIVDR) is a complex problem with multiple interconnected and context dependent causes. Although the factors influencing HIVDR are known and well-studied, HIVDR remains a threat to the effectiveness of antiretroviral therapy. To understand the complexity of HIVDR, a comprehensive, systems approach is needed. Therefore, a local systems map was developed integrating all reported factors influencing HIVDR in the Dar es Salaam Urban Cohort Study area in Tanzania. The map was designed based on semi-structured interviews and workshops with people living with HIV and local actors who encounter people living with HIV during their daily activities. We visualized the feedback loops driving HIVDR, compared the local map with a systems map for Sub-Saharan Africa, previously constructed from interviews with international HIVDR experts, and suggest potential interventions to prevent HIVDR. We found several interconnected balancing and reinforcing feedback loops related to poverty, stigmatization, status disclosure, self-esteem, knowledge about HIVDR and healthcare system workload, among others, and identified three potential leverage points. Insights from this local systems map were complementary to the insights from the Sub-Saharan systems map showing that both viewpoints are needed to fully understand the system. This study provides a strong baseline for quantitative modelling, and for the identification of context-dependent, complexity-informed leverage points.
KW - Case study
KW - Complex adaptive system
KW - Dar es Salaam
KW - HIV drug resistance
KW - Leverage points
KW - Systems mapping
KW - Tanzania
UR - http://www.scopus.com/inward/record.url?scp=85120680042&partnerID=8YFLogxK
UR - https://pubmed.ncbi.nlm.nih.gov/34959490/
UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8707982/
U2 - 10.3390/pathogens10121535
DO - 10.3390/pathogens10121535
M3 - Article
C2 - 34959490
AN - SCOPUS:85120680042
SN - 2076-0817
VL - 10
SP - 1
EP - 15
JO - Pathogens
JF - Pathogens
IS - 12
M1 - 1535
ER -