Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa
| Autor(a) principal: | |
|---|---|
| Data de Publicação: | 2022 |
| Outros Autores: | , , , , , , , , , , , |
| Tipo de documento: | Artigo |
| Idioma: | eng |
| Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
| Texto Completo: | http://hdl.handle.net/10362/148016 |
Resumo: | Funding Information: This study was partially funded by VLIR-UOS. The study sponsors had no role in the study design, the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. Publisher Copyright: © 2022, The Author(s). |
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Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africaconceptual mapping of a complex adaptive system based on multi-disciplinary expert insightsHIVdrug resistancedrug resistance mechanismssub-Saharan AfricaComplex adaptive systemconceptual mappingR MedicineQR355 VirologyPublic Health, Environmental and Occupational HealthHealth PolicyInfectious DiseasesSDG 3 - Good Health and Well-beingSDG 1 - No PovertySDG 10 - Reduced InequalitiesFunding Information: This study was partially funded by VLIR-UOS. The study sponsors had no role in the study design, the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. Publisher Copyright: © 2022, The Author(s).Background: HIV drug resistance (HIVDR) continues to threaten the effectiveness of worldwide antiretroviral therapy (ART). Emergence and transmission of HIVDR are driven by several interconnected factors. Though much has been done to uncover factors influencing HIVDR, overall interconnectedness between these factors remains unclear and African policy makers encounter difficulties setting priorities combating HIVDR. By viewing HIVDR as a complex adaptive system, through the eyes of multi-disciplinary HIVDR experts, we aimed to make a first attempt to linking different influencing factors and gaining a deeper understanding of the complexity of the system. Methods: We designed a detailed systems map of factors influencing HIVDR based on semi-structured interviews with 15 international HIVDR experts from or with experience in sub-Saharan Africa, from different disciplinary backgrounds and affiliated with different types of institutions. The resulting detailed system map was conceptualized into three main HIVDR feedback loops and further strengthened with literature evidence. Results: Factors influencing HIVDR in sub-Saharan Africa and their interactions were sorted in five categories: biology, individual, social context, healthcare system and ‘overarching’. We identified three causal loops cross-cutting these layers, which relate to three interconnected subsystems of mechanisms influencing HIVDR. The ‘adherence motivation’ subsystem concerns the interplay of factors influencing people living with HIV to alternate between adherence and non-adherence. The ‘healthcare burden’ subsystem is a reinforcing loop leading to an increase in HIVDR at local population level. The ‘ART overreliance’ subsystem is a balancing feedback loop leading to complacency among program managers when there is overreliance on ART with a perceived low risk to drug resistance. The three subsystems are interconnected at different levels. Conclusions: Interconnectedness of the three subsystems underlines the need to act on the entire system of factors surrounding HIVDR in sub-Saharan Africa in order to target interventions and to prevent unwanted effects on other parts of the system. The three theories that emerged while studying HIVDR as a complex adaptive system form a starting point for further qualitative and quantitative investigation.Instituto de Higiene e Medicina Tropical (IHMT)Global Health and Tropical Medicine (GHTM)TB, HIV and opportunistic diseases and pathogens (THOP)Universidade NOVA de LisboaRUNKiekens, AnneleenDierckx de Casterlé, BernadettePellizzer, GiampietroMosha, Idda H.Mosha, FaustaRinke de Wit, Tobias F.Sangeda, Raphael Z.Surian, AlessioVandaele, NicoVranken, LiesbetKillewo, JaphetJordan, MichaelVandamme, Anne Mieke2023-01-23T22:15:45Z2022-122022-12-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10362/148016eng1471-2458PURE: 50655823https://doi.org/10.1186/s12889-022-12738-4info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-03-11T05:29:16Zoai:run.unl.pt:10362/148016Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:53:09.023860Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
| dc.title.none.fl_str_mv |
Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa conceptual mapping of a complex adaptive system based on multi-disciplinary expert insights |
| title |
Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa |
| spellingShingle |
Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa Kiekens, Anneleen HIV drug resistance drug resistance mechanisms sub-Saharan Africa Complex adaptive system conceptual mapping R Medicine QR355 Virology Public Health, Environmental and Occupational Health Health Policy Infectious Diseases SDG 3 - Good Health and Well-being SDG 1 - No Poverty SDG 10 - Reduced Inequalities |
| title_short |
Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa |
| title_full |
Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa |
| title_fullStr |
Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa |
| title_full_unstemmed |
Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa |
| title_sort |
Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa |
| author |
Kiekens, Anneleen |
| author_facet |
Kiekens, Anneleen Dierckx de Casterlé, Bernadette Pellizzer, Giampietro Mosha, Idda H. Mosha, Fausta Rinke de Wit, Tobias F. Sangeda, Raphael Z. Surian, Alessio Vandaele, Nico Vranken, Liesbet Killewo, Japhet Jordan, Michael Vandamme, Anne Mieke |
| author_role |
author |
| author2 |
Dierckx de Casterlé, Bernadette Pellizzer, Giampietro Mosha, Idda H. Mosha, Fausta Rinke de Wit, Tobias F. Sangeda, Raphael Z. Surian, Alessio Vandaele, Nico Vranken, Liesbet Killewo, Japhet Jordan, Michael Vandamme, Anne Mieke |
| author2_role |
author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
Instituto de Higiene e Medicina Tropical (IHMT) Global Health and Tropical Medicine (GHTM) TB, HIV and opportunistic diseases and pathogens (THOP) Universidade NOVA de Lisboa RUN |
| dc.contributor.author.fl_str_mv |
Kiekens, Anneleen Dierckx de Casterlé, Bernadette Pellizzer, Giampietro Mosha, Idda H. Mosha, Fausta Rinke de Wit, Tobias F. Sangeda, Raphael Z. Surian, Alessio Vandaele, Nico Vranken, Liesbet Killewo, Japhet Jordan, Michael Vandamme, Anne Mieke |
| dc.subject.por.fl_str_mv |
HIV drug resistance drug resistance mechanisms sub-Saharan Africa Complex adaptive system conceptual mapping R Medicine QR355 Virology Public Health, Environmental and Occupational Health Health Policy Infectious Diseases SDG 3 - Good Health and Well-being SDG 1 - No Poverty SDG 10 - Reduced Inequalities |
| topic |
HIV drug resistance drug resistance mechanisms sub-Saharan Africa Complex adaptive system conceptual mapping R Medicine QR355 Virology Public Health, Environmental and Occupational Health Health Policy Infectious Diseases SDG 3 - Good Health and Well-being SDG 1 - No Poverty SDG 10 - Reduced Inequalities |
| description |
Funding Information: This study was partially funded by VLIR-UOS. The study sponsors had no role in the study design, the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. Publisher Copyright: © 2022, The Author(s). |
| publishDate |
2022 |
| dc.date.none.fl_str_mv |
2022-12 2022-12-01T00:00:00Z 2023-01-23T22:15:45Z |
| dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
| dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
| format |
article |
| status_str |
publishedVersion |
| dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10362/148016 |
| url |
http://hdl.handle.net/10362/148016 |
| dc.language.iso.fl_str_mv |
eng |
| language |
eng |
| dc.relation.none.fl_str_mv |
1471-2458 PURE: 50655823 https://doi.org/10.1186/s12889-022-12738-4 |
| dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
| eu_rights_str_mv |
openAccess |
| dc.format.none.fl_str_mv |
application/pdf |
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reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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