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Table 3 Overview of elements included in each factor of Fig. 2

From: Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa: conceptual mapping of a complex adaptive system based on multi-disciplinary expert insights

Adherence motivation subsystem Healthcare system burden ART overreliance subsystem Interconnected wicked problems
Psychosocial Social support Quality of care Timely acting on unsuppressed viral load Global effort to tackle HIVDR Food insecurity
Acceptance of HIV status Substance abuse Accessibility of health centre (including safety) Tracing of PLHIV Drug prices Gender inequality
Community stigma and gossip Adherence and retention Adherence counselling Well-functioning supply chain Global effort to tackle HIVDR Lower social status
Concerns about side effects of ART Adherence Administrative and political barriers Health literacy and empowerment HIVDR funding Migration
Depression Engagement and retention in care ART treatment approach / policy Individual and community empowerment Need to show success of the ART programme Punitive laws for MSM and sex workers
Engagement in risk behaviour Engagement in alternative care Assuring quality of ART Individual education level Research focus War and disease outbreaks
Financial situation Clinical manifestations Availability and quality of equipment Incentive to search for information Resource allocation with focus on population  
Forgetfulness Concurrent disease and opportunistic infections Patient-provider relationship Misinformation Availability of ART with a higher genetic barrier  
Having examples of well-functioning ART Feeling and looking healthy Competence of healthcare workers Religious beliefs Availability of better drugs  
HIV status disclosure Side effects of ART Correct prescribing practices Understanding of HIV infection and treatment   
Hospital design Biology Distance to the healthcare centre Health system resources   
Linguistic issues Drug levels in body Healthcare provider stigma Healthcare system workload   
Pill burden Drug-drug interactions Job satisfaction and motivation of healthcare workers    
Pill fatigue Efficiency of drug combination Peer support group    
Priority given to treatment HIVDR selection Quality of data systems    
Readiness to start taking ART Optimal absorption of drug Required frequency of hospital visits    
Self-stigmatisation Transmission of HIV(DR) Resistance (and subtype) testing    
Social obligations VL suppression Stock availability of ART and reagents