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