Social, Economic, and Psychosocial Determinants of Antiretroviral Therapy Outcomes in a Fragile Health System: Evidence from Central Equatoria State, South Sudan
Abstract:
The advent of antiretroviral therapy on a global scale has seen HIV becoming a manageable condition in millions of people, yet this success has not been achieved in conflict-ridden and fragile settings where the outcome of treatment is dependent of economic, social, and psychosocial factors. Protracted political instability, pervasive poverty, population displacement, and constrained health system capacity, makes HIV care in South Sudan challenging. Thus, there is paucity of empirical evidence on the determinants of antiretroviral therapy outcome at primary health care centres. The aim of this study was to examine economic, social, and psychosocial factors, determining the outcome of antiretroviral therapy among adults living with HIV attending clinics at selected primary health care centres in Central Equatoria State. In a cross-sectional analysis of 128 participants across six primary health care facilities, a composite outcome indicator comprising retention in care, extended treatment, clinical status, and viral load containing was constructed. The findings of this study reveal that 71.9% of the participants achieved a favourable composite treatment outcome. Both high perceived social support, and high HIV and antiretroviral therapy-related knowledge were significantly associated with higher odds of favourable outcomes. On the other hand, high economic hardship and high internalized stigma, were associated with substantially reduced odds of treatment success. Adjusting for sociodemographic variables yielded no statistically significant associations. The findings of this study thus indicate that the predominant determinants of antiretroviral therapy outcomes in Central Equatoria State are economic, social, and psychosocial factors, rather than sociodemographic characteristics. Therefore, strengthening HIV programmes in fragile settings requires an integrated interventions approach that address stigma, social support, and economic vulnerability as well as biomedical care.References:
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