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A Social Network Analysis of HIV Treatment Partners and Patient Viral Suppression in Botswana

Bogart, Laura M., PhD*; Mosepele, Mosepele, MD, MSc†,‡; Phaladze, Nthabiseng, PhD§; Lekoko, Bright, RN; Klein, David J., MS*; MacCarthy, Sarah, ScD*; Green, Harold D. Jr, PhD*,‖

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1, 2018 - Volume 78 - Issue 2 - p 183–192
doi: 10.1097/QAI.0000000000001661
Prevention Research

Objective: Many national HIV guidelines recommend that health care providers encourage patients to identify a treatment partner from their social network to support antiretroviral therapy adherence. This study examined associations of patient and treatment partner characteristics with patient viral suppression in Botswana.

Design: One hundred thirty-one patients [67 (51.1%) virally suppressed and 64 (48.9%) not suppressed] and their treatment partners were recruited for cross-sectional interviews from one HIV clinic.

Methods: Participants completed surveys assessing social network, sociodemographic, and psychosocial characteristics. Open-ended questions explored treatment partner relationship quality.

Results: Multivariate logistic regressions indicated a higher likelihood of viral suppression among patients who reported greater average emotional closeness to their network members [odds ratio (95% confidence interval) = 3.8 (1.3 to 11.5), P = 0.02] and whose treatment partners were spouses/partners [odds ratio (95% confidence interval) = 2.6 (1.0 to 6.7), P = 0.04]. Qualitative analyses indicated that treatment partners of suppressed patients provided both medical and nonmedical support, whereas treatment partners of unsuppressed patients focused mainly on adherence reminders and appointment accompaniment. Treatment partners, especially of unsuppressed patients, requested ongoing training and counseling skills.

Conclusions: Additional research is needed to further explore effective characteristics of treatment partners to inform HIV treatment guidelines. Standard training for treatment partners could include medical-related information and counseling education.

*Health Unit, RAND Corporation, Santa Monica, CA;

Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana;

Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana;

§School of Nursing, University of Botswana, Gaborone, Botswana; and

Indiana University Network Science Institute, Indiana University, Bloomington, IN.

Correspondence to: Laura M. Bogart, PhD, Health Unit, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138 (e-mail:

Supported by R21MH107454 (L.M.B., principal investigator). The writing of the manuscript was additionally supported by P30MH058107.

The authors have no funding or conflicts of interest to disclose.

L.M.B. conceptualized and designed the study and assessment, led the analysis plan and interpretation of the results, and drafted the manuscript; M.M. conceptualized and designed the study, co-led the interpretation of the results, and critically revised the manuscript; N.P. helped to design the study and assessment, interpreted the results, and critically revised the manuscript; B.L. collected all study data, helped to design the assessment and interpret the results, and helped to critically revise the manuscript; D.J.K. led the quantitative data analysis, helped to interpret the results, and critically revised the manuscript; S.M. helped with the qualitative data analysis and with the interpretation of results, and critically revised the manuscript; H.D.G. helped to design the study and assessment, interpreted the results, and critically revised the manuscript. All authors approved the final version and agree to be accountable for all aspects of the work.

L.M.B. and M.M. are sharing first authorship.

Received November 22, 2017

Accepted February 05, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.