Nro et al’s wider systematic review (1966 ebruary 2005) while the study of a specific police officer population was presumably excluded from their review for focusing on this specific population [19].By employing meta-ethnography and Vadadustat supplement undertaking third order interpretations of the order L-660711 sodium salt primary themes identified in the studies they included in their review, Munro et al `developed a model to depict [an] understanding of the main influences on adherence’ [27]. The model accordingly includes four broad components, namely: `structural, personal, and health service factors influencing adherence, as well as social context’ [27]. We used these broad `components’ to inform our categorisation of the primary themes identified in the included primary studies whilst being sensitive to new categorisations that emerge from analysis and translation of the data across the included studies. Accordingly, we generated five major, interacting themes (Figure 2), which we believe best represent the data. These include: individual personal beliefs, HIV/AIDS treatment related factors, socio-economic factors, family and other support structures, and factors related to health providers. Our review hence largely confirms the findings of the systematic review by Munro et al [27], while highlighting and emphasising issues found to be especially pertinent in the specific context of adherence to a prophylactic therapy for TB patients living with HIV/AIDS. Socio-economic factors identified in this review, which represent wider societal influences over which a patient has little or no control, such as, issues related to poverty, competing social commitments and service availability (distance to facilities and supply of drugs), are also widely recognised as critical factors determining patients’ health behaviour [27]. Other studies examining adherence to HIV and TB medication in developing countries also identify medication related costs, especially financial costs for transport and food, and competition from other livelihood responsibilities [34]. HIV treatment and related issues represent a critical aspect of our analysis of factors; a theme that is especially pertinent to the topic at hand as it reflects the complications arising from the management/prevention of co-infection with two chronic diseases that have multifaceted societal ramifications. The themes that were pertinent under this broad theme are: denial of HIV status, HIV disclosure, stigma, and attitudes towards concurrent treatment of TB and HIV/AIDS. The double burden of stigma due to TB and HIV has been documented to exacerbate and compound the already existing stigma due to HIV in communities, whereby individuals living with both TB and HIV are found to be more likely to perceive stigma regarding their condition and to have very low disease-specific knowledge, particularly with regard to its severity [29,30]. Munseri and colleagues explain the low adherence rate for women compared to men in their studies, stating, `in our setting [Tanzania], IPT is linked to HIV, and women in this study do not want their HIV status to be disclosed in fear of separation from their spouses…’ [23]. This further illustrates the complex interactions between the different major factors whereby gender values in specific socio-cultural settings influence how stigma attached to TB and HIV plays out to induce a differential ability of men and women to disclose their status. Regarding the influence of the concurrent administration of I.Nro et al’s wider systematic review (1966 ebruary 2005) while the study of a specific police officer population was presumably excluded from their review for focusing on this specific population [19].By employing meta-ethnography and undertaking third order interpretations of the primary themes identified in the studies they included in their review, Munro et al `developed a model to depict [an] understanding of the main influences on adherence’ [27]. The model accordingly includes four broad components, namely: `structural, personal, and health service factors influencing adherence, as well as social context’ [27]. We used these broad `components’ to inform our categorisation of the primary themes identified in the included primary studies whilst being sensitive to new categorisations that emerge from analysis and translation of the data across the included studies. Accordingly, we generated five major, interacting themes (Figure 2), which we believe best represent the data. These include: individual personal beliefs, HIV/AIDS treatment related factors, socio-economic factors, family and other support structures, and factors related to health providers. Our review hence largely confirms the findings of the systematic review by Munro et al [27], while highlighting and emphasising issues found to be especially pertinent in the specific context of adherence to a prophylactic therapy for TB patients living with HIV/AIDS. Socio-economic factors identified in this review, which represent wider societal influences over which a patient has little or no control, such as, issues related to poverty, competing social commitments and service availability (distance to facilities and supply of drugs), are also widely recognised as critical factors determining patients’ health behaviour [27]. Other studies examining adherence to HIV and TB medication in developing countries also identify medication related costs, especially financial costs for transport and food, and competition from other livelihood responsibilities [34]. HIV treatment and related issues represent a critical aspect of our analysis of factors; a theme that is especially pertinent to the topic at hand as it reflects the complications arising from the management/prevention of co-infection with two chronic diseases that have multifaceted societal ramifications. The themes that were pertinent under this broad theme are: denial of HIV status, HIV disclosure, stigma, and attitudes towards concurrent treatment of TB and HIV/AIDS. The double burden of stigma due to TB and HIV has been documented to exacerbate and compound the already existing stigma due to HIV in communities, whereby individuals living with both TB and HIV are found to be more likely to perceive stigma regarding their condition and to have very low disease-specific knowledge, particularly with regard to its severity [29,30]. Munseri and colleagues explain the low adherence rate for women compared to men in their studies, stating, `in our setting [Tanzania], IPT is linked to HIV, and women in this study do not want their HIV status to be disclosed in fear of separation from their spouses…’ [23]. This further illustrates the complex interactions between the different major factors whereby gender values in specific socio-cultural settings influence how stigma attached to TB and HIV plays out to induce a differential ability of men and women to disclose their status. Regarding the influence of the concurrent administration of I.
