AIDS Research and Treatment 5 Table 2: Application of conceptual framework to the programs in Kenya and Mozambique. Essential elements to become expert patients Country Information and skills Motivation to take responsibility Peer support Kenya [20, 21] Mozambique [22] CCC (i) Trained in medical and psychosocial tasks (ii) Oﬀer psychosocial support (iii) Deliver ART in the community (iv) Refer problem cases when needed (i) Formal training (ii) Remuneration (iii) Strict control and supervision (iv) Proximity with fellow peers (v) Recognition by PLWHA and HCW CCC (i) Better understanding of psychosocial barriers (ii) Rely on day-to-day experience living with HIV/AIDS (iii) Considered as advocates (iv) ↑ Communication between HCW and community Information loop between HCW and CAG (i) Direct social, health and members and sharing information and skills economic beneﬁts CAG members in the community: (ii) Proximity with fellow peers, (i) Social relationship networks (i) ↑ Information circulating in the reinforced during continuous contributes to: community contacts in the community and (a) Continuous information sharing (ii)↑ Skills of CAG members to periodic group sessions (b) Problem solving skills (a) Provide ART in the community (iii) Recognition by PLWHA and (ii) Proximity—mutual psychosocial (b) Overcome daily obstacles to adherence HCW or ﬁnancial support to address (c) Oﬀer psychosocial support common challenges (d) Refer problem cases when needed ART: antiretroviral treatment, CAG: community ART groups, CCC: community care coordinators, HCW: health care worker, PLWHA: people living with HIV/AIDS. diabetes and hypertension, is severely burdening health systems in many countries. The commonly used provider- centred models are resource intensive, as they require high inputs in skilled health workers. Consequently, it is becoming increasingly diﬃcult to keep up with growing needs and demands of people living with CLLC, even in high-income countries. Therefore, there is a growing interest in strengthening self-management, putting patients with CLLC at the centre of a web of support, surrounded by expert patients, peer groups, and health professionals. In this way, patients could be empowered to manage their own CLLC and take full res- ponsibility for their conditions and their lives [23]. This is thought to have the potential not only to contain the esca- lation of health care costs, but also to improve outcomes. People for whom a CLLC is diagnosed reach a turning point in their life. They need to “rebalance” their daily habits to the requirements of their condition and play as such a crucial role in the management of their condition. Indeed, people living with CLLC take daily decisions linked to pill intake and interpretation of signs and symp- toms, requiring often subtle adaptations in diet or behaviour. Such daily adaptations and long-term management often turn them into real experts in living with a chronic condi- tion. Their engagement can be expanded and patients can become more autonomous, as already commonly practiced in diabetes care in high-income countries. We believe that there is a need to frame HIV/AIDS as a CLLC, requiring lifelong adherence to medication. When PLWHA acquire self-management skills and are empowered to become expert patients, their physical and psychosocial well-being is expected to improve as PLWHA will function more autonomously, which is essential to sustain lifelong adherence to treatment. In addition, their dependency on scarce skilled medical staﬀ is expected to decrease. The latter is particularly relevant for SSA, where the burden for HIV is the highest and health systems the weakest, and where big proportions of populations remain unattended to today [8, 9, 12]. Involvement of PLWHA as expert patients in simp- liﬁed care tasks, which represent the bulk of HIV services, can relieve the weak health systems in most SSA countries with high HIV prevalence, in order to cope with the increasing patient load. Hence, involvement of PLWHA as expert pa- tients can bring advantages for both the provider and the patient. A Cochrane review showed that adequate informa- tion and practice of medication management skills among PLWHA resulted in better adherence, which is known to result in better treatment outcomes [7]. The process of infor- mation exchange can be boosted through social interactions among peers, who add to their acquired knowledge their expertise of day-to-day living with the disease [8, 9]. To rein- force their level of self-management and to become expert patients, PLWHA need to acquire self-management skills for three sets of tasks faced by people with chronic condi- tions: (1) medical management of their condition such as taking medication and self-monitoring, (2) developing and maintaining supportive social relationships with healthcare workers and community members, and (3) coping with psy- chological distress such as fear for stigma and anger, frustra- tion, and the sadness of having a lifelong condition (“living positively”) [13, 24]. Adequate information and practice of self-management skills are not enough to achieve and sustain behavioural change. They need to be combined with motivation, deﬁned as the driving force by which humans achieve their goals [6]. The motivation to take responsibility in self-care to achieve adherent behaviour depends on the importance given to