1
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Mulu NNT. Practices of health citizenship in South Africa: a case study of the Treatment Action Campaign (TAC) in Khayelitsha, Cape Town. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:217-225. [PMID: 37934617 DOI: 10.2989/16085906.2023.2274932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/01/2023] [Indexed: 11/09/2023]
Abstract
This article examines the Treatment Action Campaign's (TAC) evolution and attrition as a social movement organisation to discern its implications for practices of health citizenship at the grassroots level. A qualitative approach to case study research was used to collect and analyse data. Practices of health citizenship were framed around the integration of biomedical knowledge and people's experiences of grassroots activism. By exploring how the TAC's brand of activism filtered down to the community level, the findings reveal the importance of diverse forms of activist-led collective action in promoting health-seeking behaviour. These comprise activist-led branch meetings, community workshops, health promotion talks at clinics and community radio stations, as well as protest action at community clinics. Findings indicate that participation in TAC-led activism in Khayelitsha is not a passive form of responsible HIV citizenship. Rather, it is an active process through which TAC members integrate their lived experiences with biomedical knowledge to construct meanings and articulate grievances to enhance the quality of health service delivery in their community. Also, although the TAC's practices of health citizenship have not changed significantly over time, its campaigns have evolved based on contextual factors. These practices have entrenched ways of being, doing and knowing that have become an important resource for activist-led health promotion. Key stakeholders in government and civil society can harness these practices to strengthen health systems.
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Affiliation(s)
- Ngwi Nnam Thecla Mulu
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
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2
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Keene CM, Euvrard J, Amico KR, Ragunathan A, English M, McKnight J, Orrell C. Conceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) Framework. BMC Health Serv Res 2023; 23:435. [PMID: 37143067 PMCID: PMC10161576 DOI: 10.1186/s12913-023-09433-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/14/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND As the crisis-based approach to HIV care evolves to chronic disease management, supporting ongoing engagement with HIV care is increasingly important to achieve long-term treatment success. However, 'engagement' is a complex concept and ambiguous definitions limit its evaluation. To guide engagement evaluation and development of interventions to improve HIV outcomes, we sought to identify critical, measurable dimensions of engagement with HIV care for people on treatment from a health service-delivery perspective. METHODS We used a pragmatic, iterative approach to develop a framework, combining insights from researcher experience, a narrative literature review, framework mapping, expert stakeholder input and a formal scoping review of engagement measures. These inputs helped to refine the inclusion and definition of important elements of engagement behaviour that could be evaluated by the health system. RESULTS The final framework presents engagement with HIV care as a dynamic behaviour that people practice rather than an individual characteristic or permanent state, so that people can be variably engaged at different points in their treatment journey. Engagement with HIV care for those on treatment is represented by three measurable dimensions: 'retention' (interaction with health services), 'adherence' (pill-taking behaviour), and 'active self-management' (ownership and self-management of care). Engagement is the product of wider contextual, health system and personal factors, and engagement in all dimensions facilitates successful treatment outcomes, such as virologic suppression and good health. While retention and adherence together may lead to treatment success at a particular point, this framework hypothesises that active self-management sustains treatment success over time. Thus, evaluation of all three core dimensions is crucial to realise the individual, societal and public health benefits of antiretroviral treatment programmes. CONCLUSIONS This framework distils a complex concept into three core, measurable dimensions critical for the maintenance of engagement. It characterises elements that the system might assess to evaluate engagement more comprehensively at individual and programmatic levels, and suggests that active self-management is an important consideration to support lifelong optimal engagement. This framework could be helpful in practice to guide the development of more nuanced interventions that improve long-term treatment success and help maintain momentum in controlling a changing epidemic.
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Affiliation(s)
- Claire M Keene
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - K Rivet Amico
- Health Behaviour and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Ayesha Ragunathan
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mike English
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jacob McKnight
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catherine Orrell
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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3
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Young I, Boydell N. 'Don't lose it on the bus!': Casting the normative biosexual citizen in early Scottish pre-exposure prophylaxis provision. SOCIOLOGY OF HEALTH & ILLNESS 2023. [PMID: 36920962 DOI: 10.1111/1467-9566.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
The introduction of HIV pre-exposure prophylaxis (PrEP) raises important questions around how new biotechnologies are negotiated within contemporary settings and how they can shape the moral governance of biocitizens, or as we explore, biosexual citizens. This article draws on qualitative interviews and focus groups to consider how the normative biosexual citizen was cast at the start of provision in Scotland by clinical and community practitioners. Our findings show how practitioners navigated ideas around who was deserving of support and access to PrEP in the context of limited resources, interpreted what legitimate risk narratives might look like for different groups and translated particular gendered, sexualised and racialised risk profiles in the context of PrEP provision. This draws attention to how normative biosexual citizenship was not determined through meeting a set of clinical criteria and adhering to a prophylaxis regime but cast through ongoing negotiations with clinical and community practitioners in relation to normative ideas of essential care, constrained resources, risk narratives and gendered and racialised bodies. Our research indicates how access to PrEP will continue to demand particular enactments of normative biosexual citizenship that may well be at odds with the experiences and needs of communities affected by HIV.
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Affiliation(s)
- Ingrid Young
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nicola Boydell
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
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4
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Romijnders KAGJ, de Groot L, Vervoort SCJM, Basten M, van Welzen BJ, Kretzschmar ME, Reiss P, Davidovich U, van der Loeff MFS, Rozhnova G. The experienced positive and negative influence of HIV on quality of life of people with HIV and vulnerable to HIV in the Netherlands. Sci Rep 2022; 12:21887. [PMID: 36536038 PMCID: PMC9761623 DOI: 10.1038/s41598-022-25113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
This qualitative study aimed to explore the experienced influence of HIV on the quality of life (QoL) of people with HIV (PHIV) and key populations without but are vulnerable to HIV in the Netherlands. We conducted and thematically analyzed interviews with 29 PHIV and 13 participants from key populations without HIV (i.e., men who have sex with men). PHIV and key populations shared positive meaningful experiences regarding HIV, i.e., feeling grateful for ART, life, and the availability of PrEP, being loved and supported in the light of HIV, and providing support to the community. Negative predominant experiences regarding HIV were described by both PHIV and key populations as the negative effects of ART, challenges with regards to disclosing HIV, social stigmatization, and self-stigma. It remains important to support HIV community organizations in their efforts to reduce social stigmatization and to continue improving biomedical interventions for HIV.
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Affiliation(s)
- Kim A. G. J. Romijnders
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Laura de Groot
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sigrid C. J. M. Vervoort
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maartje Basten
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Berend J. van Welzen
- grid.7692.a0000000090126352Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mirjam E. Kretzschmar
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter Reiss
- grid.509540.d0000 0004 6880 3010Amsterdam UMC location University of Amsterdam, Global Health, Amsterdam, The Netherlands ,grid.450091.90000 0004 4655 0462Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam UMC location University of Amsterdam, Infectious Diseases, Amsterdam, The Netherlands ,Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Udi Davidovich
- grid.7177.60000000084992262Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands ,grid.413928.50000 0000 9418 9094Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Maarten F. Schim van der Loeff
- grid.509540.d0000 0004 6880 3010Amsterdam UMC location University of Amsterdam, Global Health, Amsterdam, The Netherlands ,grid.450091.90000 0004 4655 0462Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands ,grid.413928.50000 0000 9418 9094Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Ganna Rozhnova
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ,grid.9983.b0000 0001 2181 4263BioISI – Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal ,grid.5477.10000000120346234Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht, The Netherlands
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5
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Denardo D, Mojola SA, Schatz E, Gómez-Olivé FX. Antiretroviral therapy and aging as resources for managing and resisting HIV-related stigma in rural South Africa. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100148. [PMID: 36687383 PMCID: PMC9851406 DOI: 10.1016/j.ssmqr.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The widespread roll-out of antiretroviral therapy (ART) in Africa has contributed to a large population of adults aging with HIV. However, little is known about how HIV-related stigma interacts with aging in the ART era. This study uses in-depth interviews with middle-aged and older South Africans living with HIV to explore stigma-related experiences and response strategies. Participants describe a persistence of stigma which requires the deployment of a range of common and age-based stigma management and resistance strategies. We find that participants minimize their exposure to stigma through selective disclosure of their HIV status; neutralize HIV-related stigma through comparisons to chronic illnesses common among older adults, and deflect stigma through asserting an ART-adherent identity and othering younger non-adherent adults. Overall, our study highlights the roles of ART and aging as resources for managing and resisting HIV-related stigma.
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Affiliation(s)
- Danielle Denardo
- Social and Behavioral Sciences, Soka University of America, Aliso Viejo, CA, USA,Corresponding author.. 1.949.480.4216, 1 University Drive, Aliso Viejo, CA, 92656, USA, (D. Denardo)
| | - Sanyu A. Mojola
- Department of Sociology, School of Public and International Affairs, Office of Population Research, Princeton University, Princeton, NJ, USA,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
| | - Enid Schatz
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa,Department of Public Health and Department of Women’s & Gender Studies, University of Missouri, Columbia, MO, USA
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
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6
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Burns R, Venables E, Odhoch L, Kocholla L, Wanjala S, Mucinya G, Bossard C, Wringe A. Slipping through the cracks: a qualitative study to explore pathways of HIV care and treatment amongst hospitalised patients with advanced HIV in Kenya and the Democratic Republic of the Congo. AIDS Care 2022; 34:1179-1186. [PMID: 34445917 DOI: 10.1080/09540121.2021.1966697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Advanced HIV causes substantial mortality in sub-Saharan Africa despite widespread antiretroviral therapy coverage. This paper explores pathways of care amongst hospitalised patients with advanced HIV in rural Kenya and urban Democratic Republic of the Congo, with a view to understanding their care-seeking trajectories and poor health outcomes. Thirty in-depth interviews were conducted with hospitalised patients with advanced HIV who had previously initiated first-line antiretroviral therapy, covering their experiences of living with HIV and care-seeking. Interviews were audio-recorded, transcribed and translated before being coded inductively and analysed thematically. In both settings, participants' health journeys were defined by recurrent, severe symptoms and complex pathways of care before hospitalisation. Patients were often hospitalised after multiple failed attempts to obtain adequate care at health centres. Most participants managed their ill-health with limited support networks, lived in fragile economic situations and often experienced stress and other mental health concerns. Treatment-taking was sometimes undermined by strict messaging around adherence that was delivered in health facilities. These findings reveal a group of patients who had "slipped through the cracks" of health systems and social support structures, indicating both missed opportunities for timely management of advanced HIV and the need for interventions beyond hospital and clinical settings.
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Affiliation(s)
- Rose Burns
- Epicentre, Médecins sans Frontières, Paris, France
| | - Emilie Venables
- Southern Africa Medical Unit: Médecins Sans Frontières, Cape Town, South Africa.,University of Cape Town, Cape Town, South Africa
| | | | - Lilian Kocholla
- Homabay County Teaching and Referral Hospital, Homa Bay, Kenya
| | | | - Gisele Mucinya
- Médecins Sans Frontières, Kinshasa, Democratic Republic of the Congo
| | | | - Alison Wringe
- London School of Hygiene and Tropical Medicine, London, UK
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7
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Marshall AD, Martinello M, Treloar C, Matthews GV. Perceptions of hepatitis C treatment and reinfection risk among HIV-positive men who have sex with men and engage in high risk behaviours for hepatitis C transmission: The CEASE qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103828. [PMID: 35994937 DOI: 10.1016/j.drugpo.2022.103828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Globally, treatment uptake for hepatitis C virus (HCV) infection among HIV-HCV coinfected men who have sex with men (MSM) has substantially increased since the advent of interferon-free direct-acting antivirals (DAA). However, HIV-positive MSM who engage in high risk behaviours are at an increased risk of HCV reinfection post-treatment. The aim of this study was to investigate perceptions of HCV diagnosis, treatment and reinfection risk among HCV-HIV coinfected MSM who engage in drug use and/or high risk sexual behavior in Sydney, Australia. METHODS Participants were recruited from the Control and Elimination within AuStralia of HEpatitis C from people living with HIV (CEASE) cohort (n=402) who reported engaging in drug use and/or high risk sexual behavior for transmission of HCV infection. Participants were interviewed about their perceptions of HCV diagnosis, treatment, and reinfection risk. Interview data were transcribed, coded, and analyzed thematically. RESULTS Of 33 participants interviewed (mean age 49 years), many participants were 'shocked' by their HCV diagnosis. Participants who believed they acquired HCV infection through sexual exposure felt it was important that their healthcare practitioner agreed with their perspective to mitigate stigmatizing experiences. Overall, participants expressed high satisfaction with their treatment experience due to long-standing therapeutic relationships with their HIV physician. Many participants expressed knowledge of how to prevent HCV reinfection from injection drug use, yet other than condom usage, most were unsure how to reduce high risk sexual activity with such discussions occurring less frequently with healthcare practitioners. CONCLUSION Findings indicate that MSM who engage in drug use and high risk sexual activity would benefit from additional education on reducing reinfection risk through sexual activity and services to reduce substance use, if requested.
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Affiliation(s)
- Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
| | | | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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8
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Beeman A, Bengtson AM, Swartz A, Colvin CJ, Lurie MN. Cyclical Engagement in HIV Care: A Qualitative Study of Clinic Transfers to Re-enter HIV Care in Cape Town, South Africa. AIDS Behav 2022; 26:2387-2396. [PMID: 35061116 PMCID: PMC9167245 DOI: 10.1007/s10461-022-03582-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 01/25/2023]
Abstract
Long-term patient engagement and retention in HIV care is an ongoing challenge in South Africa's strained health system. However, some patients thought to be "lost to follow-up" (LTFU) may have "transferred" clinics to receive care elsewhere. Through semi-structured interviews, we explored the relationship between clinic transfer and long-term patient engagement among 19 treatment-experienced people living with HIV (PLWH) who self-identified as having engaged in a clinic transfer at least once since starting antiretroviral therapy (ART) in Gugulethu, Cape Town. Our findings suggest that patient engagement is often fluid, as PLWH cycle in and out of care multiple times during their lifetime. The linear nature of the HIV care cascade model poorly describes the lived realities of PLWH on established treatment. Further research is needed to explore strategies for reducing unplanned clinic transfers and offer more supportive care to new and returning patients.
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Affiliation(s)
- Aly Beeman
- Brown University School of Public Health, Providence, RI, USA
| | - Angela M Bengtson
- Department of Epidemiology, Brown University School of Public Health, Box GS-121-2, Room 221, 121 South Main Street, Providence, RI, 02912, USA
| | - Alison Swartz
- Department of Epidemiology, Brown University School of Public Health, Box GS-121-2, Room 221, 121 South Main Street, Providence, RI, 02912, USA
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Department of Epidemiology, Brown University School of Public Health, Box GS-121-2, Room 221, 121 South Main Street, Providence, RI, 02912, USA
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Mark N Lurie
- Department of Epidemiology, Brown University School of Public Health, Box GS-121-2, Room 221, 121 South Main Street, Providence, RI, 02912, USA.
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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9
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Vernooij E. HIV Support Groups and the Chronicities of Everyday Life in eSwatini. Med Anthropol 2022; 41:287-301. [PMID: 35266844 DOI: 10.1080/01459740.2022.2043306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Drawing on ethnographic research, I examine the evolution of HIV support groups and biosociality during the "treat-all era" in eSwatini. I show how support groups are shaped by local actors to cater to a need for social solidarity that transcends diagnostic status, and thereby move beyond donors' HIV-centric rationales to use the groups for HIV treatment scale-up. In this particular phase of the HIV epidemic, I suggest, support groups make up a particular kind of biosociality, which is shaped by shared experiences of structural vulnerability to chronic illness, and a desire to be prepared for future diseases and other misfortune.
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Affiliation(s)
- Eva Vernooij
- Department of Social Anthropology, School of Social and Political Sciences, University of Edinburgh, Edinburgh, United Kingdom
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10
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Herrera AA, Sánchez AO. 'If you aren't married yet, you'll be married to your treatment from now on': embodied mediations in a women's HIV peer advisory project in Mexico. CULTURE, HEALTH & SEXUALITY 2022; 24:406-420. [PMID: 33393881 DOI: 10.1080/13691058.2020.1852312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
Treatment as Prevention is a key biopolitical intervention on the HIV epidemic but relies on individual adherence to antiretroviral treatment in order to have an effect on the population as a whole. Informed by a discussion of biopower, this paper analyses the complex relationships between discourses of competent authorities and modes of subjectification through a qualitative analysis of findings from 5 years of fieldwork associated with the action-research project Yantzin: Women HIV Peer Advisors in Mexico. It looks at the production of subjects of adherence, whereby peer advisors emerge as key agents at the interface between scientific and experiential knowledge. Contradictorily, the desire to live becomes feasible only by engaging with these biopolitical interventions. We discuss how peer advisors twist these technologies in such a way that they provide not only operations of power but also courses of action for desire. Through embodied mediation strategies that critique obedience to medical prescription and translate scientific information into bodily and emotionally shared experiences, peer advisors' work goes beyond the behavioural rationality of biomedical models offering embodied proof for other women that, even when living with HIV, a project of happiness is possible.
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Affiliation(s)
- Ana Amuchástegui Herrera
- Departmento de Educación y Comunicación, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
| | - Azucena Ojeda Sánchez
- Epidemiología y Salud Pública, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Mexico City, Mexico
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11
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Marshall AD, Rance J, Grebely J, Treloar C. 'Not just one box that you tick off' - Deconstructing the hepatitis C care cascade in the interferon-free direct acting antiviral era from the client perspective. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103610. [PMID: 35151085 DOI: 10.1016/j.drugpo.2022.103610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To achieve hepatitis C viral (HCV) elimination targets set by the World Health Organisation, pillars of the HCV care cascade are often referenced to track progress. The aim of this qualitative study was to explore the limitations of the care cascade framework through the real-world accounts of 'HCV journeys' among people who inject drugs (PWID), with particular attention to the intersection of PWID agency and structural determinants in the healthcare system. METHODS An in-depth analysis was conducted on five case studies to better understand participant experiences 'behind the cascade pillars'. The five case studies were drawn from the ETHOS Engage cohort as exemplars of the real-world complexities of people's HCV cascade journeys. Inclusion criteria for the qualitative study were participant has voluntarily signed the informed consent form, aged ≥18 years, HCV antibody positive by self-report, clients of selected sites participating in the ETHOS Engage cohort, and sufficiently proficient in English to participate in an interview. Thirty-four semi-structured interviews were conducted with participants who had received or had not received HCV treatment to identify barriers and facilitators to HCV care. RESULTS Participants 'housed' at the 'HCV RNA diagnosed pillar' (n = 2; Will; Julie) reported withholding their HCV serostatus in certain healthcare settings for fear that disclosure would lead to discriminatory decision-making from their treating physician. among participants who had completed treatment (n = 3; Corey; John; Nora) two reported still being unsure of their HCV status >6 months post-treatment. Ongoing feelings of frustration and shame were expressed in this 'post-cure care pillar' due to a perceived lack of quality care from clinic services and continued uneasiness when discussing drug use and reinfection while receiving opioid agonist treatment (OAT). Both case 'categories' described often tenuous therapeutic relationships with their physicians and recommended task-shifting to nurses and trusted case workers for ongoing care. CONCLUSION The care cascade provides a linear, two dimensional snapshot of clinical targets. Our findings illuminate structural barriers not visible behind its 'static' pillars, presenting insights into experiences among PWID otherwise dismissed as 'disengaged' or 'lost to follow-up'.
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Affiliation(s)
- A D Marshall
- The Kirby Institute, UNSW Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Australia.
| | - J Rance
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - J Grebely
- The Kirby Institute, UNSW Sydney, Australia
| | - C Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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12
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Gittings L, Colvin CJ, Hodes R. Blood and Blood: Anti-retroviral Therapy, Masculinity, and Redemption among Adolescent Boys in the Eastern Cape Province of South Africa. Med Anthropol Q 2022; 36:367-390. [PMID: 35029315 PMCID: PMC9279516 DOI: 10.1111/maq.12686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
Adolescents living with perinatally acquired HIV are among the first generation in South Africa to grow up with anti‐retroviral therapy and democratic freedoms. In this article, we explore the biosocial lives of adolescent boys and young men living with HIV in the Eastern Cape Province of South Africa. We conducted qualitative research with 36 adolescent boys and young men in 2016‒2018, including life history narratives, semi‐structured interviews, and analysis of health facility files. [masculinity, South Africa, HIV, adolescence]
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Affiliation(s)
- Lesley Gittings
- Centre for Social Science Research, University of Cape Town.,Factor-Inwentash Faculty of Social Work, University of Toronto
| | - Christopher J Colvin
- Department of Public Health Sciences, University of Virginia.,Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town.,Department of Epidemiology, Brown University
| | - Rebecca Hodes
- Centre for Sexualities, AIDS & Gender, University of Pretoria.,Department of Historical and Heritage Studies, University of Pretoria
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13
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Mojola SA, Angotti N, Denardo D, Schatz E, Olivé FXG. The end of AIDS? HIV and the new landscape of illness in rural South Africa. Glob Public Health 2022; 17:13-25. [PMID: 33290168 PMCID: PMC8184878 DOI: 10.1080/17441692.2020.1851743] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The global HIV/AIDS scientific community has begun to hail the dawn of 'the End of AIDS' with widespread anti-retroviral therapy (ART) and dramatic declines in AIDS-related mortality. Drawing on community focus groups and in-depth individual interviews conducted in rural South Africa, we examine the complex unfolding of the end of AIDS in a hard-hit setting. We find that while widespread ART has led to declines in AIDS-related deaths, stigma persists and is now freshly motivated. We argue that the shifting landscape of illness in the community has produced a new interpretive lens through which to view living with HIV and dying from AIDS. Most adults have one or more chronic illnesses, and ART-managed HIV is now considered a preferred diagnosis because it is seen as easier to manage, more responsive to medication, and less dangerous compared to diseases like cancer, hypertension, and diabetes. Viewed through this comparative lens, dying from AIDS elicits stigmatising individual blame. We find that blame persists despite community acknowledgement of structural barriers to ART adherence. Setting the ending of AIDS within its wider health context sheds light on the complexities of the epidemiological and health transitions underway in much of the developing world.
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Affiliation(s)
- Sanyu A. Mojola
- Department of Sociology, School of Public and International Affairs, and the Office of Population Research, Princeton University, Princeton, NJ 08544
| | - Nicole Angotti
- Department of Sociology and Center on Health, Risk and Society, American University, Washington D.C. and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
| | - Danielle Denardo
- Social and Behavioral Sciences, Soka University of America, Aliso Viejo, CA
| | - Enid Schatz
- Department of Public Health and Department of Women’s & Gender Studies, University of Missouri and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
| | - F. Xavier Gómez Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand
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14
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Stevenson J. ‘It feels like my visibility matters’: Women ageing with HIV overcoming the ‘violence of invisibility’ through community, advocacy and the radical act of care for others. WOMEN'S HEALTH 2022; 18:17455057221095911. [PMID: 35459420 PMCID: PMC9036364 DOI: 10.1177/17455057221095911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: A participatory qualitative study exploring women’s experiences of ageing with HIV in London, United Kingdom. The research considered how the concept of ‘community’ was relevant to women’s experiences and what constructions of ‘community’ could be discerned in the experiences, accounts given and discourses employed by older women living with HIV. Methods: The research presented in this article was conducted as a PhD study between 2015 and 2019. The study was structured in multiple and overlapping phases, and adopted a feminist and participatory approach. The methods used in the research were as follows: participatory literature review, participatory creative workshops, policy review and stakeholder interviews, life story interviews, and a participatory analysis workshop. Results: Eighteen women living with HIV aged over 50 participated in creative workshops and fourteen women in life story interviews. Women’s experiences of ageing with HIV are shaped by intersecting identities, community responses, and personal connections. Ageing with HIV brings challenges, added to and augmented by other difficulties women face in their lives, but women draw on individual and community assets in order to adapt, cope and thrive. Belonging to a community of women living with HIV and a broader community of people living with HIV created a vital space of safety, in which women found support, advice, and meaning. Conclusions: Women ageing with HIV countered the ‘violence of invisibility’ through forming community with other women living with HIV, rejecting stigma, and enacting a personal form of advocacy through care for others.
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Affiliation(s)
- Jacqui Stevenson
- Jacqui Stevenson, Independent Researcher and Advocate, Flat B, 15 Eugenia Road, London SE16 2RU, UK.
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15
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Opoku MP, Torgbenu EL, J-F, Nketsia W, Mprah WK, Edusei AK. Living with HIV in Ghana: Disclosure of status and experiences of persons receiving antiretroviral therapy. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2021; 20:204-213. [PMID: 34517791 DOI: 10.2989/16085906.2021.1964546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Barriers to treatment faced by people living with HIV (PLWH) have been well explored in the literature. Despite the importance of antiretroviral therapy (ART) in the treatment of HIV and prevention of AIDS, in the Ghanaian context only about 32% of infected persons have access to treatment. This underscores a need to understand the experiences of PLWH receiving ART to provide baseline information for policymakers' efforts to increase access to treatment. This study captures the voices of PLWH who were receiving ART in Ghana. A total of 35 participants receiving treatment in a hospital setting (11 males, 24 females; mean age 38 years, age range 21-60 years) took part in semi-structured face-to-face interviews to discuss their opinions about the cause of their HIV infection and its impact on their lives. The study found that the participants were susceptible to discrimination in their communities and at health care facilities. Some participants experienced marriage breakdowns, unemployment, social isolation, and were unable to perform everyday chores and responsibilities. Concerted efforts to address the barriers to treatment faced by PLWH are needed.
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Affiliation(s)
- Maxwell Peprah Opoku
- Special Education Department, United Arab Emirates University, Al Ain, United Arab Emirates.,School of Education, University of Tasmania, Launceston, Australia
| | | | - J-F
- School of Education, University of Tasmania, Launceston, Australia.,Faculty of Education, Crandall University, Moncton, New Brunswick, Canada
| | - William Nketsia
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Applied Sciences, Ho, Ghana.,School of Education, Western Sydney University, Sydney, Australia
| | - Wisdom Kwadwo Mprah
- Centre for Disability Rehabilitation Studies, Department of Health Promotion, Disability Studies and Education, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Kweku Edusei
- Centre for Disability Rehabilitation Studies, Department of Health Promotion, Disability Studies and Education, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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16
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Beyond a ‘post-cure’ world: Sketches for a new futurology of hepatitis C. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103042. [DOI: 10.1016/j.drugpo.2020.103042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
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17
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Utilising an access to care integrated framework to explore the perceptions of hepatitis C treatment of hospital-based interventions among people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103356. [PMID: 34226111 DOI: 10.1016/j.drugpo.2021.103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gaps remain in the hepatitis C virus (HCV) care cascade for people who use drugs (PWUD). Acute medical or surgical illnesses requiring hospitalisation are an opportunity to address addiction, but how inpatient strategies could affect HCV care accessibility for PWUD remains unknown. We explored patient perspectives of hospital-based interventions using an integrated framework of access to HCV care. METHODS We conducted a qualitative study of hospitalised adults (n=27) with HCV and addiction admitted to an urban academic medical centre in the United States between June and November 2019. Individual interviews were audio-recorded, transcribed, and dual-coded. We analysed data with coding specific for hospital-based interventions including screening, conducting HCV-related laboratory work-up, starting treatment, connecting with peers, and coordinating outpatient care. We analysed coded data at the semantic level for emergent themes using a framework approach based off an integrated framework of access to HCV care. RESULTS The majority of participants primarily used opioids (78%), were white (85%) and men (67%). Participants frequently reported HCV screening during previous hospitalisation with rare inpatient connection to HCV-related services. Participants expressed willingness to discuss HCV treatment candidacy during hospitalisation; however, lack of inpatient conversations led to perception that "nothing could be done" during admission. Participants expressed interest in completing inpatient HCV work-up to "get the ball rollin'" - consolidating care would enhance outpatient service permeability by reducing barriers. Others resisted HCV care coordination, preferring to focus on "immediate" issues including health conditions and addiction treatment. Participants also expressed openness to engaging with peers about HCV, noting shared drug use experience as critical to a peer relationship when discussing HCV. CONCLUSION Hospitalised PWUD have varied priorities, necessitating adaptable interventions for addressing HCV. Hospitalisation can be an opportunity to address HCV access to care including identification of treatment eligibility, consolidation of care, and facilitation of HCV-related referrals.
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18
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Yilmaz V. Rethinking Universal Health Coverage: A qualitative study of patient organisation perspectives on the Turkish health-care system. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1372-1387. [PMID: 34086996 DOI: 10.1111/1467-9566.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 04/29/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
Universal health coverage (UHC) has been elevated to the status of a global policy target, but this was at the expense of losing its aspirational meaning. As a case in point, Turkey has been one of the countries that has achieved UHC, according to the technocratic definition. This article employs a combination of deductive and inductive thematic analysis methods to explore patient organisation (PO) perspectives on the Turkish health-care system based on 26 respondent interviews from 19 POs in Istanbul. Highlighting the inadequacy of the technocratic definition of UHC, the article maintains that an analysis of PO perspectives opens the way for a nuanced and bottom-up assessment of essential service coverage and financial protection by identifying elusive gaps in both dimensions that would otherwise be lost in generalist evaluations. The findings also underline the importance of keeping intact the UHC's aspirational element to enable POs to participate in the politics of priority setting in health care.
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Affiliation(s)
- Volkan Yilmaz
- Social Policy, Institute for Graduate Studies in Social Sciences & Social Policy Forum Research Centre, Bogazici University, Istanbul, Turkey
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19
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Keogh P, Dodds C. Tempering hope with Intimate Knowledge: Contrasting emergences of the concept 'uninfectious' in HIV. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1100-1116. [PMID: 33945160 DOI: 10.1111/1467-9566.13264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/20/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
In this paper, we contrast two emergences of the concept of 'uninfectious' (that pharmaceuticals can render someone living with HIV non-infectious) in HIV. First, using Novas' framing of 'political economies of hope', we describe the deployment of 'uninfectious' as part of global health campaigns. Second, we draw on Raffles' (International Social Science Journal, 2002, 54, 325) concept of 'intimate knowledge' to theorise our own account of 'uninfectious' through a re-analysis of qualitative data comprising the intimate experiences of people living with or around HIV collected at various points over the last 25 years. Framed as intimate knowledge, 'uninfectious' becomes known through people's multiple engagements with and developing understandings of HIV over a prolonged period. As contingent and specific, intimate knowledge does not register within the biomedical/scientific ontological system that underpins discourses of hope employed in global campaigns. The concept of intimate knowledge offers the potential to critique discourses of hope in biomedicine problematising claims to universality whilst enriching biomedical understandings with accounts of affective, embodied experience. Intimate knowledge may also provide a bridge between different epistemological traditions in the sociology of health and illness.
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Affiliation(s)
- Peter Keogh
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Catherine Dodds
- School for Policy Studies, University of Bristol, Bristol, UK
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20
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Nicholls EJ, Rhodes T, Egede SJ. Situating adherence to medicines: The embodied practices and hinterlands of HIV antiretrovirals. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1085-1099. [PMID: 33774846 DOI: 10.1111/1467-9566.13270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
Adherence to medicines tends to be envisaged as a matter of actors' reasoned actions, though there is increasing emphasis on situating adherence as a practice materialised in everyday routines. Drawing on the qualitative interview accounts of Black African women living with HIV in London, UK, we treat adherence to HIV medicines as not only situated in the practices of the immediate and everyday but also relating to a hinterland of historical and social relations. We move from accounts which situate adherence as an embodied matter of affect in the present, to accounts which locate adherence as a condition of precarity, which also trace to enactments of time and place in the past. Adherence is therefore envisaged as a multiple and fluid effect which is made-up in-the-now and in relation to a hinterland of practices which locate elsewhere.
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Affiliation(s)
- Emily Jay Nicholls
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
| | - Tim Rhodes
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Siri Jonina Egede
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
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21
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Rance J, Rhodes T, Lancaster K. Pharmaceutical citizenship in an era of universal access to hepatitis C treatment: Situated potentials and limits. Health (London) 2021; 26:736-752. [PMID: 33506718 DOI: 10.1177/1363459320988887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Until recently, the only medical treatment available for the hepatitis C virus (HCV) was interferon-based therapy, a notoriously long and arduous treatment with limited success. However, in December 2015, the Australian Government announced a scheme of 'universal access' to new, highly effective direct-acting antiviral therapies (DAAs). This article draws on in-depth interviews with community actors engaged in national and state-based drug user and viral hepatitis advocacy to trace how universal access to curative medicines affords revised notions of citizenship and social inclusion among people who inject drugs and others affected by HCV. To inform our analysis, we draw on and combine critical perspectives from the biological citizenship literature, particularly pharmaceutical citizenship, along with work on the concepts of 'publics and counterpublics'. We ask: what kinds of emergent HCV communities or publics are being enacted through our participant accounts in response to the new DAA-era of universal access, and what forms of citizenship and inclusion (or non-citizenship and exclusion) do they postulate? Some accounts indeed enacted treatment as an individual, sometimes collective, 'good': a citizenship potential. However, a number of accounts enacted situated limits to a straightforward actualisation of this potential, performing a model of public health governance that prioritised viral cure whilst rendering injecting drug use and its attendant social disadvantages an absent presence. Reconceptualising HCV treatment within a counterpublic health sensibility would, by engaging with the everyday health needs and aspirations of people living with HCV in conditions of social disadvantage, create space for new social inclusions and citizenships.
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Affiliation(s)
| | - Tim Rhodes
- UNSW Sydney, Australia.,London School of Hygiene and Tropical Medicine, UK
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22
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Msimango L, Gibbs A, Shozi H, Ngobese H, Humphries H, Drain PK, Garrett N, Dorward J. Acceptability of point-of-care viral load testing to facilitate differentiated care: a qualitative assessment of people living with HIV and nurses in South Africa. BMC Health Serv Res 2020; 20:1081. [PMID: 33239012 PMCID: PMC7690121 DOI: 10.1186/s12913-020-05940-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 11/18/2020] [Indexed: 11/21/2022] Open
Abstract
Background Providing viral load (VL) results to people living with HIV (PLHIV) on antiretroviral therapy (ART) remains a challenge in low and middle-income countries. Point-of-care (POC) VL testing could improve ART monitoring and the quality and efficiency of differentiated models of HIV care. We assessed the acceptability of POC VL testing within a differentiated care model that involved task-shifting from professional nurses to less highly-trained enrolled nurses, and an option of collecting treatment from a community-based ART delivery programme. Methods We undertook a qualitative sub-study amongst clients on ART and nurses within the STREAM study, a randomized controlled trial of POC VL testing and task-shifting in Durban, South Africa. Between March and August 2018, we conducted 33 semi-structured interviews with clients, professional and enrolled nurses and 4 focus group discussions with clients. Interviews and focus groups were audio recorded, transcribed, translated and thematically analysed. Results Amongst 55 clients on ART (median age 31, 56% women) and 8 nurses (median age 39, 75% women), POC VL testing and task-shifting to enrolled nurses was acceptable. Both clients and providers reported that POC VL testing yielded practical benefits for PLHIV by reducing the number of clinic visits, saving time, travel costs and days off work. Receiving same-day POC VL results encouraged adherence amongst clients, by enabling them to see immediately if they were ‘good’ or ‘bad’ adherers and enabled quick referrals to a community-based ART delivery programme for those with viral suppression. However, there was some concern regarding the impact of POC VL testing on clinic flows when implemented in busy public-sector clinics. Regarding task-shifting, nurses felt that, with extra training, enrolled nurses could help decongest healthcare facilities by quickly issuing ART to stable clients. Clients could not easily distinguish enrolled nurses from professional nurses, instead they highlighted the importance of friendliness, respect and good communication between clients and nurses. Conclusions POC VL testing combined with task-shifting was acceptable to clients and healthcare providers. Implementation of POC VL testing and task shifting within differentiated care models may help achieve international treatment targets. Trial registration NCT03066128, registered 22/02/2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05940-w.
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Affiliation(s)
- Lindani Msimango
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Hlengiwe Shozi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Hope Ngobese
- Ethekwini Municipal Health Department, Durban, South Africa
| | - Hilton Humphries
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Paul K Drain
- Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, USA.,Department of Medicine, School of Medicine, University of Washington, Seattle, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Jienchi Dorward
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa. .,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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23
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Dziuban A, Sekuler T. The temporal regimes of HIV/AIDS activism in Europe: chrono-citizenship, biomedicine and its others. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1841114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Agata Dziuban
- Institute of Sociology, Jagiellonian University, Kraków, Poland
| | - Todd Sekuler
- Institute of European Ethnology, Humboldt-Universität Zu Berlin, Berlin, Germany
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24
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Gagnon M, Guta A, Upshur R, Murray SJ, Bungay V. "It gets people through the door": a qualitative case study of the use of incentives in the care of people at risk or living with HIV in British Columbia, Canada. BMC Med Ethics 2020; 21:105. [PMID: 33109165 PMCID: PMC7590593 DOI: 10.1186/s12910-020-00548-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/16/2020] [Indexed: 11/22/2022] Open
Abstract
Background There has been growing interest in the use of incentives to increase the uptake of health-related behaviours and achieve desired health outcomes at the individual and population level. However, the use of incentives remains controversial for ethical reasons. An area in which incentives have been not only proposed but used is HIV prevention, testing, treatment and care—each one representing an interconnecting step in the "HIV Cascade." Methods The main objective of this qualitative case study was to document the experiences of health care and service providers tasked with administrating incentivized HIV testing, treatment, and care in British Columbia, Canada. A second objective was to explore the ethical and professional tensions that arise from the use of incentives as well as strategies used by providers to mitigate them. We conducted interviews with 25 providers and 6 key informants, which were analyzed using applied thematic analysis. We also collected documents and took field notes. Results Our findings suggest that incentives target populations believed to pose the most risk to public health. As such, incentives are primarily used to close the gaps in the HIV Cascade by getting the "right populations" to test, start treatment, stay on treatment, and, most importantly, achieve (and sustain) viral suppression. Participants considered that incentives work because they "bring people through the door." However, they believed the effectiveness of incentives to be superficial, short-lived and one-dimensional—thus, failing to address underlying structural barriers to care and structural determinants of health. They also raised concerns about the unintended consequences of incentives and the strains they may put on the therapeutic relationship. They had developed strategies to mitigate the ensuing ethical and professional tensions and to make their work feel relational rather than transactional. Conclusions We identify an urgent need to problematize the use of incentives as a part of the "HIV Cascade" agenda and interrogate the ethics of engaging in this practice from the perspective of health care and service providers. More broadly, we question the introduction of market logic into the realm of health care—an area of life previously not subject to monetary exchanges.
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Affiliation(s)
- Marilou Gagnon
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada.
| | - Adrian Guta
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON, N9A 0C5, Canada
| | - Ross Upshur
- Dalla Lana Chair in Clinical Public Health, Dalla Lana School of Public Health, 678-155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Stuart J Murray
- Canada Research Chair in Rhetoric and Ethics, Department of English Language and Literature, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Vicky Bungay
- Canada Research Chair in Gender, Equity and Community Engagement, School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada
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25
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Seguin ML, Rangnekar A, Renedo A, Palafox B, McKee M, Balabanova D. Systematic review of frameworks used to conceptualise health pathways of individuals diagnosed with cardiovascular diseases. BMJ Glob Health 2020; 5:e002464. [PMID: 32928800 PMCID: PMC7490945 DOI: 10.1136/bmjgh-2020-002464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 11/04/2022] Open
Abstract
The treatment of cardiovascular disease (CVD) is managed inadequately globally. Theoretically informed frameworks have the potential to account for the multiple elements which constitute the CVD patient pathway, and capture their inter-relationships and processes of change. However, a review and critique of such frameworks is currently lacking. This systematic review aims to identify and critically assess frameworks of access to and utilisation of care which capture the pathways of patients diagnosed with one or more CVDs. The specific objectives are to (1) review how existing frameworks have been used and adapted to capture CVD patient pathways and (2) draw on elements of Strong Structuration Theory to critically appraise them, in terms of their ability to capture the dynamics of the patient journey and the factors that influence it. Five bibliographic databases were searched in January 2019. We included qualitative and quantitative studies containing frameworks used to capture the patient pathway of individuals with CVD, encompassing symptoms, diagnosis, treatment and long-term management. Data on patient behaviour and structural factors were interpreted according to elements of Strong Structuration Theory to assess frameworks on their ability to capture a holistic patient journey. The search yielded 15 articles. The majority were quantitative and all focused on management of CVDs, primarily hypertension. Commonly used frameworks included the common-sense self-regulation model, transtheoretical model and theory of planned behaviour. A critique drawing on elements of Strong Structuration Theory revealed these frameworks narrowly focused on patient attributes (patient beliefs/attitudes) and resulting patient action, but neglected external structures that interacted with these to produce particular outcomes, which results in an individualistic and linear view of the patient pathway. We suggest that a framework informed by Strong Structuration Theory is sufficiently flexible to examine the patient pathway, while avoiding a strict linear view facilitated by other frameworks.
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Affiliation(s)
- Maureen L Seguin
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Avanti Rangnekar
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Alicia Renedo
- Social and Environmental Health Research, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Benjamin Palafox
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Dina Balabanova
- Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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26
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Goodyear T, Ti L, Carrieri P, Small W, Knight R. "Everybody living with a chronic disease is entitled to be cured": Challenges and opportunities in scaling up access to direct-acting antiviral hepatitis C virus treatment among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 81:102766. [PMID: 32416525 DOI: 10.1016/j.drugpo.2020.102766] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recent advances in the safety, tolerability, and efficacy of hepatitis C virus (HCV) treatments have led to the introduction of policy changes that include, in some settings, universal coverage of direct-acting antiviral (DAA) treatment for people living with HCV. However, people who inject drugs (PWID), a population with disproportionately high rates of HCV, often experience significant social and structural barriers to care, including when seeking treatment and care for blood-borne viruses. The objective of this study is to identify implementation challenges and opportunities for improving HCV-related care and scaling up DAA treatment for PWID living with HCV in a setting with universal DAA coverage since 2018. METHODS Informed by a critical interpretive framework, this study thematically analyzes data from in-depth, semi-structured interviews conducted between October 2018 and February 2019 with a purposive sample of 15 expert stakeholders (e.g., clinicians, community-based organization representatives, policy makers) related to HCV care or research in British Columbia, Canada. RESULTS Our analysis revealed two key thematics: First, participants described existing challenges for scaling up DAA treatment, including how contextual factors (e.g., housing, stigma) restrict opportunities for PWID to engage in care. Participants also described how strained and compartmentalized health services are onerous to navigate for patients. Second, participants described opportunities for improving HCV-related care through various structural interventions (e.g., improved housing, decriminalization of substance use), and enhanced and more accessible models of care (e.g., decentralized, integrated, outreach-focused, and peer- and nurse-led services). CONCLUSIONS These findings emphasize that several key service delivery and system-level adaptations are required in order to equitably scale up access of DAAs to PWID living with HCV, including policies and programs that are responsive to socio-structural determinants of health.
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Affiliation(s)
- Trevor Goodyear
- British Columbia Centre on Substance Use, Vancouver, Canada; School of Nursing, University of British Columbia, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Will Small
- British Columbia Centre on Substance Use, Vancouver, Canada; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada.
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Horter S, Seeley J, Bernays S, Kerschberger B, Lukhele N, Wringe A. Dissonance of Choice: Biomedical and Lived Perspectives on HIV Treatment-Taking. Med Anthropol 2020; 39:675-688. [PMID: 32078396 DOI: 10.1080/01459740.2020.1720981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Treat-all recommends prompt treatment initiation for those diagnosed HIV positive, requiring adaptations to individuals' behavior and practice. Drawing on data from a longitudinal qualitative study in Eswatini, we examine the choice to initiate treatment when asymptomatic, the dissonance between the biomedical logic surrounding Treat-all and individuals' conceptions of treatment necessity, and the navigation over time of ongoing engagement with care. We reflect on the perspectives of healthcare workers, responsible for implementing Treat-all and holding a duty of care for their patients. We explore how the potentially differing needs and priorities of individuals and the public health agenda are navigated and reconciled. Rationalities regarding treatment-taking extend beyond the biomedical realm, requiring adjustments to sense of self and identity, and decision-making that is situated and socially embedded. Sense of choice and ownership for this process is important for individuals' engagement with treatment and care.
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Affiliation(s)
- Shona Horter
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine , London, UK.,Research Department, Medecins Sans Frontieres , Nhlangano, Swaziland
| | - Janet Seeley
- Global Health and Development, London School of Hygiene and Tropical Medicine , London, UK.,MRC/UVRI Uganda Research Unit On AIDS , Entebbe, Uganda
| | - Sarah Bernays
- The University of Sydney School of Public Health , Sydney, Australia
| | | | | | - Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine , London, UK
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Reddy S, Gibbs A, Spooner E, Ngomane N, Reddy T, |Luthuli N, Ramjee G, Coutsoudis A, Kiepiela P. Assessment of the Impact of Rapid Point-of-Care CD4 Testing in Primary Healthcare Clinic Settings: A Survey Study of Client and Provider Perspectives. Diagnostics (Basel) 2020; 10:E81. [PMID: 32024166 PMCID: PMC7168920 DOI: 10.3390/diagnostics10020081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/05/2019] [Accepted: 12/07/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The high burden of disease in South Africa presents challenges to public health services. Point-of-care (POC) technologies have the potential to address these gaps and improve healthcare systems. This study ascertained the acceptability and impact of POC CD4 testing on patients' health and clinical management. METHODS We conducted a qualitative survey study with patients (n = 642) and healthcare providers (n = 13) at the Lancers Road (experienced POC) and Chesterville (non-experienced POC) primary healthcare (PHC) clinics from September 2015 to June 2016. RESULTS Patients (99%) at Lancers and Chesterville PHCs were positive about POC CD4 testing, identifying benefits: No loss/delay of test results (6.4%), cost/time saving (19.5%), and no anxiety (5.1%), and 58.2% were ready to initiate treatment. Significantly more patients at Chesterville than Lancers Road PHC felt POC would provide rapid clinical decision making (64.7% vs. 48.1%; p < 0.0001) and better clinic accessibility (40.4% vs. 24.7%; p < 0.0001) respectively. Healthcare providers thought same-day CD4 results would impact: Clinical management (46.2%), patient readiness (46.2%), and adherence (23.0%), and would reduce follow-up visits (7.7%), while 38.5% were concerned that further tests and training (15.4%) were required before antiretroviral therapy (ART) initiation. CONCLUSION The high acceptability of POC CD4 testing and the immediate health, structural, and clinical management benefits necessitates POC implementation studies.
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Affiliation(s)
- Shabashini Reddy
- South African Medical Research Council, Durban 4000, South Africa;
- Wits Health Consortium, Parktown, Johannesburg 2091, South Africa
| | - Andrew Gibbs
- South African Medical Research Council, Gender and Health Research Unit, Durban Centre for Rural Health, University of KwaZulu Natal, Durban 4000, South Africa;
| | - Elizabeth Spooner
- South African Medical Research Council, HIV Prevention Research Unit, Durban 3600, South Africa; (E.S.); (G.R.)
| | | | - Tarylee Reddy
- South African Medical Research Council, Biostatistics Unit, Durban 4000, South Africa;
| | | | - Gita Ramjee
- South African Medical Research Council, HIV Prevention Research Unit, Durban 3600, South Africa; (E.S.); (G.R.)
| | - Anna Coutsoudis
- School of Clinical Medicine, University of KwaZulu Natal, Durban 4000, South Africa;
| | - Photini Kiepiela
- South African Medical Research Council, Durban 4000, South Africa;
- Wits Health Consortium, Parktown, Johannesburg 2091, South Africa
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Lazuardi E, Bell S, Newman CE. A 'scoping review' of qualitative literature about engagement with HIV care in Indonesia. Sex Health 2019; 15:283-291. [PMID: 30021685 DOI: 10.1071/sh17163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/01/2018] [Indexed: 01/19/2023]
Abstract
Background The Indonesian response to HIV has been informed largely by quantitative evidence. This review examines what is known about the Indonesian HIV care cascade from published qualitative research. METHODS A 'scoping review' method was used to synthesise and interpret the findings of 17 eligible peer-reviewed publications. RESULTS Qualitative findings are reported in relation to two themes. Factors influencing successful engagement include a lack of HIV-related knowledge among clients, fear of stigma or lack of privacy/confidentiality at services, limited accessibility and affordability, and poor linkages between services. Factors affecting the broader response include a failure to adapt programs to specific socio-cultural settings, political issues in the distribution of donor funding, distrust and poor communication between service users and providers, the need for cultural privacy in particular community settings, and systemic experiences of gendered stigmatisation. CONCLUSIONS Enhancing understanding of the Indonesian context would benefit from future qualitative research on HIV care in urban settings, describing the experiences of the most at-risk populations, and examining the role of clinics and providers in delivering HIV care in an increasingly decentralised health system.
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Affiliation(s)
- Elan Lazuardi
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Stephen Bell
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia
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Seckinelgin H. People don't live on the care cascade: The life of the HIV care cascade as an international AIDS policy and its implications. Glob Public Health 2019; 15:321-333. [PMID: 31596684 DOI: 10.1080/17441692.2019.1673784] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article analyses how the HIV care cascade, an analytical tool, has become a policy practice that determines the direction and content of international AIDS policy. It traces the development of the cascade through from its emergence around 2011 to its position framing global AIDS policy by 2018. The article distinguishes between the cascade model as a mapping tool and the care cascade as a policy that aims to end the AIDS epidemic. It then argues that the move from an analytical to a policy tool has important implications, both for the scope of policies and for policy-relevant research. It concludes by considering its implications in determining policy direction. The qualitative research that informs the article is based on published care cascade research and policy documents, and observations of the presentations and discussions at the 2012 and 2018 International AIDS Conferences (IAS). The article uses textual analysis to develop its argument.
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Affiliation(s)
- Hakan Seckinelgin
- Department of Social Policy, London School of Economics and Political Science, London, UK
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Abstract
Fluctuations in global health funding can significantly impact the lives of people who depend on donor-funded programs for life-long care. In this article, I examine shifting HIV policies that expanded antiretroviral therapy (ART) while reducing "care" services meant to improve ART access and adherence. I describe how these changes were experienced by HIV+ women accessing ART at a hospital in Tanzania in 2011-2012, highlighting their increasing precarity and uncertainty for care amidst donor instability and eroding program services. This research suggests that stable funding in support of long-term care services is important to help HIV+ people maintain life-long ART.
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Affiliation(s)
- Meredith G Marten
- Department of Anthropology, University of West Florida, Pensacola, Florida, USA
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Abstract
Indigenous leaders remain concerned that systemic oppression and culturally unsafe care impede Indigenous peoples living with HIV from accessing health services that make up the HIV cascade of care. We conducted a systematic review to assess the evidence related to experiences of the HIV care cascade among Indigenous peoples in Australia, Canada, New Zealand, and United States. We identified 93 qualitative and quantitative articles published between 1996 and 2017 reporting primary data on cascade outcomes disaggregated by Indigenous identity. Twelve involved data from Australia, 52 from Canada, 3 from New Zealand and 26 from United States. The majority dealt with HIV testing/diagnosis (50). Relatively few addressed post-diagnosis experiences: linkage (14); retention (20); treatment initiation (21); adherence (23); and viral suppression (24). With the HIV cascade of care increasingly the focus of global, national, and local HIV agendas, it is critical that culturally-safe care for Indigenous peoples is available at all stages.
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Seckinelgin H. HIV care cascade and sustainable wellbeing of people living with HIV in context. J Int AIDS Soc 2019; 22:e25259. [PMID: 30784216 PMCID: PMC6381287 DOI: 10.1002/jia2.25259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hakan Seckinelgin
- Department of Social Policy, London School of Economics and Politics (LSE), London, United Kingdom
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Young I, Davis M, Flowers P, McDaid LM. Navigating HIV citizenship: identities, risks and biological citizenship in the treatment as prevention era. HEALTH RISK & SOCIETY 2019; 21:1-16. [PMID: 31105468 PMCID: PMC6494283 DOI: 10.1080/13698575.2019.1572869] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023]
Abstract
The use of HIV Treatment as Prevention (TasP) has radically changed our understandings of HIV risk and revolutionised global HIV prevention policy to focus on the use of pharmaceuticals. Yet, there has been little engagement with the very people expected to comply with a daily pharmaceutical regime. We employ the concept of HIV citizenship to explore responses by people living with HIV in the UK to TasP. We consider how a treatment-based public health strategy has the potential to reshape identities, self-governance and forms of citizenship, domains which play a critical role not only in compliance with new TasP policies, but in how HIV prevention, serodiscordant relationships and (sexual) health are negotiated and enacted. Our findings disrupt the biomedical narrative which claims an end to HIV through scaling up access to treatment. Responses to TasP were framed through shifting negotiations of identity, linked to biomarkers, cure and managing treatment. Toxicity of drugs - and bodies - were seen as something to manage and linked to the shifting possibilities in serodiscordant environments. Finally, a sense of being healthy and responsible, including appropriate use of resources, meant conflicting relationships with if and when to start treatment. Our research highlights how HIV citizenship in the TasP era is negotiated and influenced by intersectional experiences of community, health systems, illness and treatment. Our findings show that the complexities of HIV citizenship and ongoing inequalities, and their biopolitical implications, will intimately shape the implementation and sustainability of TasP.
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Affiliation(s)
- Ingrid Young
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Melbourne
| | - Paul Flowers
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lisa M McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Marent B, Henwood F, Darking M. Development of an mHealth platform for HIV Care: Gathering User Perspectives Through Co-Design Workshops and Interviews. JMIR Mhealth Uhealth 2018; 6:e184. [PMID: 30339132 PMCID: PMC6231792 DOI: 10.2196/mhealth.9856] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 08/24/2018] [Accepted: 09/10/2018] [Indexed: 11/14/2022] Open
Abstract
Background Despite advances in testing and treatment, HIV incidence rates within European countries are at best stable or else increasing. mHealth technology has been advocated to increase quality and cost-effectiveness of health services while dealing with growing patient numbers. However, studies suggested that mHealth apps are rarely adopted and often considered to be of low quality by users. Only a few studies (conducted in the United States) have involved people living with HIV (PLWH) in the design of mHealth. Objective The goal of this study was to facilitate a co-design process among PLWH and clinicians across 5 clinical sites in the European Union to inform the development of an mHealth platform to be integrated into clinical care pathways. We aimed to (1) elicit experiences of living with HIV and of working in HIV care, (2) identify mHealth functionalities that are considered useful for HIV care, and (3) identify potential benefits as well as concerns about mHealth. Methods Between January and June 2016, 14 co-design workshops and 22 semistructured interviews were conducted, involving 97 PLWH and 63 clinicians. Data were analyzed thematically and iteratively, drawing on grounded theory techniques. Results Findings were established into 3 thematic clusters: (1) approaching the mHealth platform, (2) imagining the mHealth platform, and (3) anticipating the mHealth platform’s implications. Co-design participants approached the mHealth platform with pre-existing concerns arising from their experiences of receiving or providing care. PLWH particularly addressed issues of stigma and questioned how mHealth could enable them to manage their HIV. Clinicians problematized the compatibility of mHealth with existing information technology systems and questioned which patients should be targeted by mHealth. Imagining the potential of mHealth for HIV care, co-design participants suggested medical functionalities (accessing test results, managing medicines and appointments, and digital communication channels), social functionalities (peer support network, international travel, etc), and general features (security and privacy, credibility, language, etc). Co-design participants also anticipated potential implications of mHealth for self-management and the provision of care. Conclusions Our approach to co-design enabled us to facilitate early engagement in the mHealth platform, enabling patient and clinician feedback to become embedded in the development process at a preprototype phase. Although the technologies in question were not yet present, understanding how users approach, imagine, and anticipate technology formed an important source of knowledge and proved highly significant within the technology design and development process.
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Affiliation(s)
- Benjamin Marent
- School of Applied Social Science, University of Brighton, Falmer, United Kingdom
| | - Flis Henwood
- School of Applied Social Science, University of Brighton, Falmer, United Kingdom
| | - Mary Darking
- School of Applied Social Science, University of Brighton, Falmer, United Kingdom
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- School of Applied Social Science, University of Brighton, Falmer, United Kingdom
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36
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Marent B, Henwood F, Darking M. Ambivalence in digital health: Co-designing an mHealth platform for HIV care. Soc Sci Med 2018; 215:133-141. [PMID: 30232053 DOI: 10.1016/j.socscimed.2018.09.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/29/2018] [Accepted: 09/03/2018] [Indexed: 11/29/2022]
Abstract
In reaction to polarised views on the benefits or drawbacks of digital health, the notion of 'ambivalence' has recently been proposed as a means to grasp the nuances and complexities at play when digital technologies are embedded within practices of care. This article responds to this proposal by demonstrating how ambivalence can work as a reflexive approach to evaluate the potential implications of digital health. We first outline current theoretical advances in sociology and organisation science and define ambivalence as a relational and multidimensional concept that can increase reflexivity within innovation processes. We then introduce our empirical case and highlight how we engaged with the HIV community to facilitate a co-design space where 97 patients (across five European clinical sites: Antwerp, Barcelona, Brighton, Lisbon, Zagreb) were encouraged to lay out their approaches, imaginations and anticipations towards a prospective mHealth platform for HIV care. Our analysis shows how patients navigated ambivalence within three dimensions of digital health: quantification, connectivity and instantaneity. We provide examples of how potential tensions arising through remote access to quantified data, new connections with care providers or instant health alerts were distinctly approached alongside embodied conditions (e.g. undetectable viral load) and embedded socio-material environments (such as stigma or unemployment). We conclude that ambivalence can counterbalance fatalistic and optimistic accounts of technology and can support social scientists in taking-up their critical role within the configuration of digital health interventions.
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Affiliation(s)
- Benjamin Marent
- School of Applied Social Science, University of Brighton, Mayfield House Falmer, BN1 9PH, United Kingdom.
| | - Flis Henwood
- School of Applied Social Science, University of Brighton, Mayfield House Falmer, BN1 9PH, United Kingdom.
| | - Mary Darking
- School of Applied Social Science, University of Brighton, Mayfield House Falmer, BN1 9PH, United Kingdom.
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- School of Applied Social Science, University of Brighton, Mayfield House Falmer, BN1 9PH, United Kingdom
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Rai T, Bruton J, Day S, Ward H. From activism to secrecy: Contemporary experiences of living with HIV in London in people diagnosed from 1986 to 2014. Health Expect 2018; 21:1134-1141. [PMID: 30168239 PMCID: PMC6250870 DOI: 10.1111/hex.12816] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 06/21/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Successes in biomedicine have transformed HIV from a debilitating and frequently fatal infection to a chronic, manageable condition. Objective To explore how the contemporary metanarrative of HIV as a chronic condition is understood by patients and how it varies depending on when they were diagnosed. Design Qualitative interviews with 52 people living with HIV who were diagnosed during different phases in the history of the epidemic. Setting and participants Participants were recruited from two HIV clinics in London to include four “HIV generations”: generation 1 were those who had been diagnosed pre‐1997 (pre‐ART), generation 2 from 1997 to 2005 (complex ART), generation 3 from 2006 to 2012 (simpler ART) and generation 4 diagnosed in the year before the study (2013‐2014). Results Participants in all HIV generations took their medication as prescribed, attended clinic appointments and were well informed about their immunological biomarkers. While the pre‐treatment generation had been engaged in community endeavours such as activism, public education and use of support groups, those more recently diagnosed had little experience of collective activities and their HIV was essentially a private matter, separate from their social identity. These strategies worked for some; however, those experiencing clinical or social problems related to HIV or wider issues often relied exclusively on their HIV clinic for wider support. Conclusion The loss of public conversation around HIV, the imperative for patients to take on greater individual responsibility for HIV management and the streamlining of HIV services alongside reductions in ancillary support services may expose some people to suboptimal health outcomes.
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Affiliation(s)
- Tanvi Rai
- School of Public Health, Imperial College London, London, UK
| | - Jane Bruton
- School of Public Health, Imperial College London, London, UK
| | - Sophie Day
- School of Public Health, Imperial College London, London, UK
| | - Helen Ward
- School of Public Health, Imperial College London, London, UK
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39
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de Kok BC, Widdicombe S, Pilnick A, Laurier E. Doing patient-centredness versus achieving public health targets: A critical review of interactional dilemmas in ART adherence support. Soc Sci Med 2018; 205:17-25. [PMID: 29631198 DOI: 10.1016/j.socscimed.2018.03.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 12/19/2022]
Abstract
Anti-retroviral Therapy (ART) transformed HIV into a chronic disease but its individual and public health benefits depend on high levels of adherence. The large and rising number of people on ART, now also used as prevention, puts considerable strain on health systems and providers in low and middle as well as high-income countries, which are our focus here. Delivering effective adherence support is thus crucial but challenging, especially given the promotion of patient-centredness and shared decision making in HIV care. To illuminate the complexities of ART adherence support delivered in and through clinical encounters, we conducted a multi-disciplinary interpretative literature review. We reviewed and synthesized 82 papers published post 1997 (when ART was introduced) belonging to three bodies of literature: public health and psychological studies of ART communication; anthropological and sociological studies of ART; and conversation analytic studies of patient-centredness and shared decision-making. We propose three inter-related tensions which make patient-centredness particularly complex in this infectious disease context: achieving trust versus probing about adherence; patient-centredness versus reaching public health targets; and empowerment versus responsibilisation as 'therapeutic citizens'. However, there is a dearth of evidence concerning how precisely ART providers implement patient-centredness, shared-decision making in practice, and enact trust and therapeutic citizenship. We show how conversation analysis could lead to new, actionable insights in this respect.
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Affiliation(s)
- B C de Kok
- Department of Anthropology, University of Amsterdam, Nieuwe Achtergracht 166, PO Box 15508, 1001 NA, Amsterdam, The Netherlands.
| | - S Widdicombe
- Psychology, 7 George Square, Edinburgh, EH8 9JZ, UK.
| | - A Pilnick
- Language, Medicine and Society, School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - E Laurier
- Geography, Drummond Street, Edinburgh, EH8 9XP, UK.
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Camlin CS, Charlebois ED, Geng E, Semitala F, Wallenta J, Getahun M, Kampiire L, Bukusi EA, Sang N, Kwarisiima D, Clark TD, Petersen ML, Kamya MR, Havlir DV. Redemption of the "spoiled identity:" the role of HIV-positive individuals in HIV care cascade interventions. J Int AIDS Soc 2018; 20. [PMID: 29210185 PMCID: PMC5810337 DOI: 10.1002/jia2.25023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 10/05/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction The concept of “therapeutic citizenship” has drawn attention to ways in which public testimony, the “story‐telling in the public sphere” undertaken by people living with HIV (PLHIV), has shaped the global response to the epidemic. This paper presents qualitative findings from two large studies in eastern Africa that reveal how the advent of population‐based HIV testing campaigns and efforts to accelerate antiretroviral “treatment for all” has precipitated a rapidly expanding therapeutic citizenship “project,” or social movement. The title of this paper refers to Goffman's original conceptualization of stigma as a social process through which a person's identity is rendered “spoiled.” Methods Data were derived from qualitative studies embedded within two clinical trials, Sustainable East African Research in Community Health (SEARCH) (NCT# 01864603) in Kenya and Uganda, and START‐ART (NCT# 01810289) in Uganda, which aimed to offer insights into the pathways through which outcomes across the HIV care continuum can be achieved by interventions deployed in the studies, any unanticipated consequences, and factors that influenced implementation. Qualitative in‐depth semi‐structured interviews were conducted among cohorts of adults in 2014 through 2015; across both studies and time periods, 217 interviews were conducted with 166 individuals. Theoretically informed, team‐based analytic approaches were used for the analyses. Results Narratives from PLHIV, who have not always been conceptualized as actors but rather usually as targets of HIV interventions, revealed strongly emergent themes related to these individuals' use of HIV biomedical resources and discourses to fashion a new, empowered subjecthood. Experiencing the benefits of antiretroviral therapy (ART) emboldens many individuals to transform their “spoiled” identities to attain new, valorized identities as “advocates for ART” in their communities. We propose that the personal revelation of what some refer to as the “gospel of ARVs,” the telling of personal stories about HIV in the public sphere and actions to accompany other PLHIV on their journey into care, is driven by its power to redeem the “spoiled identity:” it permits PLHIV to overcome self‐stigma and regain full personhood within their communities. Conclusions PLHIV are playing an unanticipated but vital role in the successful implementation of HIV care cascade interventions.
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Affiliation(s)
| | | | - Elvin Geng
- University of California, San Francisco, CA, USA
| | - Fred Semitala
- Makerere University Joint AIDS Program, Kampala, Uganda
| | | | | | | | | | - Norton Sang
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Dalsone Kwarisiima
- Makerere University Joint AIDS Program, Kampala, Uganda.,Makerere University School of Medicine, and Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Maya L Petersen
- Berkeley School of Public Health, University of California, Berkeley, CA, USA
| | - Moses R Kamya
- Makerere University School of Medicine, and Infectious Diseases Research Collaboration, Kampala, Uganda
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Bernays S, Bukenya D, Thompson C, Ssembajja F, Seeley J. Being an 'adolescent': The consequences of gendered risks for young people in rural Uganda. CHILDHOOD (COPENHAGEN, DENMARK) 2018; 25:19-33. [PMID: 29472746 PMCID: PMC5802539 DOI: 10.1177/0907568217732119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The behaviour of adolescents is recognised increasingly as having substantial and long-term consequences for their health. We examined the meaning of 'adolescence' in southern Uganda with HIV-positive young people aged 11-24 years. Adolescent girls and boys are described differently in the local language (Luganda). Adolescence is described as a behavioural rather than a life course category and an inherently dangerous one. The practices, risks and consequences of 'adolescent' behaviour are highly gendered. Local understandings of adolescence are likely to have a significant impact on the efficacy of interventions designed to minimise their 'risky behaviour'.
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Affiliation(s)
- Sarah Bernays
- London School of Hygiene & Tropical Medicine, UK; The University of Sydney, Australia
| | - Dominic Bukenya
- Medical Research Council/Uganda Virus Research Institute, Uganda
| | | | - Fatuma Ssembajja
- Medical Research Council/Uganda Virus Research Institute, Uganda
| | - Janet Seeley
- Janet Seeley, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1E 7HT, UK.
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Scaling a waterfall: a meta-ethnography of adolescent progression through the stages of HIV care in sub-Saharan Africa. J Int AIDS Soc 2018; 20:21922. [PMID: 28953326 PMCID: PMC5640312 DOI: 10.7448/ias.20.1.21922] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction: Observational studies have shown considerable attrition among adolescents living with HIV across the “cascade” of HIV care in sub-Saharan Africa, leading to higher mortality rates compared to HIV-infected adults or children. We synthesized evidence from qualitative studies on factors that promote or undermine engagement with HIV services among adolescents living with HIV in sub-Saharan Africa. Methods: We systematically searched five databases for studies published between 2005 and 2016 that met pre-defined inclusion criteria. We used a meta-ethnographic approach to identify first, second and third order constructs from eligible studies, and applied a socio-ecological framework to situate our results across different levels of influence, and in relation to each stage of the HIV cascade. Results and discussion: We identified 3089 citations, of which 24 articles were eligible for inclusion. Of these, 17 were from Southern Africa while 11 were from Eastern Africa. 6 explored issues related to HIV testing, 11 explored treatment adherence, and 7 covered multiple stages of the cascade. Twelve third-order constructs emerged to explain adolescents’ engagement in HIV care. Stigma was the most salient factor impeding adolescents’ interactions with HIV care over the past decade. Self-efficacy to adapt to life with HIV and support from family or social networks were critical enablers supporting uptake and retention in HIV care and treatment programmes. Provision of adolescent-friendly services and health systems issues, such as the availability of efficient, confidential and comfortable services, were also reported to drive sustained care engagement. Individual-level factors, including past illness experiences, identifying mechanisms to manage pill-taking in social situations, financial (in)stability and the presence/absence of future aspirations also shaped adolescents HIV care engagement. Conclusions: Adolescents’ initial and ongoing use of HIV care was frequently undermined by individual-level issues; although family, community and health systems factors played important roles. Interventions should prioritise addressing psychosocial issues among adolescents to promote individual-level engagement with HIV care, and ultimately reduce mortality. Further research should explore issues relating to care linkage and ART initiation in different settings, particularly as “test and treat” policies are scaled up.
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Skovdal M, Wringe A, Seeley J, Renju J, Paparini S, Wamoyi J, Moshabela M, Ddaaki W, Nyamukapa C, Ondenge K, Bernays S, Bonnington O. Using theories of practice to understand HIV-positive persons varied engagement with HIV services: a qualitative study in six Sub-Saharan African countries. Sex Transm Infect 2017; 93:e052977. [PMID: 28736396 PMCID: PMC5739842 DOI: 10.1136/sextrans-2016-052977] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/03/2017] [Accepted: 05/06/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This article considers the potential of 'theories of practice' for studying and understanding varied (dis)engagement with HIV care and treatment services and begins to unpack the assemblage of elements and practices that shape the nature and duration of individuals' interactions with HIV services. METHODS We obtained data from a multicountry qualitative study that explores the use of HIV care and treatment services, with a focus on examining the social organisation of engagement with care as a practice and as manifested in the lives of people living with HIV in sub-Saharan Africa. The dataset comprised of 356 interviews with participants from six countries. RESULTS We noted fluctuating interactions with HIV services in all countries. In line with theories of practice, we found that such varied engagement can be explained by (1) the availability, absence and connections between requisite 'materialities' (eg, health infrastructure, medicines), 'competencies' (eg, knowing how to live with HIV) and 'meanings' (eg, trust in HIV services, stigma, normalisation of HIV) and (2) a host of other life practices, such as working or parenting. These dynamics either facilitated or inhibited engagement with HIV services and were intrinsically linked to the discursive, cultural, political and economic fabric of the participating countries. CONCLUSION Practice theory provides HIV researchers and practitioners with a useful vocabulary and analytical tools to understand and steer people's differentiated HIV service (dis)engagement. Our application of practice theory to engagement in HIV care, as experienced by HIV service users and providers in six sub-Saharan African countries, highlights the need for a practice-based approach in the delivery of differentiated and patient-centred HIV services.
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Affiliation(s)
- Morten Skovdal
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Alison Wringe
- London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda
| | - Jenny Renju
- London School of Hygiene and Tropical Medicine, London, UK
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Sara Paparini
- London School of Hygiene and Tropical Medicine, London, UK
| | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | - Mosa Moshabela
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu Natal, Durban, South Africa
| | | | - Constance Nyamukapa
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Imperial College London, London, UK
| | | | - Sarah Bernays
- London School of Hygiene and Tropical Medicine, London, UK
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Wringe A, Moshabela M, Nyamukapa C, Bukenya D, Ondenge K, Ddaaki W, Wamoyi J, Seeley J, Church K, Zaba B, Hosegood V, Bonnington O, Skovdal M, Renju J. HIV testing experiences and their implications for patient engagement with HIV care and treatment on the eve of 'test and treat': findings from a multicountry qualitative study. Sex Transm Infect 2017; 93:e052969. [PMID: 28736389 PMCID: PMC5739849 DOI: 10.1136/sextrans-2016-052969] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In view of expanding 'test and treat' initiatives, we sought to elicit how the experience of HIV testing influenced subsequent engagement in HIV care among people diagnosed with HIV. METHODS As part of a multisite qualitative study, we conducted in-depth interviews in Uganda, South Africa, Tanzania, Kenya, Malawi and Zimbabwe with 5-10 health workers and 28-59 people living with HIV, per country. Topic guides covered patient and provider experiences of HIV testing and treatment services. Themes were derived through deductive and inductive coding. RESULTS Various practices and techniques were employed by health workers to increase HIV testing uptake in line with national policies, some of which affected patients' subsequent engagement with HIV services. Provider-initiated testing was generally appreciated, but rarely considered voluntary, with instances of coercion and testing without consent, which could lead to disengagement from care.Conflicting rationalities for HIV testing between health workers and their clients caused tensions that undermined engagement in HIV care among people living with HIV. Although many health workers helped clients to accept their diagnosis and engage in care, some delivered static, morally charged messages regarding sexual behaviours and expectations of clinic use which discouraged future care seeking. Repeat testing was commonly reported, reflecting patients' doubts over the accuracy of prior results and beliefs that antiretroviral therapy may cure HIV. Repeat testing provided an opportunity to develop familiarity with clinical procedures, address concerns about HIV services and build trust with health workers. CONCLUSION The principles of consent and confidentiality that should underlie HIV testing and counselling practices may be modified or omitted by health workers to achieve perceived public health benefits and policy expectations. While such actions can increase HIV testing rates, they may also jeopardise efforts to connect people diagnosed with HIV to long-term care, and undermine the potential of test and treat interventions.
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Affiliation(s)
- Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mosa Moshabela
- University of KwaZulu Natal, Durban, South Africa
- African Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Dominic Bukenya
- Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda
| | - Ken Ondenge
- Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | - Janet Seeley
- African Health Research Institute, KwaZulu-Natal, South Africa
- Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda
- Department of Global Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathryn Church
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Basia Zaba
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Victoria Hosegood
- African Health Research Institute, KwaZulu-Natal, South Africa
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Oliver Bonnington
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Morten Skovdal
- University of Copenhagen, Copenhagen, Denmark
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Jenny Renju
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
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Bernays S, Paparini S, Seeley J, Rhodes T. "Not Taking it Will Just be Like a Sin": Young People Living with HIV and the Stigmatization of Less-Than-Perfect Adherence to Antiretroviral Therapy. Med Anthropol 2017; 36:485-499. [PMID: 28379042 DOI: 10.1080/01459740.2017.1306856] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Global health priorities are being set to address questions on adherence to HIV antiretroviral therapy in adolescence. Few studies have explored young people's perspectives on the complex host of social and relational challenges they face in dealing with their treatment in secret and their condition in silence. In redressing this, we present findings from a longitudinal qualitative study with young people living with HIV in the UK, Ireland, US, and Uganda, embedded within the BREATHER international clinical trial. Drawing from Goffman's notion of stigma, we analyze relational dynamics in HIV clinics, as rare spaces where HIV is "known," and how young people's relationships may be threatened by non-adherence to treatment. Young people's reflections on and strategies for maintaining their reputation as patients raise questions about particular forms of medicalization of HIV and the moralization of treatment adherence that affect them, and how these may restrict opportunities for care across the epidemic.
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Affiliation(s)
- Sarah Bernays
- a School of Public Health , University of Sydney , Sydney , Australia.,b London School of Hygiene and Tropical Medicine , London , United Kingdom
| | - Sara Paparini
- b London School of Hygiene and Tropical Medicine , London , United Kingdom.,c Graduate Institute of International and Development Studies , Geneva , Switzerland
| | - Janet Seeley
- d Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda
| | - Tim Rhodes
- b London School of Hygiene and Tropical Medicine , London , United Kingdom
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