159 research outputs found
3.‘It is better to die’: experiences of traditional health practitioners within the HIV treatment as prevention trial communities in rural South Africa (ANRS 12249 TasP Trial).
No full textExperiences of people living with HIV/AIDS in a plural health care system: probing tensions and complexities.
Get PDFDoctoral Degree. University of KwaZulu-Natal, Durban.HIV/AIDS is treated biomedically. People living with HIV (PLHIV) are expected to strictly adhere to active antiretroviral treatment (ART) prescribed by biomedical health practitioners in order to “progress” on the cascade of care. Poor progression on the cascade of care, however, has been shown to exist amongst PLHIV. The use of multiple health systems – biomedicine, traditional healing and religious healing, known as medical pluralism, has been said to be a contributing factor in the poor adherence to HIV testing and treatment. Some PLHIV, however, have been shown to be in care while practicing medical pluralism. Thus, this study explores the experiences of such PLHIV in their practice of medical pluralism, especially how navigate the systems and treatments utilised.
This study was conducted at the Hlabisa sub-District, a rural area in uMkhanyakude District of KwaZulu-Natal, South Africa, though qualitative ethnography. Eighteen participants were recruited using theoretical and purposive sampling. Nine PLHIV were the primary participants in the study. Of the nine PLHIV, four were also traditional healers. The other nine participants, made up of five biomedical healthcare practitioners, three traditional healers and one faith/religious healer, were the secondary participants.
The study found that the PLHIV in the study consciously made concurrent, parallel or sequential use of plural healthcare for various health conditions when they believed such conditions can best or only be treated using specific health systems. None of the participants sought to “treat” or “cure” HIV using health systems outside biomedicine. The study found that some of the participants refused initiation into ART due to the attitude of the biomedical health practitioners towards the participants’ use of plural health. Primary participants who maintained their ART all reported to have had suppressed viral loads and high CD4 counts. Their health-seeking behaviours can be seen as an expression of their agency. Hence, rather than excluding them from using basic primary health services due to their plural health use, a better understanding and appreciation of their reasons, motivations, and manners of practising medical pluralism is needed. This will aid in the development of health programmes that better cater for their health needs
Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa
Get PDFOBJECTIVES: There are concerns that medical pluralism may delay patients' progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with HIV (PLHIV) in African settings remain unclear. We sought to establish the manifestation of medical pluralism among PLHIV, and explore mechanisms through which medical pluralism contributes bottlenecks along the HIV care cascade.METHODS: We conducted a multicountry exploratory qualitative study in seven health and demographic surveillance sites in six eastern and southern African countries: Uganda, Kenya, Tanzania, Malawi, Zimbabwe and South Africa. We interviewed 258 PLHIV at different stages of the HIV cascade-of-care, 48 family members of deceased PLHIV and 53 HIV healthcare workers. Interviews were conducted using shared standardised topic guides, and data managed through NVIVO 8/10/11. We conducted a thematic analysis of healthcare pathways and bottlenecks related to medical pluralism.RESULTS: Medical pluralism, manifesting across traditional, faith-based and biomedical health-worlds, contributed to the care cascade bottlenecks for PLHIV through three pathways of impact. First, access to HIV treatment was delayed through the nature of health-related beliefs, knowledge and patient journeys. Second, HIV treatment was interrupted by availability of alternative options, perceived failed treatment and exploitation of PLHIV by opportunistic traders and healers. Lastly, the mixing of biomedical healthcare providers and treatment with traditional and faith-based options fuelled tensions driven by fear of drug-to-drug interactions and mistrust between providers operating in different health-worlds.CONCLUSION: Medical pluralism contributes to delays and interruptions of care along the HIV cascade, and mistrust between health providers. Region-wide interventions and policies are urgently needed in sub-Saharan Africa to minimise potential harm and consequences of medical pluralism for PLHIV. The role of sociocultural beliefs in mediating bottlenecks necessitate adoption of culture-sensitive approaches intervention designs and policy reforms appropriate to the context of sub-Saharan Africa.</p
How percived value of scholaly output drives researchers behaviour in publishing
No full textThe session focused on the importance of what authors as producers of knowledge value in the research ecosystem. The session also deliberates on how ranking and promotion shape researchers' behaviour
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.
Get PDFOBJECTIVE: 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
Benefits of health reform for households in rural South Africa following implementation of ward-based primary healthcare outreach teams: a qualitative inquiry
No full textBackground: Major national primary healthcare reforms are seldom implemented, and few studies have explored the benefits of primary healthcare outreach teams to rural households, a knowledge gap we sought to address with this study. Objective: The objective of this study was to explore the community benefits in the context of PHC services delivered in rural households by outreach teams. Methods: The study was conducted in the iLembe District on the east coast of KwaZulu-Natal, South Africa between July 2015 and January 2017. In-depth, explorative and semi-structured qualitative interviews were conducted as part of a mixed-method study. A total of 21 in-depth interviews with key informants and four focus group discussions (n = 28) were conducted with purposefully sampled households and outreach team members. Content analysis was used to explore and understand the households’ experiences of primary healthcare services provided by outreach teams. Results: Household members benefited from outreach team services tailored to specific households and individuals, which improved the efficiency of healthcare services, access to appropriate health information and the overall experience of healthcare, particularly among those who are physically unwell, on chronic treatment, default treatment or immunisation, or who need referrals for clinical and social services. The benefits to household members included personalised care in the home, improved referral pathways, awareness of health events, improved adherence to treatment and reduction in opportunity costs of healthcare. Conclusion: It is perceived that participants have benefitted from the model of PHC service delivery by outreach teams through improved access to healthcare services, and by allowing community members to receive services that are responsive to their needs since the outreach team members’ advocate and negotiate to deliver services on behalf of community members. These stated benefits, as perceived by household members, have the potential to improve health outcomes and increase satisfaction levels amongst household members
Understanding patterns of health system utilisation among people living with HIV/Aids attending rural HIV services
No full textFollowing the successful introduction of antiretroviral therapy (ART) in resource-limited settings, we have observed an unprecedented explosion in the expansion of ART programs throughout sub-Saharan Africa, resulting in a 13-fold increase in coverage since 2004. In spite of these achievements, uptake of ART remains low. The gap in treatment coverage is approximately 50% of those who need ART in South Africa, while the country boasts the largest ART program worldwide. Rural areas are particularly prone to lower ART coverage rates, largely a result of existing health care inequities. The ART coverage gap will widen given the recent introduction of new treatment guidelines, which allows for ART commencement at CD4 350 cells/mm3. Furthermore, approximately one-third of ART patients are lost to follow up after two years of treatment initiation in sub-Saharan Africa. This study explores factors associated with ART access and utilisation in a rural area, in order to reduce the gap in knowledge on patient and health system factors. Unaddressed, these factors may continue to hinder adoption of rigorous interventions to improve ART uptake and retention.
This research employs the A-Framework to conceptualize access to health care, where dimensions of access include availability (physical access), affordability (financial access), and acceptability (cultural access). A data triangulation approach was adopted as very little was known on the utilization patterns of health care by HIV/AIDS patients. Quantitative research (2008-2010) employed a four-site rural-urban comparative analysis of 1266 participants, and was part of a 5-year project Researching Equity and Access to Health care (REACH).This was complemented by a more in-depth qualitative assessment (2006-2007) that followed the treatment experience of 32 patients before and after ART initiation in the rural Bushbuckridge site.
We found plural utilisation of health care to be a cross-cutting theme throughout this thesis. While the movement of patients between providers at various levels within the traditional and formal health sector may be a sign of agency, it may also result in excessive health costs that threaten the livelihoods of individuals and their households. We discuss a number of strategies to improve ART initiation and adherence including the need to incorporate metrics for pluralism into routine assessments; the importance of decentralized, humane and high quality care and support services; support for efforts to enhance patient self-efficacy through education, awareness and social support interventions; the incorporation and regulation of traditional healers into the formal system; risk protection mechanisms that reduce financial barriers and consequences of HIV care including grants, subsidies and National Health Insurance, and support for wider efforts to reduce urban-rural inequalities
Acceptability of HIV self-testing in sub-Saharan Africa: scoping study.
Get PDFCAPRISA, 2018.Abstract available in pdf
The perceived role of ward-based primary healthcare outreach teams in rural KwaZulu-Natal, South Africa
Get PDFBackground: The aim of ward-based outreach teams (WBOTs) is to improve access to primary healthcare (PHC) services including health promotion and disease prevention in South Africa. Limited information is available in South Africa on user perceptions of services provided by WBOTs in rural households.
Aim: The study aimed to explore community awareness and perception of WBOTs, as well people’s motivation to engage and use WBOT services.
Setting: The study was conducted between July and September 2015 in iLembe district, KwaZulu-Natal.
Methods: This was exploratory-descriptive qualitative research. Purposive sampling technique was used in this study. A total of 16 key informant interviews and 4 focus group discussions were conducted. The voice recordings were transcribed in isiZulu and translated into English.
Results: Four themes emerged from the data analysis, namely bringing services closer, organising services, expanding services and forming bridges. Respondents demonstrated insightful knowledge and understanding of services provided by WBOTs. They expressed an appreciation of the way WBOT services brought healthcare closer to people and serve to bridge the gap between the community and local healthcare facilities. Respondents identified unclear WBOT work schedules and the failure to carry medication other than vitamin A as the main challenges. However, WBOTs did deliver medication for controlled chronic patients in their households.
Conclusion: The study suggests that WBOTs provide a commendable service, but need to expand their service package to further increase access to PHC services and cater for community health needs
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