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Barrington C, Rosenberg A, Kerrigan D, Blankenship KM. Probing the Processes: Longitudinal Qualitative Research on Social Determinants of HIV. AIDS Behav 2021; 25:203-213. [PMID: 33772696 PMCID: PMC8473579 DOI: 10.1007/s10461-021-03240-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
Abstract
Longitudinal qualitative research can provide rich understanding of the life circumstances of vulnerable groups who experience health inequities, of whether, how and why these circumstances change, and of how these circumstances and processes of change impact health. But, this rich understanding is not automatic and requires systematic and thoughtful approaches to data collection and analysis. The purpose of this paper is to describe two longitudinal qualitative studies embedded in mixed-methods studies of social determinants of HIV in the United States and the Dominican Republic. We compare these two studies to critically reflect on specific techniques that facilitate longitudinal and iterative data collection, management, and analysis, in particular the use of participant-specific matrices and analytic summaries across the distinct phases of the research. We conclude that combining cross-sectional and longitudinal analysis that engages with both themes and processes of change can contribute to improved contextualization and understanding of social determinants of HIV.
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Affiliation(s)
- Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB 7440, Chapel Hill, NC, 27599, USA.
| | - Alana Rosenberg
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Leyva-Moral JM, Palmieri PA, Loayza-Enriquez BK, Vander Linden KL, Elias-Bravo UE, Guevara-Vasquez GM, Davila-Olano LY, Aguayo-Gonzalez MP. 'Staying alive' with antiretroviral therapy: a grounded theory study of people living with HIV in Peru. BMJ Glob Health 2021; 6:e006772. [PMID: 34711579 PMCID: PMC8557298 DOI: 10.1136/bmjgh-2021-006772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/05/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To achieve an optimal quality of life through chronic disease management, people living with HIV (PLHIV) must adhere to antiretroviral therapy (ART). ART has been available throughout Peru since 2004 without cost in all regions; yet only 60% (43 200) of PLHIV receive ART and 32% are virally suppressed. Despite the low adherence, little is known about the experience of PLHIV with ART adherence in the context of Latin America. METHODS A constructivist grounded theory design was used to understand the ART adherence experiences of PLHIV in Northern Peru. Unstructured interviews were conducted with 18 participants resulting in theoretical saturation. All interviews were recorded, immediately transcribed and analysed concurrently with data collection using constant comparative analysis with Atlas.ti (V.8) software. Rigour was maintained through openness, reflexivity, audit trail, memo writing, debriefings, member checks and positionality. RESULTS The core category 'staying alive' emerged through the interaction of four categories, including: (1) overcoming barriers; (2) working with the healthcare team; (3) tailoring self-care strategies; and (4) appreciating antiretrovirals. Adherence is not a spontaneous outcome, instead, the surprise of HIV diagnosis transitions to living with HIV as a chronic disease. The healthcare team helps PLHIV realise ART is their life source by enhancing, supporting and facilitating self-care and overcoming barriers. CONCLUSION Adherence emerges from experiential learning as PLHIV recognised ART as their life source in balance with their desire to continue living a normal life. Social support and healthcare team interventions help PLHIV implement tailored self-care strategies to overcome personal, social, and structural barriers to adherence. Healthcare professionals need to recognise the challenges confronted by PLHIV as they learn how to continue living while trying to stay alive.
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Affiliation(s)
- Juan Manuel Leyva-Moral
- Grup de Recerca Infermera en Vulnerabilitat i Salut (GRIVIS), Departament d'Infermeria, Universitat Autonoma de Barcelona, Barcelona, Spain
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
| | - Patrick Albert Palmieri
- South American Center for Qualitative Research, Universidad Privada Norbert Wiener, Lima, Peru
- College of Graduate Health Studies, A.T. Still University, Kirksville, Missouri, USA
| | - Blanca Katiuzca Loayza-Enriquez
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Facultad de Medicina Humana, Universidad San Martin de Porres, Chiclayo, Peru
| | - Kara Lynette Vander Linden
- Department of Research, Saybrook University, Pasadena, California, USA
- Glaser Center for Grounded Theory, Institute for Research and Theory Methodologies, Poway, California, USA
| | - Ursula Elisa Elias-Bravo
- Escuela de Enfermería, Universidad Cientifica del Sur, Miraflores, Peru
- Estrategia Sanitaria de Prevención y Control de VIH-SIDA, Hospital Regional Lambayeque, Chiclayo, Peru
| | - Genesis Masiel Guevara-Vasquez
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Departamento del Desarrollo de Investigación Básica Clínica, Hospital Regional Lambayeque, Chiclayo, Peru
| | | | - Mariela Patricia Aguayo-Gonzalez
- Grup de Recerca Infermera en Vulnerabilitat i Salut (GRIVIS), Departament d'Infermeria, Universitat Autonoma de Barcelona, Barcelona, Spain
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
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The Lived Experience of Antiretroviral Therapy for Pregnant Women: Antiretroviral Therapy Adherence as a Balancing Act. J Assoc Nurses AIDS Care 2020; 31:448-456. [PMID: 31094866 DOI: 10.1097/jnc.0000000000000096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We explored 10 pregnant women's experiences with antiretroviral therapy (ART) adherence using a qualitative approach. Semistructured interviews were conducted with pregnant ethnic minority women living with HIV and receiving integrated HIV/obstetric care at a Midwestern academic medical center in the United States. Data were analyzed using an interpretive phenomenology approach to identify major themes. We found an overarching theme: ART Adherence as a Balancing Act (striving to adhere to ART while having to simultaneously navigate daily challenges). We also identified four interrelated subthemes: struggles, support, motivators, and reminders. Findings highlight the need for clinicians to be sensitive to the emotional burdens of living with HIV while pregnant, a constant factor affecting quality of life and adherence. Having conversations about barriers and facilitators to adherence and encouraging women to identify strategies that support adherence are needed rather than focusing solely on pill counts and viral load.
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Mitchell E, Lazuardi E, Rowe E, Anintya I, Wirawan DN, Wisaksana R, Subronto YW, Prameswari HD, Kaldor J, Bell S. Barriers and Enablers to HIV Care Among Waria (Transgender Women) in Indonesia: A Qualitative Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:538-552. [PMID: 31815531 DOI: 10.1521/aeap.2019.31.6.538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Transgender women (waria) in Indonesia have high rates of HIV and experience barriers accessing HIV services. This qualitative research explored barriers and facilitators to HIV care among waria in Indonesia. Between 2015 and 2016, 42 participants were involved in focus group discussions and in-depth interviews across three urban sites in Indonesia to examine participants' experiences and views on HIV prevention, testing, treatment initiation, and treatment adherence. Data were analyzed thematically. Barriers to accessing HIV care services included perceptions of health and HIV treatment, confidentiality and stigma concerns, and poor access to health insurance. Facilitators to HIV care included recognition of health and perceived susceptibility, perceptions of treatment benefits and consequences of non-adherence, access to social support, and patient-friendly services. Research findings highlight the importance of improving HIV treatment literacy, safeguarding community responses to addressing HIV vulnerability, addressing confidentiality and stigma issues, ensuring services are transgender-friendly, and increasing health insurance coverage.
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Affiliation(s)
| | - Elan Lazuardi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Emily Rowe
- Kerti Praja Foundation, Denpasar, Indonesia
| | - Irma Anintya
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Dewa N Wirawan
- Kerti Praja Foundation, Denpasar, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - Rudi Wisaksana
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
- Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Yanri W Subronto
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Hellen Dewi Prameswari
- HIV AIDS and STI Subdirectorate, Directorate of Communicable Disease Prevention and Control, Directorate General of Disease Prevention and Control, Ministry of Health of Indonesia, Jakarta, Indonesia
| | - John Kaldor
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Stephen Bell
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Yerges AL, Stevens PE, Mkandawire-Valhmu L, Bauer W, Ng'ombe Mwenyekonde T, Weinhardt LS, Galvao LW. Women's narratives of living in polygamous marriages: Rural Malawian experience distilled and preserved in poetic constructions. Health Care Women Int 2017; 38:873-891. [PMID: 28481143 DOI: 10.1080/07399332.2017.1326494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Polygamy in sub-Saharan Africa has been linked to poverty, infant mortality, and HIV; however, it is unknown how interpersonal dynamics within polygamous households may influence population health outcomes. Findings from this postcolonial feminist study derive from interview data in a larger mixed-methods study in rural Malawi. We used thematic narrative analysis to probe 25 women's stories and applied an arts-based research technique, poetic construction, to present the results. Participants' evocative expressions, distilled and preserved in poetic form, illustrate themes of perseverance, grief, agency, and reflection. We discuss how gender relations, childrearing, tradition, economics, and health intersect in polygamous households.
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Affiliation(s)
- April L Yerges
- a College of Nursing , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin , USA
| | - Patricia E Stevens
- a College of Nursing , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin , USA
| | | | - Wendy Bauer
- a College of Nursing , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin , USA
| | | | - Lance S Weinhardt
- c Zilber School of Public Health , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin , USA
| | - Loren W Galvao
- d Center for Global Health Equity, College of Nursing , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin , USA
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Barroso J, Leblanc NM, Flores D. It's Not Just the Pills: A Qualitative Meta-Synthesis of HIV Antiretroviral Adherence Research. J Assoc Nurses AIDS Care 2017; 28:462-478. [PMID: 28286006 DOI: 10.1016/j.jana.2017.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/14/2017] [Indexed: 11/16/2022]
Abstract
Antiretroviral therapy (ART) improves the health and longevity of people living with HIV infection (PLWH) and also prevents transmission of the virus. Yet, lack of adherence to ART regimens has been a persistent problem, even with simpler regimens. Guidelines that deal with ART adherence are based almost solely on quantitative studies; this focus ignores the context and complexity of patients' lives. Guidelines are also focused on the individual. We argue that the solution is to include the broader communities in which patients live, and to deal with systemic disparities that persist worldwide; this can be done in part through demedicalizing HIV care for healthy PLWH. We present findings from a qualitative meta-synthesis of 127 studies conducted around the world on the last two pillars of the HIV treatment cascade: starting and remaining on ART until optimal viral suppression is achieved. We use Maslow's hierarchy of needs to frame our findings.
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Mosack KE, Stevens PE, Brouwer AM, Wendorf AR. Shared Illness and Social Support Within Two HIV-Affected African American Communities. QUALITATIVE HEALTH RESEARCH 2016; 26:1495-1507. [PMID: 26515921 DOI: 10.1177/1049732315612044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A key source of resiliency within HIV-affected African American communities is informal social support. Data from dyadic conversations and focus groups were used to address the following research question: What are HIV-positive African Americans' social support experiences within their informal social networks in response to HIV-related problems? Circumstances that exacerbated HIV-related problems included others' fear of contagion, reticence to be involved, judgment and rejection, and disregard for privacy Support from HIV-negative others buffered the impact of problems when others communicate interest, take the initiative to help, or make a long-term investment in their success. Support from other HIV-positive persons was helpful given the shared connection because of HIV, the opportunity to commiserate about what is mutually understood, and the fight for mutual survival Based on these findings, we offer suggestions for future research and social network interventions aimed at bolstering connections between HIV-positive peers, reducing stigma, and improving family support.
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Affiliation(s)
- Katie E Mosack
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | | | - Angela R Wendorf
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Dowse R, Ramela T, Barford KL, Browne S. Developing visual images for communicating information aboutantiretroviral side effects to a low-literate population. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 9:213-24. [PMID: 25860626 DOI: 10.2989/16085906.2010.530172] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The side effects of antiretroviral (ARV) therapy are linked to altered quality of life and adherence. Poor adherence has also been associated with low health-literacy skills, with an uninformed patient more likely to make ARV-related decisions that compromise the efficacy of the treatment. Low literacy skills disempower patients in interactions with healthcare providers and preclude the use of existing written patient information materials, which are generally written at a high reading level. Visual images or pictograms used as a counselling tool or included in patient information leaflets have been shown to improve patients' knowledge, particularly in low-literate groups. The objective of this study was to design visuals or pictograms illustrating various ARV side effects and to evaluate them in a low-literate South African Xhosa population. Core images were generated either from a design workshop or from posed photos or images from textbooks. The research team worked closely with a graphic artist. Initial versions of the images were discussed and assessed in group discussions, and then modified and eventually evaluated quantitatively in individual interviews with 40 participants who each had a maximum of 10 years of schooling. The familiarity of the human body, its facial expressions, postures and actions contextualised the information and contributed to the participants' understanding. Visuals that were simple, had a clear central focus and reflected familiar body experiences (e.g. vomiting) were highly successful. The introduction of abstract elements (e.g. fever) and metaphorical images (e.g. nightmares) presented problems for interpretation, particularly to those with the lowest educational levels. We recommend that such visual images should be designed in collaboration with the target population and a graphic artist, taking cognisance of the audience's literacy skills and culture, and should employ a multistage iterative process of modification and evaluation.
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Affiliation(s)
- Ros Dowse
- a Rhodes University , Faculty of Pharmacy , PO Box 94 , Grahamstown , 6140 , South Africa
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Liamputtong P, Haritavorn N, Kiatying-Angsulee N. Local discourse on antiretrovirals and the lived experience of women living with HIV/AIDS in Thailand. QUALITATIVE HEALTH RESEARCH 2015; 25:253-263. [PMID: 25212858 DOI: 10.1177/1049732314550005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Antiretrovirals (ARVs) have been seen as life-saving for HIV-positive people. However, ARVs have a darker side. Since 2000, many HIV-positive people in Thailand have received ARV treatments, but the understanding of ARVs and practices of medication-taking among HIV-positive women have not received much attention. We discuss local discourses employed by HIV-positive women and health work by these individuals in their attempts to adhere to ARVs restrictions. The local discourse of ARVs was ya tan rok AIDS "medications that could resist HIV/AIDS." ARVs provided hope for the women. Although the women were affected by the side effects of ARVs, they continued to take their medication to be able to live longer and perform their duties as mothers and carers. They were more concerned about the practice of medication-taking. Understanding why these women were adherent to their ARVs offers insights into the social impact of these ARVs on their lives.
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Weinhardt LS, Galvao LW, Mwenyekonde T, Grande KM, Stevens P, Yan AF, Mkandawire-Valhmu L, Masanjala W, Kibicho J, Ngui E, Emer L, Watkins SC. Methods and protocol of a mixed method quasi-experiment to evaluate the effects of a structural economic and food security intervention on HIV vulnerability in rural Malawi: The SAGE4Health Study. SPRINGERPLUS 2014; 3:296. [PMID: 25019044 PMCID: PMC4082534 DOI: 10.1186/2193-1801-3-296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/31/2014] [Indexed: 11/23/2022]
Abstract
Background Poverty and lack of a predictable, stable source of food are two fundamental determinants of ill health, including HIV/AIDS. Conversely, episodes of poor health and death from HIV can disrupt the ability to maintain economic stability in affected households, especially those that rely on subsistence farming. However, little empirical research has examined if, and how, improvements in people’s economic status and food security translate into changes in HIV vulnerability. Methods In this paper, we describe in detail the methods and protocol of an academic-NGO collaboration on a quasi-experimental, longitudinal study of the mechanisms and magnitude of the impact of a multilevel economic and food security program (Support to Able-Bodied Vulnerable Groups to Achieve Food Security; SAFE), as implemented by CARE. Primary outcomes include HIV vulnerability (i.e., HIV risk behaviors, HIV infection), economic status (i.e., income, household assets) and food security (including anthropometric measures). We recruited participants from two types of areas of rural central Malawi: traditional authorities (TA) selected by CARE to receive the SAFE program (intervention group) and TAs receiving other unrelated CARE programming (controls). In the intervention TAs, we recruited 598 program participants (398 women, 200 men) and interviewed them at baseline and 18- and 36-month follow-ups; we interviewed 301 control households. In addition, we conducted random surveys (n = 1002) in the intervention and control areas with a 36-month assessment interval, prior to and after implementation of SAFE. Thus, we are examining intervention outcomes both in direct SAFE program participants and their larger communities. We are using multilevel modeling to examine mediators and moderators of the effects of SAFE on HIV outcomes at the individual and community levels and determine the ways in which changes in HIV outcomes feed back into economic outcomes and food security at later interviews. Finally, we are conducting a qualitative end-of-program evaluation consisting of in-depth interviews with 90 SAFE participants. Discussion In addition to examining pathways linking structural factors to HIV vulnerability, this research will yield important information for understanding the impact of a multilevel environmental/structural intervention on HIV, with the potential for other sustainable long-term public health benefits.
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Affiliation(s)
- Lance S Weinhardt
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201 USA
| | - Loren W Galvao
- Center for Global Health Equity, College of Nursing, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201-0413 USA
| | | | - Katarina M Grande
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201 USA
| | - Patricia Stevens
- College of Nursing, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201-0413 USA
| | - Alice F Yan
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201 USA
| | - Lucy Mkandawire-Valhmu
- College of Nursing, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201-0413 USA
| | - Winford Masanjala
- Department of Economics, University of Malawi, Chancellor College, P.O. Box 280, Zomba, Malawi
| | - Jennifer Kibicho
- College of Nursing, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201-0413 USA
| | - Emmanuel Ngui
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201 USA
| | - Lindsay Emer
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201 USA
| | - Susan C Watkins
- University of Pennsylvania, Philadelphia, PA USA ; California Center for Population Research, University of California-Los Angeles, 4284 Public Affairs Bldg, PO Box 957236, Los Angeles, CA 90095-7236 USA
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Musheke M, Bond V, Merten S. Self-care practices and experiences of people living with HIV not receiving antiretroviral therapy in an urban community of Lusaka, Zambia: implications for HIV treatment programmes. AIDS Res Ther 2013; 10:12. [PMID: 23675734 PMCID: PMC3657294 DOI: 10.1186/1742-6405-10-12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 05/07/2013] [Indexed: 11/29/2022] Open
Abstract
Background Despite the increasingly wider availability of antiretroviral therapy (ART), some people living with HIV (PLHIV) and eligible for treatment have opted to adopt self-care practices thereby risking early AIDS-related mortality. Methods A qualitative study was conducted in urban Zambia to gain insights into PLHIV self-care practices and experiences and explore the implications for successful delivery of ART care. Between March 2010 and September 2011, in-depth interviews were conducted with PLHIV who had dropped out of treatment (n=25) and those that had opted not to initiate medication (n=37). Data was entered into and managed using Atlas ti, and analysed inductively using latent content analysis. Results PHIV used therapeutic and physical health maintenance, psychological well-being and healthy lifestyle self-care practices to maintain physical health and mitigate HIV-related symptoms. Herbal remedies, faith healing and self-prescription of antibiotics and other conventional medicines to treat HIV-related ailments were used for therapeutic and physical health maintenance purposes. Psychological well-being self-care practices used were religiosity/spirituality and positive attitudes towards HIV infection. These practices were modulated by close social network relationships with other PLHIV, family members and peers, who acted as sources of emotional, material and financial support. Cessations of sexual relationships, adoption of safe sex to avoid re-infections and uptake of nutritional supplements were the commonly used risk reduction and healthy lifestyle practices respectively. Conclusions While these self-care practices may promote physical and psychosocial well-being and mitigate AIDS-related symptoms, at least in the short term, they however undermine PLHIV access to ART care thereby putting PLHIV at risk of early AIDS-related mortality. The use of scientifically unproven herbal remedies raises health and safety concerns; faith healing may create fatalism and resignation with death while the reported self-prescription of antibiotics to treat HIV-related infections raises concerns about future development of microbial drug resistance amongst PLHIV. Collectively, these self-care practices undermine efforts to effectively abate the spread and burden of HIV and reduce AIDS-related mortality. Therefore, there is need for sensitization campaigns on the benefits of ART and the risks associated with widespread self-prescription of antibiotics and use of scientifically unproven herbal remedies.
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Wendorf AR, Mosack KE. Navigating hazardous conditions: understanding HIV medication adherence in the context of depression. QUALITATIVE HEALTH RESEARCH 2013; 23:541-554. [PMID: 23221125 DOI: 10.1177/1049732312469462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Depression is highly prevalent among HIV-positive individuals and has been identified as an important predictor of suboptimal adherence to highly active antiretroviral treatment (HAART). To date, however, researchers have not adequately examined how depression influences adherence among depressed HIV-positive patients. The aim of our study was to explore the process by which depression interacts with other factors relevant to medication adherence decision making to influence adherence to HAART. We used principles of grounded theory to guide our methods. We conducted interviews with 21 HIV-positive individuals diagnosed with comorbid depressive disorders. Results indicated that depression, HIV-related cues, and health and self-care beliefs combined to influence coping strategies. Coping strategies, in turn, predicted whether participants were able to adhere to HAART. These findings can be used by practitioners to broaden the scope of factors they consider when treating depressed patients who might be at risk for nonadherence.
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Affiliation(s)
- Angela R Wendorf
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53201, USA.
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Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review. AIDS Behav 2012; 16:2119-43. [PMID: 22644066 PMCID: PMC3481055 DOI: 10.1007/s10461-012-0212-3] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This is a systematic review of eighty-two published studies investigating the impact of DSM-IV mental disorders on combination antiretroviral therapy (cART) adherence and persistence among persons living with HIV/AIDS (PLWHA). Sixty-two articles examined depression, with 58 % (N = 32/62) finding lower cART adherence and persistence. Seventeen articles examined one or more anxiety disorders, with the majority finding no association with cART adherence or persistence. Eighty percent of the studies that evaluated the impact of psychotic (N = 3), bipolar (N = 5) and personality disorders (N = 2) on cART adherence and persistence also found no association. Seven out of the nine studies (78 %) evaluating the impact of antidepressant treatment (ADT) on cART adherence found improvement. Adherence and depression measurements varied significantly in studies; common research measurements would improve data harmonization. More research specifically addressing the impact of other mental disorders besides depression on cART adherence and RCTs evaluating ADT on cART adherence are also needed.
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Affiliation(s)
- Sandra A Springer
- Yale AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06511, USA.
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White MJ, Judd MD, Poliandri S. Illumination with a Dim Bulb? What do social scientists learn by employing qualitative data analysis software (QDAS) in the service of multi-method designs? SOCIOLOGICAL METHODOLOGY 2012; 42:43.-76. [PMID: 23543938 PMCID: PMC3610334 DOI: 10.1177/0081175012461233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although there has been much optimistic discussion of integrating quantitative and qualitative findings into sociological analysis, there remains a gap regarding the application of mixed approaches. We examine the potential gains and pitfalls of such integration in the context of the growing analytic power of contemporary qualitative data analysis software (QDAS) programs. We illustrate the issues with our own research in a mixed-methods project examining low fertility in Italy, a project that combines analysis of large nationally representative survey data with qualitative in-depth interviews with women across four (4) cities in Italy. Despite the enthusiasm for mixed-methods research, the available software appears to be underutilized. In addition, we suggest that the sociological research community will want to address several conceptual and inferential issues with these approaches.
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Individual and contextual factors influencing patient attrition from antiretroviral therapy care in an urban community of Lusaka, Zambia. J Int AIDS Soc 2012; 15 Suppl 1:1-9. [PMID: 22713354 PMCID: PMC3499928 DOI: 10.7448/ias.15.3.17366] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/23/2012] [Accepted: 04/29/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Despite the relatively effective roll-out of free life-prolonging antiretroviral therapy (ART) in public sector clinics in Zambia since 2005, and the proven efficacy of ART, some people living with HIV (PLHIV) are abandoning the treatment. Drawing on a wider ethnographic study in a predominantly low-income, high-density residential area of Lusaka, this paper reports the reasons why PLHIV opted to discontinue their HIV treatment. METHODS Opened-ended, in-depth interviews were held with PLHIV who had stopped ART (n =25), ART clinic staff (n=5), religious leaders (n=5), herbal medicine providers (n=5) and lay home-based caregivers (n=5). In addition, participant observations were conducted in the study setting for 18 months. Interview data were analysed using open coding first, and then interpreted using latent content analysis. The presentation of the results is guided by a social-ecological framework. FINDINGS Patient attrition from ART care is influenced by an interplay of personal, social, health system and structural-level factors. While improved corporeal health, side effects and need for normalcy diminished motivation to continue with treatment, individuals also weighed the social and economic costs of continued uptake of treatment. Long waiting times for medical care and placing "defaulters" on intensive adherence counselling in the context of insecure labour conditions and livelihood constraints not only imposed opportunity costs which patients were not willing to forego, but also forced individuals to balance physical health with social integrity, which sometimes forced them to opt for faith healing and traditional medicine. CONCLUSIONS Complex and dynamic interplay of personal, social, health system and structural-level factors coalesces to influence patient attrition from ART care. Consequently, while patient-centred interventions are required, efforts should be made to improve ART care by extending and establishing flexible ART clinic hours, improving patient-provider dialogue about treatment experiences and being mindful of the way intensive adherence counselling is being enforced. In the context of insecure labour conditions and fragile livelihoods, this would enable individuals to more easily balance time for treatment and their livelihoods. As a corollary, the perceived efficacy of alternative treatment and faith healing needs to be challenged through sensitizations targeting patients, religious leaders/faith healers and herbal medicine providers.
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Women and vulnerability to HAART non-adherence: a literature review of treatment adherence by gender from 2000 to 2011. Curr HIV/AIDS Rep 2012; 8:277-87. [PMID: 21989672 DOI: 10.1007/s11904-011-0098-0] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A literature review of original research articles on adherence to antiretroviral therapy (ART) in developed countries, covering January 2000 to June 2011, was conducted to determine if gender differences exist in the prevalence of nonadherence to ART. Of the 1,255 articles reviewed, only 189 included data on the proportion of the study population that was adherent and only 57 (30.2%) of these reported proportional adherence values by gender. While comparing articles was challenging because of varied reporting strategies, women generally exhibit poorer adherence than men. Thirty of the 44 articles (68.2%) that reported comparative data on adherence by gender found women to be less adherent than men. Ten articles (17.5%) reported significant differences in proportional adherence by gender, nine of which showed women to be less adherent than men. These findings suggest that in multiple studies from developed countries, female gender often predicts lower adherence. The unique circumstances of HIV-positive women require specialized care to increase adherence to ART.
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Sankar A, Neufeld S, Berry R, Luborsky M. Cultural rationales guiding medication adherence among African American with HIV/AIDS. AIDS Patient Care STDS 2011; 25:547-55. [PMID: 21777141 PMCID: PMC3192053 DOI: 10.1089/apc.2010.0345] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To date, only modest gains have been achieved in explaining adherence to medical regimens, limiting effective interventions. This is a particularly important issue for African Americans who are disproportionately affected by the HIV epidemic. Few studies have focused on intragroup variation among African Americans in adherence to ART. The aim of this study was to identify and describe the cultural rationales guiding African American patients' formulation and evaluation of adherence. Rationales are key features of purposeful human action. In-depth interviews with 80 seropositive African Americans were tape recorded, transcribed, and analyzed. Participant CD4, viral load and medical histories were collected at each data point. Analysis of four waves of panel data identified three types of adherence rationales: Authoritative Knowledge Rationale (AKR; n=29, 36.3%), Following Doctors' Orders Rationale (DOR; n=24, 30.0%) and Individualized Adherence Rationale (IAR; n=27, 33.8%). Differences in mean reported adherence between the rationale groups did not achieve statistical significance. However, the fraction reporting low adherence (<70%), although not different by rationale group at the first interview (T1), was significantly higher for the IAR group by the fourth interview (T4). Objective clinical markers (CD4 and viral load) improved over time (from T1 to T4) for AKR and DOR groups, but remained unchanged for the IAR group, yet self-reported adherence declined for all groups over the course of the four interviews.
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Affiliation(s)
- Andrea Sankar
- Department of Anthropology, Wayne State University, Detroit, Michigan 48103, USA.
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Hopfer S, Clippard JR. College women's HPV vaccine decision narratives. QUALITATIVE HEALTH RESEARCH 2011; 21:262-77. [PMID: 20841433 DOI: 10.1177/1049732310383868] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Drawing on 38 in-depth qualitative interviews with college women and college health clinicians, we collected human papillomavirus (HPV) vaccine decision narratives to identify the implicit and explicit values underlying HPV vaccine decision making. Narratives of vaccine acceptance and resistance were identified. Vaccine acceptance narratives consisted of four themes: supportive family messages, explicit health care provider endorsement, peer descriptive norms reducing stigma of vaccination, and disease framing (e.g., cancer, HPV) shaping vaccine benefit perceptions. Vaccine resistance narratives consisted of five themes: skepticism of vaccine safety, invoking alternative prevention strategies, articulating stigmatizing HPV messages, overcoming self-efficacy barriers (e.g., cost, availability, time, and fear of parental disclosure), and delay strategies. Common to all decision narratives was that relationship status framed college women's perceptions of HPV susceptibility. Theoretical and practical implications for designing HPV vaccine messages aimed at college-aged women are discussed.
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Affiliation(s)
- Suellen Hopfer
- The Pennsylvania State University, University Park, Pennsylvania 16801, USA.
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Salt E, Peden A. The complexity of the treatment: the decision-making process among women with rheumatoid arthritis. QUALITATIVE HEALTH RESEARCH 2011; 21:214-222. [PMID: 20798264 DOI: 10.1177/1049732310381086] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
There are effective medications available for the treatment of rheumatoid arthritis (RA); yet, medication adherence remains a problem. In this study, grounded theory methodology was used to investigate the decision-making process used by 30 women with RA when deciding to participate in an evidence-based treatment regimen for this disease. From the study findings, a four-phase process was identified. Pain, life functioning, and exhaustion of health care resources are the components of the initial phase, decision initiation. During knowledge acquisition, the second phase, patients attain information about RA and medications used for its treatment from varying sources. The third phase, trusting the health care provider, is defined by a trusting relationship between patients and health care providers. Patients decide to take or not take medications for RA during the final phase, decision is made. The participating women with RA used a complex decision-making process when deciding to take medications for this disease.
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Mkandawire-Valhmu L, Stevens PE. The critical value of focus group discussions in research with women living with HIV in Malawi. QUALITATIVE HEALTH RESEARCH 2010; 20:684-696. [PMID: 19926798 DOI: 10.1177/1049732309354283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article is based on a critical ethnography about HIV and gender-based issues of power and violence conducted in Malawi in 2008. In all, 72 women living with HIV were recruited from four antiretroviral treatment clinics, three rural and one urban, to participate in 12 focus groups. Informed by a postcolonial feminist perspective, we analyze the process and products of these focus groups to interrogate their capacity to facilitate collective engagement with the social and structural realities confronting women in a resource-limited, highly AIDS-affected country. We present exemplars to show how women together created collective narratives to mobilize individuals to action. Findings indicate that focus groups can be used innovatively to benefit both the research and the participants, not only as a critical method of inquiry with marginalized groups but also as a forum in which validating dialogue, mutual support, and exchange of strategic information can generate transformative change to improve women's lives.
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Affiliation(s)
- Lucy Mkandawire-Valhmu
- University of Wisconsin-Milwaukee College of Nursing, P.O. Box 413, Milwaukee, WI 53201, USA.
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Macdonald ME, Rigillo N, Brassard P. Urban aboriginal understandings and experiences of tuberculosis in Montreal, Quebec, Canada. QUALITATIVE HEALTH RESEARCH 2010; 20:506-523. [PMID: 20142607 DOI: 10.1177/1049732309360538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Tuberculosis (TB) continues to be a serious health issue for some Aboriginal populations in Canada. In this article we build on two previous studies partnered with an Aboriginal community organization to examine TB in Montreal, Quebec. The current study draws on qualitative interviews with Aboriginal participants who had either themselves contracted TB or knew someone who had the disease. Thematic analysis revealed a high level of experiential knowledge among participants, although gaps in biomedical knowledge about the disease and available resources were apparent even among those who had been ill. Negative memories and experiences relating to the colonial history of TB treatment emerged as significant for many participants, helping to explain a silence around the topic of TB in the community. Barriers to TB testing were identified, including the fear of positive test results, the burden of long-term treatment for either latent or active disease, and systemic barriers within and mistrust of the health system. Community support for, as well as negative reactions toward, individuals ill with TB were identified. We conclude with a number of community health lessons to address the treatment and prevention of TB in urban populations.
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McCall J, Browne AJ, Reimer-Kirkham S. Struggling to survive: the difficult reality of Aboriginal women living with HIV/AIDS. QUALITATIVE HEALTH RESEARCH 2009; 19:1769-1782. [PMID: 19949225 DOI: 10.1177/1049732309353907] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The increasingly high rates of mortality and morbidity among Canadian Aboriginal women who are living with HIV/ AIDS indicate that there is a need to address deficiencies in the delivery of supportive services and health care. The purpose of this qualitative study was to develop a greater understanding of the barriers, challenges, and successes experienced when accessing health and related support services from the perspective of Aboriginal women living with HIV/AIDS. The findings are organized around four themes reflected in the interview data: fear of rejection when seeking services, finding strength in adversity, struggles with symptoms, and HIV as just one of many competing problems. It is anticipated that the findings from the study will be used to inform decision making regarding the development and delivery of appropriate, responsive, and accessible policies and programs that will support Aboriginal women who are living with HIV/AIDS.
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Affiliation(s)
- Jane McCall
- St. Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada.
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Vreeman RC, Nyandiko WM, Ayaya SO, Walumbe EG, Marrero DG, Inui TS. Factors sustaining pediatric adherence to antiretroviral therapy in western Kenya. QUALITATIVE HEALTH RESEARCH 2009; 19:1716-1729. [PMID: 19949221 DOI: 10.1177/1049732309353047] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Antiretroviral therapy (ART) requires nearly perfect adherence to be effective. Although 90% of HIV-infected children live in Africa, there are limited data on pediatric adherence from this multicultural continent.We conducted a qualitative study to identify key factors contributing to pediatric ART adherence. Ten focus group discussions (N = 85) and 35 individual interviews were conducted with parents and guardians of HIV-infected children receiving ART in western Kenya. Interviews covered multiple aspects of the experience of having children take ART and factors that inhibited or facilitated medication adherence. Constant comparison, progressive coding, and triangulation methods were used to arrive at a culturally contextualized, conceptual model for pediatric ART adherence derived from the descriptions of the lived experience in this resource-limited setting. Child care, including sustained ART adherence, depends on interacting cultural and environmental determinants at the levels of the individual child, parent/caregiver, household, community, health care system, and society.
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Affiliation(s)
- Rachel C Vreeman
- Indiana University School of Medicine, Department of Pediatrics, Children's Health Services Research, Indianapolis, Indiana 46202, USA.
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