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Improving equity in access through adherence to HIV care and treatment

English title Improving equity in access through adherence to HIV care and treatment
Applicant Merten Sonja
Number 123907
Funding scheme Resource not found: 'bd31932a-e257-46d9-9dba-079f6f2c77c6'
Research institution Institut für Sozial- und Präventivmedizin Universität Basel Swiss TPH
Institution of higher education University of Basel - BS
Main discipline Public Health and Health Services
Start/End 01.03.2009 - 30.09.2012
Approved amount 530'000.00
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Keywords (8)

HIV/AIDS; antiretroviral therapy (ART); access to HIV care and treatment; gender; poverty; stigma; social exclusion; equity

Lay Summary (English)

Lead
Lay summary
Access to formal health care services has remained a major concern in resource poor settings. Despite improvements over the last years there are still many barriers keeping the more disadvantaged parts of the population from accessing adequate care, with poverty having a central role. These constraints are multi-faceted, ranging from the lack of resources for transport and treatment, a lack of a sufficient number of health professionals to provide the services, to socio-cultural issues such as gender inequity, stigma, and indigenous medical beliefs.Recent efforts to improve access to health care have often concentrated around HIV/AIDS. Antiretroviral therapy (ART) has been shown to improve survival and subjective wellbeing of people with HIV, and Zambia aims at providing equitable access to HIV related care and treatment to its people. Consequently, services have been expanded to remote areas, and an increasing number of rural people is offered nearby voluntary counseling and testing (VCT) and access to antiretroviral therapy (ART) programs. Despite all these efforts, still many persons in Zambia do not access HIV related services, and up to one third who is treated with antiretrovirals drops out of the programs. While treatment seeking constraints related to HIV/AIDS are complex, and some have been studied, how it contributes to a broader concept of powerlessness and exclusion, and how that translates into generalized insecurity and vulnerability that underlies poor adherence and lacking access to care has yet to be investigated. Barriers to HIV related services need to be addressed from different angles to capture the specific and general constraints, in order to assess their relevance from a more comprehensive perspective.
Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Project partner

Publications

Publication
A systematic review of socio-cultural barriers to access HIV/AIDS services.
Gari Sara, Doig-Acuna Camilo, Smail Tino, Musheke Maurice, Malungo Jacob, Martin Hilber Adriane, Ntalasha Harriet, Merten Sonja (2013), A systematic review of socio-cultural barriers to access HIV/AIDS services., in BMC Health Services Research, 13(1), 198.
Self-care practices and experiences of people living with HIV not receiving antiretroviral therapy in urban Zambia: Implications for HIV treatment programmes.
Musheke Maurice, Bond Virginia, Merten Sonja (2013), Self-care practices and experiences of people living with HIV not receiving antiretroviral therapy in urban Zambia: Implications for HIV treatment programmes., in AIDS Research and Therapy, 13(1), 12.
Couple experiences of provider-initiated couple HIV testing in an antenatal clinic in Lusaka, Zambia: lessons for policy and practice.
Musheke Maurice, Bond Virginia, Merten Sonja (2013), Couple experiences of provider-initiated couple HIV testing in an antenatal clinic in Lusaka, Zambia: lessons for policy and practice., in BMC Health Serv Res, 13, 97.
A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa.
Musheke Maurice, Ntalasha Harriet, Gari Sara, McKenzie Oran, Bond Virginia, Martin Hilber Adriane, Merten Sonja (2013), A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa., in BMC Public Health, 13, 220.
Individual and contextual factors influencing patient attrition from antiretroviral therapy care in an urban community of Lusaka, Zambia
Musheke Maurice, Bond Virginia, Merten Sonja (2012), Individual and contextual factors influencing patient attrition from antiretroviral therapy care in an urban community of Lusaka, Zambia, in J Int AIDS Soc, 2012(15 Supp 1), 1-9.
Patient-reported barriers and drivers of adherence to antiretrovirals in sub-Saharan Africa: a meta-ethnography
Merten Sonja, Kenter Elise, McKenzie Oran, McKenzie Oran, Musheke Maurice, Ntalasha Harriet, Martin Hilber Adriane (2010), Patient-reported barriers and drivers of adherence to antiretrovirals in sub-Saharan Africa: a meta-ethnography, in Trop Med Int Health, 2010(15 Suppl 1), 16-33.
Deterrents to HIV-Patient Initiation of Antiretroviral Therapy in Urban Lusaka, Zambia: A Qualitative Study.
Musheke Maurice, Bond Virginia, Merten Sonja, Deterrents to HIV-Patient Initiation of Antiretroviral Therapy in Urban Lusaka, Zambia: A Qualitative Study., in AIDS Patient Care STDS, 2013.
HIV testing and tolerance to gender violence: a cross-sectional study in Zambia
Gari Sara, Musheke Maurice, Malungo Jacob, Schindler Christian, Merten Sonja, HIV testing and tolerance to gender violence: a cross-sectional study in Zambia, in PLOS One.

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Swiss Researching Africa Days 19.10.2012 University of Bern, Switzerland
AIDS 2012 22.07.2012 Washington DC, USA
Symposium "Gender in Medicine" 08.12.2011 Basel, Switzerland
Structural drivers of HIV 08.09.2011 University of East Anglia, UK


Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
Stakeholder meeting POPART consortium 09.10.2012 Lusaka


Awards

Title Year
Student fellowship AIDS 2012 conference 2012
Fellowship AECID 2011
Student fellowship 'Structural drivers of HIV' Conference 2011 2011

Associated projects

Number Title Start Funding scheme
123072 Developing an institutional framework for assessing constraints to HIV testing and treatment-seeking of children in Zambia 01.01.2009 Marie Heim-Voegtlin grants
100891 Perception and interpretation of traditional and biomedical health concepts in a rural African community: Nutrition among the Ila-speaking peoples in Zambia. 01.09.2002 Fellowships for prospective researchers

Abstract

Background: HIV/AIDS continues to pose a tremendous burden on Sub-Saharan Africa. Zambia is a high prevalence country, with a generalized epidemic, where large-scale antiretroviral programs were successfully introduced and are currently universally available to those that qualify. Antiretroviral therapy (ART) has been shown to improve sur-vival and subjective wellbeing of people with HIV. However, still many persons do not access HIV related services, and up to one third who is treated with antiretrovirals drops out of the programs.Access to HIV related therapy is a multifaceted problem. Factors limiting access range from difficulties in making ART available in remote areas, to asymmetrical entitlements to financial resources for accessing treatment within communities and households, even if medication is free, and to socio-cultural norms that create barriers to HIV test-ing and to antiretroviral therapy. Particularly anticipated stigma is powerful as a force preventing people living with HIV from accessing a range of services. While single topics such as gender and stigma associated with HIV have been studied, how it contributes to a broader concept of powerlessness and exclusion, and how that translates into generalized insecurity and vulnerability that underlies poor adherence and lacking access to care has yet to be investigated in a multidisciplinary way. This study addresses this gap.Research objective: to gain policy relevant insights in the dynamics influencing treatment seeking behavior related to HIV/AIDS at the community level.Methods: In a rural and an urban area of Zambia (Monze and Lusaka) a mixed-methods study will be carried out. In a first exploratory phase a focused ethnographic study will be conducted in each site, including key informant and in-depth interviews and focus group discussions with different subgroups. In a second phase the results of this study will inform a survey questionnaire where factors influencing access to HIV related services are investigated in a community based sample including 2880 individuals. The analysis will focus on the relationship between poverty, powerlessness and exclusion with sociocultural processes such as stigmatization as they underlie access to care.Expected relevance of the project: Clarification of the relevance of power imbalances, structural exclusion, sociocul-tural norms and an individual’s bargaining power as explanation for decision-making around health care options. An analysis of external and internal factors as well as norms and values, expectations about outcomes all of which affect individual health decision making regarding HIV related treatment seeking will be of both practical and theoretical relevance. Capacity building will be evidence based, multi-disciplinary and address researchers as well as local pro-gram leaders and health professionals.Partnership: This project was planned jointly by the different partners in preceding meetings in Lusaka with full attention to the KFPE principals of Research partnership. The research partnership of ISPM Basel and Bern with the Department of Social Development studies of the University of Zambia, with the Centre for Infectious Disease Re-search of Zambia (CIDRZ) and with ZAMBART (Zambia AIDS related TB) Project brings researchers and profes-sionals from clinical, public health and social sciences together, who are committed to work across their disciplines in order to improve access to HIV related care.
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