Social Aspects of Health / Social and economic aspects of HIV care and support

Lead Research Organisation: MRC/UVRI Uganda Research Unit on AIDS

Abstract

This research investigates the social and economic costs and benefits of HIV care and support. Many patients in need of ART live in rural areas from where it is not easy to access HIV care services. The necessary investment of time and costs to access ART may affect adherence to ART. Delivery of ART services close to patients residence may reduce this problem, but may lead to difficulties related to stigma and disclosure, as well as the standard of care provided. ||Three projects have been conducted on this theme. One provided a qualitative methodological perspective on adherence to ART by participants of the randomized controlled trial of home based versus facility based ART delivery strategies conducted in Jinja and to establish to what extent patients disclosure of HIV status to family members or significant others in the community influences social wellbeing; the second undertook a cost-effectiveness study of that care delivery. The third project studied whether the introduction of ART in the peripheral health centres had an impact on the health workers in the peripheral health centres.

Technical Summary

This research investigates the social and economic costs and benefits of HIV care and support. Many patients in need of ART live in rural areas from where it is not easy to access HIV care services. The necessary investment of time and costs to access ART may affect adherence to ART. Delivery of ART services close to patients residence may reduce this problem, but may lead to difficulties related to stigma and disclosure, as well as the standard of care provided. ||Three projects have been conducted on this theme. One provided a qualitative methodological perspective on adherence to ART by participants of the randomized controlled trial of home based versus facility based ART delivery strategies conducted in Jinja and to establish to what extent patients disclosure of HIV status to family members or significant others in the community influences social wellbeing; the second undertook a cost-effectiveness study of that care delivery. The first of the projects with the Jinja trial participants studied 40 clients purposively selected at enrolment of the Jinja Trial from three sample strata: trial arm (home vs. facility), disease status at enrolment (CD4 count over 150 cells/ul or WHO stage 1 or 2, versus CD4 count under 100 cells/ul or WHO stage 3 or 4), and gender. Consenting participants gave semi-structured interviews at enrolment and at 3, 6, and 18 months after starting ART and in the 3rd year of the trial. ||The third project studied whether the introduction of ART in the peripheral health centres had an impact on the health workers in the peripheral health centres. We focused specifically on whether the roll-out resulted in an increased work load; reduced work clarity for nurses as they are asked to carry out roles and responsibilities formerly carried out by doctors and clinicians; more strained relationships between health workers and their supervisors leading to reduction in social capital; an increase in work stress, reduced role clarity and reduced social capital will lead to reduced job satisfaction and reduced job satisfaction will lead to reduced organizational citizenship behaviour. Data were collected from health centre staff who both provided and did not provide ART and, in a second phase, from health centre clients.||The different components of this programme of work have been co-funded from different sources including the core budget of the MRC/UVRI Uganda Research Unit on AIDS, the US Centre for Disease Control and Prevention (CDC) and from the Ugandan Office of the Department for International Development (DFID).
 
Description Boston SPH 
Organisation Boston University
Department School of Public Health
Country United States 
Sector Academic/University 
PI Contribution We have undertaken all the research associated with this work.
Collaborator Contribution Faculty support
Impact none other than publication listed