Research Caroline Masquillier

Abstract

HIV remains a severe public health problem in South Africa. Important gender inequities also persist in the epidemic: the adult prevalence is twice as high in women than in men, while men are significantly less likely to test and be (successfully) treated and thus more likely to die of HIV-related causes. The two are also linked: the heterosexual nature of HIV transmission transfers these male risks into (young) female vulnerabilities (and the high female HIV prevalence). A crucial way to break this destructive cycle is (early) linkage of men to HIV services, creating a need to find feasible strategies to render HIV services male-friendly and accessible. The project aims to build a research partnership –the Men & Health Consortium– which will strengthen local research capacity as well as the relationships with policy makers and societal stakeholders (building a multi-stakeholder network and improving science-society communication). These activities will enable the consortium to use crowdsourcing (as an innovative methodology) to solicit locally appropriate and specific solutions to increase men's use of HIV services – which can form the basis for future interventions and policies.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

South Africa has a high burden of severe mental illness – such as schizophrenia, bipolar disorder and major depressive disorder. In step with global movements and budgetary limitations, the country promotes deinstitutionalisation – from hospitals to local communities – to care for these people living with severe mental illness (PSMI). This push towards deinstitutionalisation, however, has not been fit with an according health care model in these communities. PSMI are discharged into a household context without any support – often resulting in treatment non-adherence and a cyclical pattern of short readmissions to the hospitals that they have been discharged from, following relapses in treatment gains. In the context of limited resources for deinstitutionalized mental health care, research into the potential of the household in the care for discharged PSMI is a clear priority. We hypothesize that improving the mental health knowledge and communication skills of households will enable ownership of the problem and increase social support to the PSMI. This will eventually positively impact treatment adherence and lower re-admission rates of PSMI. Aim of this project is to develop and test an intervention stimulating this mental-health competence of households – in a cluster randomized-controlled trial using a longitudinal process evaluation. As such, this project responds to the urgent need in many low- and middle income settings to optimize the deinstitutionalisation of PSMI.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Buffel Veerle
• Co-promoter: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Sustainable Development Goal 3 underlines the right of everyone to have timely access to primary healthcare (PHC). Despite the fact that Belgium has put various reforms in place to make PHC more affordable and accessible, inequalities in access to care are even getting bigger – creating the need for innovative measures. A new health care model should thus be designed and tested to link people who have difficulties accessing PHC (PDAP) to the existing PHC system. Such a new model requires new fundamental knowledge, as former solutions have repeatedly failed. Since the country is also confronted with increasing health demands and limited budgets, there is impetus to tap into the potential of reverse innovations from low and middleincome countries (LMICs). A review of health innovations in LMICs and a theoretical analysis on the required characteristics of such a new model resulted in a community health worker (CHW) intervention – inspired by the Family Health System in Brazil and Re-engineering PHC in South Africa. We hypothesise that an outreaching PHC model with a CHW intervention will address the access-to-care challenges in Flanders, Belgium. We will first study the interplay over time between the different barriers PDAP experience throughout the access-to-care continuum in Flanders (WP 1). Secondly, we will investigate the innovative PHC models in South Africa and Brazil to develop the CHW intervention (WP2). In WP3, we will design a new outreaching PHC model which uses CHWs to improve access to care for PDAP in Flanders. In WPs 4 and 5, we will implement and evaluate the CHW intervention in a cluster randomised controlled trial. Finally, we will also assess the cost-effectiveness of the intervention (WP6). Throughout this work, academic experts from sociology, family medicine, and economics closely collaborate with committed societal stakeholders to join scientific insights and implementation knowhow, to optimise fit to practice and societal impact.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Sustainable Development Goal 3 underlines the right of everyone to have timely access to primary healthcare (PHC). Despite the fact that Belgium has put various reforms in place to make PHC more affordable and accessible, inequalities in access to care are even getting bigger – creating the need for innovative measures. A new health care model should thus be designed and tested to link people who have difficulties accessing PHC (PDAP) to the existing PHC system. Such a new model requires new fundamental knowledge, as former solutions have repeatedly failed. Since the country is also confronted with increasing health demands and limited budgets, there is impetus to tap into the potential of reverse innovations from low and middleincome countries (LMICs). A review of health innovations in LMICs and a theoretical analysis on the required characteristics of such a new model resulted in a community health worker (CHW) intervention – inspired by the Family Health System in Brazil and Re-engineering PHC in South Africa. We hypothesise that an outreaching PHC model with a CHW intervention will address the access-to-care challenges in Flanders, Belgium. We will first study the interplay over time between the different barriers PDAP experience throughout the access-to-care continuum in Flanders (WP 1). Secondly, we will investigate the innovative PHC models in South Africa and Brazil to develop the CHW intervention (WP2). In WP3, we will design a new outreaching PHC model which uses CHWs to improve access to care for PDAP in Flanders. In WPs 4 and 5, we will implement and evaluate the CHW intervention in a cluster randomised controlled trial. Finally, we will also assess the cost-effectiveness of the intervention (WP6). Throughout this work, academic experts from sociology, family medicine, and economics closely collaborate with committed societal stakeholders to join scientific insights and implementation knowhow, to optimise fit to practice and societal impact.

Researcher(s)

• Promoter: Bastiaens Hilde
• Co-promoter: Masquillier Caroline
• Co-promoter: van Olmen Josefien

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

South Africa has a high burden of severe mental disorders. The country promotes deinstitutionalisation for people living with a severe mental disorder (PSMD) – shifting the locus of care from hospitals to local communities. This push, however, has not been fit with an according care model in these communities. PSMD are discharged into households without any support – often resulting in a cyclical pattern of short-term readmissions to the hospitals that they have been discharged from, sometimes with devastating consequences. The project aims to build a research partnership between the Univ. of KwaZulu-Natal, the Univ. of Cape Town and the Univ. of Antwerp which will (1) exchange knowledge on the potential of households in health care, (2) strengthen the relationships with policy makers and (3) improve the curriculum of social work auxiliaries providing household support. The combination of these activities is aimed at enabling a research program to durably improve the well-being of PSMD using a household intervention – thereby stopping the revolving door syndrome and the devastating social/economic/health consequences it creates.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline
• Co-promoter: van Olmen Josefien

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Cambodia is confronted with a growing diabetes epidemic, translated in an increase of the prevalence of deaths attributable to this chronic disease by 42.9% between 2005 and 2016. The diabetes epidemic is projected to severely hamper the country's much needed developmental progress. The country's public health system has been primarily designed to tackle acute diseases and is therefore not capable of comprehensively addressing this public health problem. The proposed project intends to address this problem by joining forces with two local actors – NIPH and MoPoTsyo – to generate context-sensitive strategies to co-create comprehensive but context-specific diabetes care. More specifically, it aims to (1) investigate where current policies and strategies differ from the optimal WHO ICCC framework, and (2) see how these differences translate in suboptimal outcomes in diabetes management, and finally (3) develop roadmaps (together with the stakeholders) to overcome the shortcomings in the current approaches.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline
• Co-promoter: van Olmen Josefien

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Previous studies have clearly identified the population groups who experience difficulties in the access to primary health care (PHC) in Belgium, namely financially vulnerable individuals as well as individuals with low- educational attainment. The barriers to PHC are not only related to individual characteristics, but also to the organizational characteristics of primary healthcare. In order to overcome these barriers related to access to PHC, the Federal Government (FOD Volksgezondheid) has instigated a community health worker (CHW) project in Belgium in response to the COVID-19 pandemic. Aim of the CHW project is to improve access to primary healthcare for vulnerable groups in socially disadvantaged communities. This research project will assess this implementation of this CHW project by conducting in-depth qualitative research with the CHWs themselves, the recipients of the CHW support and the CHW supervisors.

Researcher(s)

• Promoter: Masquillier Caroline
• Co-promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The impact of an HIV infection on an individual's life, family and society is enormous. Worldwide major progress has been made in reducing AIDS related morbidity and mortality by treating HIV infected people with antiretroviral treatment (ART). ART reduces infectiousness, and hence transmission of HIV. However, prevention remains the most important challenge. HIV incidence has been stable or even increased among specific subpopulations such as men having sex with men (MSM) in Western Europe, despite access to ART. An innovative response to further reduce HIV infections is urgently needed, including the development and evaluation of new tools, as well as better tailoring of approaches to key populations. Pre-exposure prophylaxis (PrEP) is such a novel prevention tool, involving ART given to uninfected persons to block HIv HIV transmission. Oral PrEP, mostly used as Truvada (containing Emtricitabine and Tenofovir), has been shown to be efficacious in 11 clinical trials, in different populations and geographical areas. The overall aim of this project is to learn how PrEP roll out can be optimized to result in maximum impact on HIV and sexual health. This question will be addressed looking at 4 interrelated themes each including research objectives (ROs): Among community of MSM (WP 1): RO 1.1 Assess the number of MSM eligible for PrEP in Flanders RO 1.2 Examine whether PrEP is reaching the right MSM – those most at risk – in Flanders RO 1.3 Explore the impact of PrEP on the sexual culture and health of MSM in Flanders Among community of Sub-Saharan African Migrants (WP 2): RO 2.1 To identify and estimate the proportion of eligible PrEP users within the SAM communities RO 2.2 To explore perceived community barriers and facilitators for PrEP acceptability and feasibility RO 2.3 To explore perceived individual barriers and facilitators for potential and actual PrEP use Among users (WP 3): RO 3.1 To differentiate patterns of PrEP use and sexual risk behaviour among PrEP users in Flanders RO 3.2 To describe differences in PrEP care needs among users RO 3.3 To document the frequency and associated factors of syndemics among PrEP Among providers (WP 4): RO 4.1 Describe (barriers to) PrEP care in Belgium RO 4.2 Inventory interventions that could address the most prevalent syndemics among PrEP users RO 4.3 Explore GPs' attitudes towards PrEP and their self-perceived roles in PrEP care. RO 4.4 Inform the development of a model for self-managed PrEP care.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

7 million patients living with HIV, overcrowded waiting rooms, lack of doctors. That is the hard reality of the South African healthcare. The government struggles with the question in which way to care for the growing group of patients living with HIV. Therefore, they summon the help of thousands of community health workers. Despite the success of the ART programme, South Africa is still faced with both prevention and treatment challenges. To tackle the remaining challenges, future endeavours need to focus on the search for additional human resources between the (I) community and (II) PLWH themselves, namely PLWH's household. To better understand, the potential role of the household as a health-enabling context for people living with HIV (PLWH), i.e. HIV competent households, longitudinal in-depth interviews with the selected PLWH and household members will be conducted at various time points.

Researcher(s)

• Promoter: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

This project evaluates activities for the promotion of sexual health of sub-Saharan African migrants (SAM) in Flanders. Based on the results of the document-analysis and the qualitative research (key informant interview and focus group discussions), the research team will formulate recommendations for future activities for SAM.

Researcher(s)

• Promoter: Masquillier Caroline
• Co-promoter: Wouters Edwin

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The response to the HIV epidemic in South Africa is complicated by human resource shortages in healthcare. Building health-enabling households with the capacity to actively stimulate a lifestyle that fosters health offers a potential strategy to tackle South Africa's current prevention and treatment challenges. Research is thus urgently needed on how to create 'HIV competent households', which adopt preventive strategies and help HIV positive members to adhere to treatment and remain in care. Aim of this post-doctoral research is to investigate to what extent and how a household intervention can: (1) increase HIV competence in people living with HIV (PLWH) and their households, and subsequently (2) improve prevention (PLWH + household) and treatment (PLWH) outcomes. Methodologically, this study adopts a longitudinal mixed methods design. To respond to our quantitative research aims, data from the cluster randomized controlled trial, the "HIV competent Household" (HCH) study, will be analysed, using latent cross-lagged modelling. To construct a comprehensive picture of the mechanisms underlying the impact of the intervention on the household and the PLWH, various qualitative data sources will be used (i.e., participatory observations and repeated in-depth interviews with PLWH; and their household members).

Researcher(s)

• Promoter: Wouters Edwin
• Fellow: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

The HIV epidemic is putting a massive burden on South Africa's health system. Given the shortage of human resources for health, community health worker (CHW) support is cited as an integral part of a sustainable antiretroviral treatment (ART) strategy. Evidence supports the potential of CHW involvement but demonstrates large variability in its effective-ness. Work by this research team demonstrated that this variability can be largely explained by the household context – CHW support stimulates ART success in HIV competent households but does not work in less competent households. This proposal aims to build on this knowledge by developing and testing – in a cluster randomized controlled trial – a household intervention to (1) stimulate HIV competence levels and create HIV competent households, and thus (2) opti-mize the impact of CHW support on individual ART outcomes. With the activities outlined, the TEAM project will (1) build new knowledge and skills at the South partner in order to (2) develop an evidence-based, feasible and sustainable strat-egy to optimize the outcomes in vulnerable contexts where this knowledge is needed most.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Approximately 13% of the Ugandan children are living with some form of disability. Promoting inclusive societies for children living with a disability has been recognized to be the cornerstone of disability policies in the international, but also in the Ugandan context. However, previous research has demonstrated that when it comes to implementing such inclusive programs and allocating adequate resources many African countries, such as Uganda, lag behind. Based on the literature review we are currently undertaking, there is a clear research need to investigate how children are included in different activities in the Ugandan society. Therefore this research project aims to investigate (1) the mechanisms by which children with a disability are included in education, rehabilitation, cultural and recreational activities in the Ugandan society; (2) which barriers impede inclusion of children with disability? As research is needed which is undertaken in collaboration with disabled children and their parents, photo elicitation will be used to answer our research questions. Fieldwork will be conducted in collaboration with researchers from Makerere University. Respondents will be recruited in collaboration with the Angel's Centre, which is a non-governmental organization, located in Wakiso district, in the central region of Uganda. This project proposal is both relevant for academic and policy purposes. For academic research, and research that feeds into policy change, this research has the potential to plug a gap in the understanding of social inclusion of children with a disability and its barriers in resource limited settings. This pilot project will not only result in academic publications and presentations, but also in new project proposals. Based on the lessons learned from this innovative pilot project, future research grant applications will be submitted aiming to build a new line of research.

Researcher(s)

• Promoter: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Both the growing group of patients living with HIV/AIDS (PLWHA) and/or TB and their encompassing care needs, place pressure on an already stretched health care system in South Africa. To provide in such a resource constrained context, additional care that patients need in order to durably comply with treatment guidelines, community support is mobilised within the framework of task-shifting. The mobilization of the community, moves support closer to the PLWHA and his/her social environment. Inspired by the socio-ecological theory, the interrelatedness and interdependency between individuals and their immediate social context in which they live should be taking into account. To date, interventions largely ignore the social context in which they are implemented. Consequently, research is required to investigate community based support within its contextual reality. This project aims to address these limitations of previous research by answering the following research question: how do the patient's household dynamics hamper or facilitate the impact of community based treatment adherence support programs on the patient? Respondents of the qualitative data collection will be involved in 'respondent validation' to enhance the quality of our data. The researcher's understanding of data collected in the studied social setting will be tested to the perception of the members of that setting, who were the source of information, resulting in cultural sensitive academic output and context specific policy recommendations.

Researcher(s)

• Promoter: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Background: Although the initial outcomes of the South African public antiretroviral treatment (ART) programme are promising, there are still important challenges to be met to successfully fight the HIV/AIDS epidemic in the long term, namely (1) HIV/AIDS care as chronic disease care requires psychosocial care on top of biomedical care to ensure long-term adherence and patient retention and (2) HIV incidence levels need to drop by positively altering the knowledge, attitudes and practices towards HIV/AIDS. Mobilizing and enabling local families and communities – to develop supportive and healthy behavior – is increasingly cited as a potential strategy to address the above-cited challenges. Ample recent studies have pointed to the need for scientific research on the factors positively impacting on the knowledge, attitudes and practices of local families towards HIV/AIDS – i.e. the AIDS competence – in order to develop interventions combating the remaining challenges in the fight against HIV/AIDS Research objectives: The overall objective of the proposed project is to develop an intervention to build health-enabling families which can fight the HIV/AIDS-epidemic in a sustainable manner. The current study aims to optimally employ the knowledge and experience of HIV/AIDS patients who initiated ART as catalysts of the spread of AIDS competence in local families and communities. Our hypothesis is that public-sector ART, with its associated treatment knowledge and experiences can over time be translated into the positive attitudinal and behavior changes – henceforth called AIDS competence – necessary to successfully and sustainably combat HIV/AIDS at the family level. Methods: The proposed study uses an explanatory mixed methods research design, within which the quantitative data from the existing Effective Aids Treatment and Support in the Free State (FEATS) cohort study (n = 2168) will be used to inform more in-depth longitudinal qualitative work. First, structural equation modeling techniques will be used to explore the relationships between various personal and family characteristics and AIDS competence over time. Special attention will be given to the mediating role of family functioning in facilitating the diffusion of AIDS competence to family members. Secondly, 50 positive deviant cases (i.e. households where positive changes in key knowledge, attitudes and behaviors were observed over time) and 50 negative deviant cases (i.e. households where no or negative changes in key knowledge, attitudes and behaviors were observed over time) will be identified with the aid of statistical analyses of the quantitative FEATS data. These cases will form the basis for further qualitative investigation into the nature and determinants of AIDS competence in positive and negative deviant cases. Four rounds of three-monthly in-depth interviews will be conducted with 100 families to fully disentangle the complex interrelationships between HIV/AIDS and ART on the one hand, and the associated AIDS competent knowledge, attitudes and behaviors at the family level. Expected outcomes: The proposed study can have both theoretical and practical implications. Theoretically, this is the first study to longitudinally study the complex interrelationships between public-sector ART, family dynamics and AIDS competence. The mixed-methods design will produce potentially valuable insights into the pathways through with AIDS competence is spread. Practically, the research project aims to optimally capitalize on the benefits of the public-sector ART programme by identifying good practices and developing interventions through which the positive ART experiences and associated AIDS knowledge can be translated into higher levels of AIDS competence at the family level.

Researcher(s)

• Promoter: Wouters Edwin
• Fellow: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

This PhD project aims to address both aforementioned limitations by developing an extended multidimensional conceptualisation of child vulnerability. Subsequently, the concept will be measured empirically using confirmatory factor analysis. Recent data from 33 Sub-Saharan African countries will be used to accomplish this measurement model. Factors that affect vulnerability outcomes for children will be determined by developing a structural model. Both models allow to investigate child vulnerability while accounting for its multidimensionality and latent nature. Lastly, the construct will be tested on its stability over time.

Researcher(s)

• Promoter: Mortelmans Dimitri
• Co-promoter: Wouters Edwin
• Fellow: Masquillier Caroline

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project