Research team

Centre for Population, Family and Health

Expertise

Caroline Masquillier has been working as a sociologist at the University of Antwerp, Belgium, for several years in collaboration with African partners. Her main research interests are related to the sociology of health and illness and she is particularly interested in the social aspects of the HIV/AIDS epidemic in Sub-Saharan Africa. For her PhD research she received the Prize of the Scientific Foundation of the Royal Flemish Academy of Science and Arts (http://www.kvab.be/prijzen/prijs-van-de-vlaamse-wetenschappelijke-stichting). During her PhD research, she conducted fieldwork in townships on the outskirts of Cape Town, South Africa, in order to shed light on the role of household dynamics in community-based HIV care. Furthermore, she conducted a Photovoice study on social inclusion of children with special needs in Uganda. Currently, she is a FWO post-doc fellow at the University of Antwerp (Center for Population, Family and Health). During this post-doc fellowship, she is performing a cluster randomized controlled trial on an HIV household Competent intervention for people living with HIV in South Africa together with partners of the University of the Western Cape. As a passion project, she is starting up Field. This creative science communication platform helps scientists of all domains to communicate their research results and the value of their work in an engaging and creative way. For her project Field., Caroline received a Vocatio prize in 2017 (http://www.vocatio.be/nl/laureats/caroline-masquillier/) and the year Prize for Science Communication of the Scientific Foundation of the Royal Flemish Academy of Science and Arts in 2018.

Qualitative in-depth research to assess a new community health worker project in Belgium 15/03/2021 - 15/02/2022

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.

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Optimise Prep to maximise impact (PROMISE). 01/01/2019 - 31/12/2022

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.

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Capacity building for optimizing primary care and community initiatives for Type II Diabetes in Cambodja. 01/01/2019 - 31/12/2022

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.

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Building HIV competent households: A sustainable answer to HIV prevention and treatment challenges in South Africa. 01/10/2018 - 30/09/2021

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).

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Bridging the gap: an intervention to capitalize on the intermediate role of the households in community support for HIV care. 01/01/2018 - 31/12/2021

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.

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HIV competent households as a sustainable answer to HIV prevention and treatment challenges in South Africa: longitudinal qualitative research. 01/01/2019 - 31/12/2020

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.

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Evaluation of activities related to sexual health of Sub-Saharan African Migrants 20/12/2018 - 31/10/2019

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.

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Social Inclusion Of Children With Special Needs In Uganda – A Photovoice Study. 01/04/2017 - 31/03/2018

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.

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Bringing care closer to the community: on the road with community health workers providing treatment adherence support for patients living with HIV/AIDS in a township on the outskirts of Cape Town, South Africa. 26/11/2015 - 31/12/2016

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.

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Antiretroviral treatment as catalyst for achieving AIDS competence in local South African communities: developing a multidimensional intervention to combat the HIV/AIDS epidemic. 01/10/2012 - 30/09/2016

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.

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The concept of "child vulnerability" in Sub-Saharan Africa. A theoretical study with empirical validation. 01/10/2011 - 30/09/2012

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.

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