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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Scale Up an integrated care package for diabetes and hypertension for vulnerable people in Cambodia, Slovenia and Belgium (SCUBY). 01/01/2019 - 30/06/2023

Abstract

Background: Diabetes and hypertension are increasingly dominant in the global burden of disease. Effective interventions for prevention, detection, treatment and control of both conditions are available, but do not reach all people in need. Countries are struggling how to scale-up interventions sustainably and effectively. There is an urgent need to develop and document strategies on how to do so. Method: This project examines the scale-up of existing evidence-based packages for control of diabetes and/or hypertension with five components: (a) identification of people with hypertension and/or type 2 diabetes and (b) treatment in primary care services, (c) health education and (d) self-management support to patients and caregivers, and (e) collaboration among caregivers. The project develops, implements and evaluates roadmaps for the national scale-up of this package, in three different types of countries: a low-middle income country with a developing health system (Cambodia), a former socialist country with a centralised health system (Slovenia), and a Western European country with a decentralised system (Belgium). The research objectives are: 1) to analyse the organisational capacity to scale-up the integrated care package and to assess contextual barriers and facilitators; 2) to develop and implement roadmaps for a national scale-up strategy in each country; 3) to evaluate the impact of scale-up on health outcomes and costs; and 4) to generate lessons for other countries. Outcomes: The project will result in comprehensive scale-up strategies and increased diabetes and hypertension control in each country. The involvement of policy-makers, professionals and patients will ensure the local relevance and impact. The project is innovative in applying the conceptual insights from scale-up science to the field of noncommunicable diseases. The lessons on scale-up will benefit policy-makers in other countries with similar contexts.

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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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Research team(s)

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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Identifying the motivational mechanisms that determine Type 2 Diabetes self-management in socio-economically disadvantaged populations 01/10/2018 - 30/09/2022

Abstract

The burden of chronic diseases including type two diabetes mellitus (T2D) is increasing rapidly, especially in low- and middle-income countries. In high-income countries, evidence shows that T2D disproportionally affects socio-economically disadvantaged and vulnerable populations, which makes it an important contributor to inequality. Self-management is an essential and effective strategy for people with T2D, but is poorly adopted in vulnerable groups and low-resource settings. Research on self-management support interventions has been focused on the general population of high-income countries, ignoring the populations that need it the most. The objective of this study is to identify the motivational mechanisms that determine self-management outcomes in vulnerable and socio-economic disadvantaged populations living in suburbs in Sweden, an urban slum in South-Africa, and a rural area in Uganda. The study is based on self-determination theory and hypothesizes that higher intrinsic motivation leads to better self-management which will improve physical and psychological outcomes. Moreover, increase of intrinsic motivation happens through fulfillment of the basic psychological needs which are perceived autonomy, competence and relatedness. In the same framework, we hypothesize that higher psychological adjustment – which refers to the absence of mental distress and the ability to cope with change – leads to better self-management and related outcomes. The study builds on an ongoing cluster-randomized experimental trial evaluating the effectiveness of a context-appropriate community intervention to enhance self-management for people with T2D called SMART2D. The aim of this new proposal is to identify the motivational mechanisms that explain the effect of the intervention in the SMART2D trial. More specifically, this new proposal will assess the mediating role of perceived autonomy, perceived relatedness, perceived competence, intrinsic motivation, and psychological adjustment. Quantitative data on these psychological factors will be collected through the SMART2D project. To determine the mediating effect of these latent variables, a structural equation model will be developed and tested. We will use multi-group structural equation modelling to test the model across the three different sites. This new project will also collect additional qualitative data through semi-structural interviews with the people at risk for or with T2D to further explain the differences across the three study settings. This study will inform us on how self-management support interventions need to be developed when targeting populations in disadvantaged or under-resourced areas, in order to make care more equal and inclusive.

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The misuse of prescription stimulants as cognitive enhancers among Flemish university and college students: the process of prescribing, supplying and acquiring. 01/10/2018 - 30/09/2021

Abstract

The university or college experience is often viewed as a time of transition, experimentation and risk-taking, especially with regard to substance misuse. While there has been an abundance of research on alcohol and marijuana misuse, other areas of this research field remain relatively unexplored, in particular the scientific knowledge on the misuse of prescription stimulants – generally prescribed to treat Attention Deficit (Hyperactivity) Disorders (AD(H)D) – by students as a means for performance enhancement. Exploratory research in Flanders reported a prevalence of up to 10% of Flemish students using prescription stimulants during the exams, resulting in considerable attention in the news media. However, there is a clear dearth in scientific knowledge on (1) which student groups are vulnerable to such drug misuse and why they misuse these stimulants (demand side) and (2) how these students access the prescription drugs (supply side). The proposed study aims to fill these research gaps and generate scientific knowledge on stimulant misuse in Flanders. From a theoretical point of view, a comprehensive theoretical model, the theory of triadic influence, will be used to disentangle the complex mechanisms through which the decision to misuse ADHD drugs can be explained. From a methodological point of view a comprehensive mixed-methods research design will be used focusing on three vital stakeholders: students, general practitioners and pharmacists.

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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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Households in HIV care: developing and testing an intervention to capitalize on the intermediate role of the household in community support for chronic HIV care. 01/01/2018 - 31/12/2021

Abstract

With 7 million South Africans currently infected with HIV and 3.5 million currently receiving lifesaving antiretroviral treatment (ART), the epidemic is putting a massive burden on the country's health system. Given the severe shortage of human resources in the healthcare sector, community health worker (CHW) support is being increasingly cited as an integral part of a sustainable ART strategy. Recent review studies support the potential of CHW involvement but also signal the large variability in the effectiveness of such support. Previous work by the current research team demonstrated that this variability can be largely explained by the household context in which the CHWs are active – demonstrating that CHW support stimulates ART adherence in HIV competent households but does not work in less competent households. The current FWO projct aims to build on this knowledge by developing and testing – in a cluster randomized controlled trial – an evidence-based household intervention to (1) stimulate HIV competence levels and create HIV competent households, and thus (2) optimize the impact of CHW support on individual ART outcomes. The resulting knowledge could potentially be a game changer for HIV treatment interventions in resource-limited settings as stimulating HIV competence at the household level could be a feasible and sustainable strategy to optimize the outcomes of these CHW interventions in a vulnerable context where this knowledge in needed most.

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Research team(s)

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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Research team(s)

For better health in university and college students: pin-pointing the interplay between social support, study stress, substance use and mental health across different study programs. 01/10/2017 - 30/09/2021

Abstract

Background: In contemporary Belgium, the university or college experience has become an important transitional period in the life course. Culturally, these years are viewed as a time of transition, experimentation and risk-taking. This transitional period in life is not without risk: increasing attention – especially in the United States – is given to the elevated stress levels that university and college students experience, which can be linked to increased substance use and mental health problems. However, little is known about the interrelationships between study stress, substance use and mental health among the Flemish student population – stressing the need for research on this relevant student health problem. In addition, students do not live and study in a social vacuum: they are surrounded by peers and embedded in study programs. This context can potentially alter the interrelationships between study stress, substance use and mental health problems: (1) social support as a potential buffer and (2) the characteristics of the study program as a driver for inter-study-program variance. Little is however known on the impact of these social and organizational factors on the described interrelationships. Objectives: The present BOF DOCPRO Bonus-project aims to address these shortcomings by examining the impact of student stress on both mental health problems and substance misuse, mediated by the on- and off-line social support available to the student and across different study programs. Methods: More specifically, we will (1) study the interrelationships between study stress, the use of three substances (stimulants, prescription sleeping pills and cannabis) and mental health problems using the 2017 Head in the Clouds dataset (expected n = approx. 20.000). (2) We will use Structural Equation Modelling to test which theoretical model best mimics the role of on- and off-line support in these interrelationships: a direct effect, an indirect effect (via study stress) or a buffer effect (impacting on the path between stress and substance use/mental health). (3) We will employ multiple group SEM to assess how these relationships differ across the different study programs: do differing levels of knowledge and competition impact on these interrelationships? The two latter research questions will be addressed using a newly gathered dataset among the students of the Association University and Colleges of Antwerp. Expected outcomes: The proposed study can have both theoretical and practical implications. Theoretically, it is the first study to explore the complex mechanisms underlying substance use and mental health problems among a large student population – with special attention for the role of social and organizational determinants. Practically, the resulting scientific knowledge potentially enables according effective preventative interventions to help students channel study stress and avoid detrimental health choices and mental health problems.

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Research team(s)

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.

Researcher(s)

Research team(s)

The misuse of prescription stimulants as cognitive enhancers among Flemish university and college students: the process of prescribing, supplying and acquiring. 01/10/2016 - 01/12/2018

Abstract

The university or college experience is often viewed as a time of transition, experimentation and risk-taking, especially with regard to substance misuse. While there has been an abundance of research on alcohol and marijuana misuse, other areas of this research field remain relatively unexplored, in particular the scientific knowledge on the misuse of prescription stimulants – generally prescribed to treat Attention Deficit (Hyperactivity) Disorders (AD(H)D) – by students as a means for performance enhancement. Exploratory research in Flanders reported a prevalence of up to 10% of Flemish students using prescription stimulants during the exams, resulting in considerable attention in the news media. However, there is a clear dearth in scientific knowledge on (1) which student groups are vulnerable to such drug misuse and why they misuse these stimulants (demand side) and (2) how these students access the prescription drugs (supply side). The proposed study aims to fill these research gaps and generate scientific knowledge on stimulant misuse in Flanders. From a theoretical point of view, a comprehensive theoretical model, the theory of triadic influence, will be used to disentangle the complex mechanisms through which the decision to misuse ADHD drugs can be explained. From a methodological point of view a comprehensive mixed-methods research design will be used focusing on three vital stakeholders: students, general practitioners and pharmacists.

Researcher(s)

Research team(s)

Towards a health-enabling working environment: developing and testing interventions to decrease HIV- and TB-stigma among healthcare workers in the Free State Province, South Africa. 01/01/2016 - 31/12/2019

Abstract

In the context of a devastating HIV/AIDS-TB co-epidemic and severe human resource shortages in the South African health sector, HIV- and TB-related stigmatization among the healthcare workforce does not only threaten the workforce's own health but also the health of the broader population visiting the health facilities. As a response, the proposed DOCPRO BOF-project aims to (1) scientifically assess the extent and sources of HIV- and TB-related stigma among the healthcare workforce as well as (2) develop and (3) test evidence-based stigma-reduction interventions in randomly selected public hospitals in the Free State Province of South Africa. A cluster randomized controlled trial (RCT) in 8 hospitals (a minimum of 584 respondents in 4 intervention and 4 control sites) in the Free State province of South Africa will be employed to address these research questions and optimally assess the net impact of the developed interventions. Several factors favor the successful completion of the proposed research activities, namely (1) the innovative character of the project and its solid research design, (2) the availability of sufficient VLIR-UOS funding to roll-out the proposed RCT in South Africa, (3) the stable, long-term research collaboration between the Southern and Northern partner, and (4) the unique opportunity for a Belgian PhD-student to optimally capitalize on the rich dataset gathered in such a large, international research project.

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Research team(s)

The impact of changing family dynamics on intergenerational solidarity 01/01/2016 - 31/12/2019

Abstract

The generations approaching retirement age have witnessed a double shift in family behaviours: a breakdown of traditional patterns of family formation, and an even larger diversity of families among their adult children. This project measures the impact of these increasingly complex lifecourses on intergenerational solidarity within families and look at upward (personal care) and downward (childcare) solidarity and the intervening role of health.

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Research team(s)

Systematic literature review of strategies to reduce TB stigma. 18/11/2015 - 01/09/2016

Abstract

Setting: While substantial progress is made in tuberculosis (TB) control, the success of public health efforts is hampered by pervasive stigma. Objective: We performed a systematic literature review to assess the effectiveness of interventions aimed at reducing TB stigma in patients, healthcare workers, caregivers and the general community. Design: Studies were eligible for inclusion if they evaluated interventions aimed at reducing TB stigma and were published between 1950-2015. We searched eight databases (Pubmed, Cochrane Library, Ovid, Embase, PsycInfo, Sociological Abstracts, CNHA and LILACS WHO) and complemented the searches by using the snowball strategy and review of relevant gray literature (WHO, STOP TB partnership, STOP TB USA, TB CDC, KNCV and the UNION conference on Tuberculosis and Lung Disease).

Researcher(s)

Research team(s)

Towards a health-enabling working environment: developing and testing interventions to decrease HIV- and TB-stigma among healthcare workers in the Free State Province, South Africa. 01/10/2015 - 30/09/2019

Abstract

In the context of a devastating HIV/AIDS-TB co-epidemic and severe human resource shortages in the South African health sector, HIV- and TB-related stigmatization among the healthcare workforce does not only threaten the workforce's own health but also the health of the broader population visiting the health facilities. In the context of a devastating HIV/AIDS-TB co-epidemic and severe human resource shortages in the South African health sector, HIV- and TB-related stigmatization among the healthcare workforce does not only threaten the workforce's own health but also the health of the broader population visiting the health facilities. As a response, the proposed DOCPRO BOF-project aims to (1) scientifically assess the extent and sources of HIV and TB-related stigma among the healthcare workforce as well as (2) develop and (3) test evidence-based stigma-reduction interventions in randomly selected public hospitals in the Free State Province of South Africa. A cluster randomized controlled trial (RCT) in 8 hospitals (a minimum of 584 respondents in 4 intervention (347 respondents) and 4 control (237 respondents) sites) in the Free State province of South Africa will be employed to address these research questions and optimally assess the net impact of the developed interventions. Several factors favour the successful completion of the proposed research activities and the envisioned PhD, namely (1) the innovative character of the project and its solid research design (a cluster RCT), (2) the availability of sufficient VLIR-UOS funding to roll-out the proposed RCT in South Africa, (3) the stable, long-term research collaboration between the Southern and Northern partner – Prof. Edwin Wouters is officially appointed as a senior research associate of the Centre for Health Systems Research & Development in South Africa – and (4) the unique opportunity for a Belgian student to optimally capitalize on the rich dataset gathered in such a large-scale, international research project.

Researcher(s)

Research team(s)

Towards a health-enabling working environment: developing and testing interventions to decrease HIV- and TB-stigma among healthcare workers in the Free State Province, South Africa. 10/04/2015 - 31/12/2018

Abstract

In the context of a devastating HIV/AIDS-TB co-epidemic and severe human resource shortages in the health sector, HIV- and TB-related stigmatization among the healthcare workforce does not only threaten the workforce's own health but also the health of the broader population visiting the health facilities. As a response, the proposed TEAM project aims to (1) scientifically assess the extent and sources of HIV & TB stigma among the healthcare workforce and (2) refine and test innovative stigma-reduction interventions in randomly selected public health sites in the Free State Province of South Africa.

Researcher(s)

Research team(s)

Popping smart pills: prescription stimulant misuse by university and college students in Flanders. 01/01/2015 - 30/09/2016

Abstract

Background: From a large-scale survey among Flemish university and college students, it is known that a substantial part of these students (almost 7%) use stimulant drugs – mainly methylphenidates, such as Ritalin®, prescribed to treat ADHD – as a means for performance enhancement. Apart from the question of unfair competition during the exams, the misuse of prescription stimulants can also have detrimental psychological and physical health effects, rendering it a research priority. Although we have a view on the prevalence of the prescription stimulant misuse by students, almost nothing is known about the characteristics of these users, its impact on students' physical and mental well-being, and the sociological and psycho-social motives to misuse stimulants. In addition, there is a dearth of knowledge on the supply side of this public health problem. Research Objectives: The proposed study aims to fill the above-cited research gaps and generate scientific knowledge on the misuse of methylphenidates in Flanders using an innovative, comprehensive research design. In particular, the proposed research program aims to study (1) which students groups misuse these stimulants as well as the subsequent impact of this use on their well-being, (2) why these students perform this behavior and (3) how these students access the prescription drugs. Methods: The study uses an exploratory mixed methods research design comprising three phases, each addressing an above-cited research objective. Firstly, the available dataset from the quantitative survey among Flemish university and college students (n = 18,000) will be employed to identify the user population and measure their well-being (1). Secondly, a more focused quantitative and qualitative data gathering will be executed to identify the mechanisms underlying the misuse by testing two alternative conceptual models described in the literature (2). Finally, a web-survey among medical doctors and pharmacists will be employed to create scientific knowledge on the supply system of the research issue (3). Expected outcomes: The proposed study can have both theoretical and practical implications. Theoretically, it is the first study to explore the complex mechanisms underlying stimulant drug use among a large student population. Practically, the resulting scientific knowledge potentially enables according effective preventative interventions to steer students away from these detrimental health choices.

Researcher(s)

Research team(s)

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.

Researcher(s)

Research team(s)

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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Research team(s)

From biographical disruption to biographical construction of a hybrid identity: a qualitative study of the impact of antiretroviral treatment on the life of HIV/AIDS-patients in South Africa. 01/01/2011 - 31/12/2013

Abstract

To gain a more profound understanding of the intrinsic dynamics (why) and processes (how) by which social factors positively or negatively affect the creation of the new identity as a chronic HIV/AIDS patient on ART, additional qualitative data is needed. The general aim is therefore to undertake a qualitative sociological study ¿ interviewing 120 HIV/AIDS patients on ART in the Free State Province of South Africa ¿ of this transition to life as a chronic HIV/AIDS patient.

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Research team(s)

The hybrid identity of the HIV/AIDS patient: a qualitative study of the impact of antiretroviral treatment on the lives of HIV/AIDS patients in South Africa 01/01/2010 - 31/12/2011

Abstract

Antiretroviral treatment has transformed AIDS from an acute, degenerative disease into a chronic - albeit incurable - illness. Hence, the illness is not an external assault on the body, but an internal one, becoming part of the patient's identity as a 'chronic HIV/AIDS patient'. This research project aims to assess the mechanisms through which the illness and the associated treatment influence the lives and the identity of the patients.

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Research team(s)

The hybrid identity of the HIV/AIDS-patient: a longitudinal study of the impact of antiretroviral treatment on the life of HIV/AIDS-patients in sub-Saharan Africa. 01/10/2009 - 31/08/2011

Abstract

The general research aim is to undertake a sociological study of the impact of HIV/AIDS and the associated ART on the lives of those affected and more specifically on the identity reconstruction of HIV/AIDS patients receiving ART in sub-Saharan Africa. This research views ART not only as the turning point in the treatment of an 'ill body', detached from the social reality, but also as a turning point in the experience of AIDS as a chronic illness, embedded in this social reality. The study will attempt to draw an overall picture of the HIV/AIDS patient receiving ART as a 'social entity' with a chronic illness, and his/her consequent place and role in society. In practice, we will study the factors that positively affect the possibility of a successful treatment and the associated identity reconstruction.

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Research team(s)

AIDS, the lonely death? The importance of social capital in the implementation of antiretroviral treatment in the public sector in South Africa. 01/10/2007 - 30/09/2009

Abstract

The research aims to discern the different dimensions of the quality of life (QoL) in AIDS patients. The notion of QoL should be understood in the broadest sense possible. In accordance with standardized scales, physical functioning as well as mental, social and role functioning and the capacities to mobilize social capital and social support networks are included in the measurement of QoL. The different dimensions of QoL in AIDS patients and the factors influencing them will be analyzed on the base of data from approximately 400 South-African AIDS patients. Special attention will be given to the influence of their antiretroviral treatment. In the research the conceptualization of the dimensions and dynamics of the quality of life in AIDS patients in South Africa is the core interest. Executed in co-operation with the Centre for Health Systems Research and Development (CHSR&D), University of the Free State (UFS), Bloemfontein, South Africa.

Researcher(s)

Research team(s)

AIDS, the lonely death? The importance of social capital in the implementation of antiretroviral treatment in the public sector in South Africa. 01/10/2005 - 30/09/2007

Abstract

The research aims to discern the different dimensions of the quality of life (QoL) in AIDS patients. The notion of QoL should be understood in the broadest sense possible. In accordance with standardized scales, physical functioning as well as mental, social and role functioning and the capacities to mobilize social capital and social support networks are included in the measurement of QoL. The different dimensions of QoL in AIDS patients and the factors influencing them will be analyzed on the base of data from approximately 400 South-African AIDS patients. Special attention will be given to the influence of their antiretroviral treatment. In the research the conceptualization of the dimensions and dynamics of the quality of life in AIDS patients in South Africa is the core interest. Executed in co-operation with the Centre for Health Systems Research and Development (CHSR&D), University of the Free State (UFS), Bloemfontein, South Africa.

Researcher(s)

Research team(s)