Who Should We Target? The Impact of Individual and Family Characteristics on the Expressed Need for Community-Based Treatment Support in HIV Patients in South Africa
Identifieur interne : 002919 ( Pmc/Curation ); précédent : 002918; suivant : 002920Who Should We Target? The Impact of Individual and Family Characteristics on the Expressed Need for Community-Based Treatment Support in HIV Patients in South Africa
Auteurs : Edwin Wouters [Belgique, Afrique du Sud] ; Frederik Le Roux Booysen [Afrique du Sud] ; Caroline Masquillier [Belgique]Source :
- PLoS ONE [ 1932-6203 ] ; 2016.
Abstract
Reviews of impact evaluations of community-based health workers and peer support groups highlight the considerable variability in the effectiveness of such support in improving antiretroviral treatment (ART) outcomes. Evidence indicates that community-based support interventions targeting patients known to be at risk will probably display better results than generic interventions aimed at the entire population of people living with HIV. It is however difficult to identify these at-risk populations, rendering knowledge on the characteristics of patients groups who are in need of community-based support a clear research priority. The current study aims to address the knowledge gap by exploring the predictors of the willingness to (1) receive the support from a community-based health worker or (2) to participate in a support group in public sector ART programme of the Free State Province of South Africa. Based on the Individual-Family-Community framework for HIV research, the study employs a comprehensive approach by not only testing classical individual-level but also family-level predictors of the willingness to receive community-based support. In addition to individual-level predictors—such as age, health status and coping styles—our analysis demonstrated the importance of family characteristics. The results indicated that discrepancies in the family’s changeability level were an important predictor of the demand for community-based support services. Conversely, the findings indicated that patients living in a family more flexible than deemed ideal are more likely to require the support of a community health worker. The current study expands theory by indicating the need to acknowledge all social ecological levels in the study of chronic HIV care. The detection of both individual level and family level determinants of the expressed need for community-based support can inform health policy to devise strategies to target scarce resources to those vulnerable patients who report the greatest need for this support. In this way, the study results are a first step in an attempt to move away from generic, broad based community-based interventions towards community support that is tailored to the patient needs at both the individual and family level.
Url:
DOI: 10.1371/journal.pone.0163963
PubMed: 27741239
PubMed Central: 5065171
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The Impact of Individual and Family Characteristics on the Expressed Need for Community-Based Treatment Support in HIV Patients in South Africa</title><author><name sortKey="Wouters, Edwin" sort="Wouters, Edwin" uniqKey="Wouters E" first="Edwin" last="Wouters">Edwin Wouters</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Sociology and Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium</addr-line></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Sociology and Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, Republic of South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Health Systems Research and Development, University of the Free State, Bloemfontein</wicri:regionArea></affiliation></author><author><name sortKey="Booysen, Frederik Le Roux" sort="Booysen, Frederik Le Roux" uniqKey="Booysen F" first="Frederik Le Roux" last="Booysen">Frederik Le Roux Booysen</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Department of Economics, University of the Free State, Bloemfontein, Republic of South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Economics, University of the Free State, Bloemfontein</wicri:regionArea></affiliation></author><author><name sortKey="Masquillier, Caroline" sort="Masquillier, Caroline" uniqKey="Masquillier C" first="Caroline" last="Masquillier">Caroline Masquillier</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Sociology and Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium</addr-line></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Sociology and Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27741239</idno><idno type="pmc">5065171</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065171</idno><idno type="RBID">PMC:5065171</idno><idno type="doi">10.1371/journal.pone.0163963</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002920</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002920</idno><idno type="wicri:Area/Pmc/Curation">002919</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002919</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Who Should We Target? The Impact of Individual and Family Characteristics on the Expressed Need for Community-Based Treatment Support in HIV Patients in South Africa</title><author><name sortKey="Wouters, Edwin" sort="Wouters, Edwin" uniqKey="Wouters E" first="Edwin" last="Wouters">Edwin Wouters</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Sociology and Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium</addr-line></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Sociology and Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, Republic of South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Health Systems Research and Development, University of the Free State, Bloemfontein</wicri:regionArea></affiliation></author><author><name sortKey="Booysen, Frederik Le Roux" sort="Booysen, Frederik Le Roux" uniqKey="Booysen F" first="Frederik Le Roux" last="Booysen">Frederik Le Roux Booysen</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Department of Economics, University of the Free State, Bloemfontein, Republic of South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Economics, University of the Free State, Bloemfontein</wicri:regionArea></affiliation></author><author><name sortKey="Masquillier, Caroline" sort="Masquillier, Caroline" uniqKey="Masquillier C" first="Caroline" last="Masquillier">Caroline Masquillier</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Sociology and Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium</addr-line></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Sociology and Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Reviews of impact evaluations of community-based health workers and peer support groups highlight the considerable variability in the effectiveness of such support in improving antiretroviral treatment (ART) outcomes. Evidence indicates that community-based support interventions targeting patients known to be at risk will probably display better results than generic interventions aimed at the entire population of people living with HIV. It is however difficult to identify these at-risk populations, rendering knowledge on the characteristics of patients groups who are in need of community-based support a clear research priority. The current study aims to address the knowledge gap by exploring the predictors of the willingness to (1) receive the support from a community-based health worker or (2) to participate in a support group in public sector ART programme of the Free State Province of South Africa. Based on the Individual-Family-Community framework for HIV research, the study employs a comprehensive approach by not only testing classical individual-level but also family-level predictors of the willingness to receive community-based support. In addition to individual-level predictors—such as age, health status and coping styles—our analysis demonstrated the importance of family characteristics. The results indicated that discrepancies in the family’s changeability level were an important predictor of the demand for community-based support services. Conversely, the findings indicated that patients living in a family more flexible than deemed ideal are more likely to require the support of a community health worker. The current study expands theory by indicating the need to acknowledge all social ecological levels in the study of chronic HIV care. The detection of both individual level and family level determinants of the expressed need for community-based support can inform health policy to devise strategies to target scarce resources to those vulnerable patients who report the greatest need for this support. In this way, the study results are a first step in an attempt to move away from generic, broad based community-based interventions towards community support that is tailored to the patient needs at both the individual and family level.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Bor, J" uniqKey="Bor J">J Bor</name></author><author><name sortKey="Herbst, Aj" uniqKey="Herbst A">AJ Herbst</name></author><author><name sortKey="Newell, M L" uniqKey="Newell M">M-L Newell</name></author><author><name sortKey="B Rnighausen, T" uniqKey="B Rnighausen T">T Bärnighausen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johnson, Lf" uniqKey="Johnson L">LF Johnson</name></author><author><name sortKey="Mossong, J" uniqKey="Mossong J">J Mossong</name></author><author><name sortKey="Dorrington, Re" uniqKey="Dorrington R">RE Dorrington</name></author><author><name sortKey="Schomaker, M" uniqKey="Schomaker M">M 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27741239</article-id><article-id pub-id-type="pmc">5065171</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0163963</article-id><article-id pub-id-type="publisher-id">PONE-D-16-16388</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Microbiology</subject><subj-group><subject>Medical Microbiology</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pathology and Laboratory Medicine</subject><subj-group><subject>Pathogens</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and life sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>RNA viruses</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Microbiology</subject><subj-group><subject>Medical Microbiology</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pathology and Laboratory Medicine</subject><subj-group><subject>Pathogens</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Community-Based Intervention</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Psychological and Psychosocial Issues</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Immunology</subject><subj-group><subject>Vaccination and Immunization</subject><subj-group><subject>Antiviral Therapy</subject><subj-group><subject>Antiretroviral Therapy</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Immunology</subject><subj-group><subject>Vaccination and Immunization</subject><subj-group><subject>Antiviral Therapy</subject><subj-group><subject>Antiretroviral Therapy</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Public and Occupational Health</subject><subj-group><subject>Preventive Medicine</subject><subj-group><subject>Vaccination and Immunization</subject><subj-group><subject>Antiviral Therapy</subject><subj-group><subject>Antiretroviral Therapy</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Mental Health and Psychiatry</subject></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Patients</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Ecology</subject><subj-group><subject>Community Ecology</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Ecology and Environmental Sciences</subject><subj-group><subject>Ecology</subject><subj-group><subject>Community Ecology</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject><subj-group><subject>Demography</subject></subj-group></subj-group></article-categories><title-group><article-title>Who Should We Target? The Impact of Individual and Family Characteristics on the Expressed Need for Community-Based Treatment Support in HIV Patients in South Africa</article-title><alt-title alt-title-type="running-head">Who Should We Target with Community Support?</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Wouters</surname><given-names>Edwin</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib><contrib contrib-type="author"><name><surname>Booysen</surname><given-names>Frederik le Roux</given-names></name><xref ref-type="aff" rid="aff003"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Masquillier</surname><given-names>Caroline</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>Department of Sociology and Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium</addr-line></aff><aff id="aff002"><label>2</label><addr-line>Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, Republic of South Africa</addr-line></aff><aff id="aff003"><label>3</label><addr-line>Department of Economics, University of the Free State, Bloemfontein, Republic of South Africa</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Pett</surname><given-names>Sarah L</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>University of New South Wales, AUSTRALIA</addr-line></aff><author-notes><fn fn-type="COI-statement" id="coi001"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p><list list-type="simple"><list-item><p><bold>Conceptualization:</bold> EW.</p></list-item><list-item><p><bold>Formal analysis:</bold> EW CM.</p></list-item><list-item><p><bold>Funding acquisition:</bold> FB.</p></list-item><list-item><p><bold>Methodology:</bold> EW.</p></list-item><list-item><p><bold>Project administration:</bold> FB.</p></list-item><list-item><p><bold>Supervision:</bold> EW.</p></list-item><list-item><p><bold>Visualization:</bold> CM.</p></list-item><list-item><p><bold>Writing – original draft:</bold> EW.</p></list-item><list-item><p><bold>Writing – review & editing:</bold> EW FB CM.</p></list-item></list></p></fn><corresp id="cor001">* E-mail: <email>edwin.wouters@uantwerpen.be</email></corresp></author-notes><pub-date pub-type="epub"><day>14</day><month>10</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>11</volume><issue>10</issue><elocation-id>e0163963</elocation-id><history><date date-type="received"><day>22</day><month>4</month><year>2016</year></date><date date-type="accepted"><day>16</day><month>9</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 Wouters et al</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>Wouters et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:href="pone.0163963.pdf"></self-uri><abstract><p>Reviews of impact evaluations of community-based health workers and peer support groups highlight the considerable variability in the effectiveness of such support in improving antiretroviral treatment (ART) outcomes. Evidence indicates that community-based support interventions targeting patients known to be at risk will probably display better results than generic interventions aimed at the entire population of people living with HIV. It is however difficult to identify these at-risk populations, rendering knowledge on the characteristics of patients groups who are in need of community-based support a clear research priority. The current study aims to address the knowledge gap by exploring the predictors of the willingness to (1) receive the support from a community-based health worker or (2) to participate in a support group in public sector ART programme of the Free State Province of South Africa. Based on the Individual-Family-Community framework for HIV research, the study employs a comprehensive approach by not only testing classical individual-level but also family-level predictors of the willingness to receive community-based support. In addition to individual-level predictors—such as age, health status and coping styles—our analysis demonstrated the importance of family characteristics. The results indicated that discrepancies in the family’s changeability level were an important predictor of the demand for community-based support services. Conversely, the findings indicated that patients living in a family more flexible than deemed ideal are more likely to require the support of a community health worker. The current study expands theory by indicating the need to acknowledge all social ecological levels in the study of chronic HIV care. The detection of both individual level and family level determinants of the expressed need for community-based support can inform health policy to devise strategies to target scarce resources to those vulnerable patients who report the greatest need for this support. In this way, the study results are a first step in an attempt to move away from generic, broad based community-based interventions towards community support that is tailored to the patient needs at both the individual and family level.</p></abstract><funding-group><funding-statement>The authors would like to give special thanks to the following funding agencies: the World Bank Research Committee; the Bank-Netherlands Partnership Program; WB-DfiD "Evaluation of the Community Response to HIV and AIDS"; the Programme to Support Pro-Poor Policy Development (PSPPD), a partnership between the Presidency, Republic of South Africa and the European Union; the Health Economics and Aids Research Division (HEARD) at the University of Kwazulu-Natal; the University of the Free State (UFS); and South Africa’s National Research Foundation (NRF).</funding-statement></funding-group><counts><fig-count count="0"></fig-count><table-count count="2"></table-count><page-count count="16"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>All relevant data are within the paper and its Supporting Information file.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>All relevant data are within the paper and its Supporting Information file.</p></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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