Antiretroviral treatment as catalyst for achieving AIDS competence in local South African communities: developing a multidimensional intervention to combat the HIV/AIDS epidemic.

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/AIDSResearch 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.

Keywords:HEALTH CARE ORGANISATION, SOCIAL CARE, MEDICAL SOCIOLOGY, HIV/AIDS

Disciplines:Social medical sciences, Social work, Other sociology and anthropology