Interrogating concepts of care in the HIV care continuum: ethnographic insights from the implementation of a “Universal Test and Treat” approach in South Africa

Wademan, Dillon; Reynolds, Lindsey

doi:10.1080/09540121.2016.1161164

Cited by 7 publications

(5 citation statements)

References 27 publications

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“…The average follow-up refers to the average time a study participant was observed in the context of the trial. strategies by the general population [29,[53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69]. Overall, the analysis of the various themes addressed within these five trials will contribute to understanding the impact of UTT strategies in various contexts as well as inform the generalization of such a strategy to new contexts.…”

Section: Trial Intervention Packagesmentioning

confidence: 98%

Comparative assessment of five trials of universal HIV testing and treatment in sub‐Saharan Africa

et al. 2018

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DesignUniversal voluntary HIV counselling and testing followed by prompt initiation of antiretroviral therapy (ART) for all those diagnosed HIV‐infected (universal test and treat, UTT) is now a global health standard. However, its population‐level impact, feasibility and cost remain unknown. Five community‐based trials have been implemented in sub‐Saharan Africa to measure the effects of various UTT strategies at population level: BCPP/YaTsie in Botswana, Max ART in Swaziland, HPTN 071 (PopART) in South Africa and Zambia, SEARCH in Uganda and Kenya and ANRS 12249 TasP in South Africa. This report describes and contrasts the contexts, research methodologies, intervention packages, themes explored, evolution of study designs and interventions related to each of these five UTT trials.MethodsWe conducted a comparative assessment of the five trials using data extracted from study protocols and collected during baseline studies, with additional input from study investigators. We organized differences and commonalities across the trials in five categories: trial contexts, research designs, intervention packages, trial themes and adaptations.ResultsAll performed in the context of generalized HIV epidemics, the trials highly differ in their social, demographic, economic, political and health systems settings. They share the common aim of assessing the impact of UTT on the HIV epidemic but differ in methodological aspects such as study design and eligibility criteria for trial populations. In addition to universal ART initiation, the trials deliver a wide range of biomedical, behavioural and structural interventions as part of their UTT strategies. The five studies explore common issues, including the uptake rates of the trial services and individual health outcomes. All trials have adapted since their initiation to the evolving political, economic and public health contexts, including adopting the successive national recommendations for ART initiation.ConclusionsWe found substantial commonalities but also differences between the five UTT trials in their design, conduct and multidisciplinary outputs. As empirical literature on how UTT may improve efficiency and quality of HIV care at population level is still scarce, this article provides a foundation for more collaborative research on UTT and supports evidence‐based decision making for HIV care in country and internationally.

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Section: Trial Intervention Packagesmentioning

confidence: 98%

Comparative assessment of five trials of universal HIV testing and treatment in sub‐Saharan Africa

et al. 2018

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“…In the high-disease-burden and resource-constrained contexts of SSA, health workers experience a range of psychosocial stressors that leave them vulnerable to developing burnout, in many cases reducing service-quality as well as negatively impacting on their own health and wellbeing [ 12 ]. Health workers also face daily interpersonal, organizational, and structural threats to their mental wellbeing [ 9 , 10 ]. Caring for PLHIV may expose health workers to secondary, or associative, stigma simply through providing services to members of a stigmatized group [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk of burnout among HIV service providers in South Africa and Zambia: findings from the HPTN 071 (PopART) trial

Steinhaus,

Nicholson,

Pliakas

et al. 2024

Hum Resour Health

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Background In the high disease burden and resource-constrained contexts of sub-Saharan Africa (SSA), health workers experience a range of psychosocial stressors that leave them vulnerable to developing burnout, which can reduce service quality and negatively impact their own health and wellbeing. As universal testing and treatment (UTT) for HIV scales up across SSA, we sought to understand the implications of this human resource-intensive approach to HIV prevention to inform decision-making about health workforce staffing and support needs. Methods Using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), we assessed the prevalence of three domains of burnout—emotional exhaustion, depersonalization, and personal accomplishment—among three cadres of health workers delivering health services in areas receiving a UTT intervention in Zambia and South Africa. These cadres included health facility workers (n = 478), community health workers (n = 159), and a study-specific cadre of community HIV care providers (n = 529). We used linear regression to assess risk factors associated with emotional exhaustion, the only domain with sufficient variation in our sample. Results The MBI-HSS was completed by 1499/2153 eligible participants (69.6% response rate). Less than 1% of health workers met Maslach’s definition for burnout. All groups of health workers reported lower levels of emotional exhaustion than found in previous studies of this type (mean score scores ranged from 10.7 to 15.4 out of 54 across health cadres). Higher emotional exhaustion was associated with higher educational attainment (βadj = 2.24, 95% CI 0.76 to 3.72), greater years providing HIV services (βadj = 0.20, 95% CI 0.03 to 0.36), and testing negative for HIV at last HIV test (βadj = − 3.88 − 95% CI 5.69 to − 2.07). Working as a CHW was significantly associated with lower emotional exhaustion (βadj = − 2.52, 95% CI − 4.69 to − 0.35). Among all health workers, irrespective of HIV status, witnessing stigmatizing behaviors towards people living with HIV among their co-workers was associated with significantly increased emotional exhaustion (βadj = 3.38, 95% CI 1.99 to 4.76). Conclusions The low level of burnout detected among health workers is reassuring. However, it remains important to assess how UTT may affect levels of emotional exhaustion among health workers over time, particularly in the context of emerging global pandemics, as burnout may impact the quality of HIV services they provide and their own mental health and wellbeing. Interventions to reduce HIV stigma in health facilities may protect against emotional exhaustion among health workers, as well as interventions to increase mindfulness and resilience among health workers at risk of burnout. Trial registration ClinicalTrials.gov number: NCT01900977.

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“…One study conducted in 2009 indicated that implementation of universal treatment in high prevalence sub-Saharan Africa (SSA) settings would require over 17,000 additional health workers and that to initiate universal access to treatment at CD4 cell counts of ≤ 350 cells/µl, South Africa alone would require a minimum of 6,300 additional health workers [5]. In addition to an expanded health workforce needed to support UTT, many qualitative studies report that health workers in SSA already see their current care targets as unattainable, with some compensating by using time outside of working hours as well as personal resources to deliver care to patients in need [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…In the high-disease-burden and resource-constrained contexts of SSA, health workers experience a range of psychosocial stressors that leave them vulnerable to developing burnout, in many cases reducing service-quality as well as negatively impacting on their own health and wellbeing [12]. Health workers also face daily interpersonal, organizational, and structural threats to their mental wellbeing [9,10]. Caring for PLHIV may expose health workers to secondary, or associative, stigma simply through providing services to members of a stigmatized group [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Risk of Emotional Exhaustion among HIV Service Providers in South Africa and Zambia: Findings from the HPTN 071 (PopART) Trial

Steinhaus

Nicholson

Pliakas

et al. 2022

Preprint

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Background In the high disease burden and resource-constrained contexts of SSA, health workers experience a range of psychosocial stressors that leave them vulnerable to developing burnout, which can reduce service quality and negatively impact their own health and wellbeing. As universal testing and treatment (UTT) for HIV scales up across SSA, it is important to understand the implications of this human resource intensive approach to HIV prevention to inform decision making about health workforce staffing and support needs. MethodsUsing the Maslach Burnout Inventory, we assessed the prevalence of three domains of burnout—emotional exhaustion, depersonalization, and personal accomplishment— among three cadres of health workers delivering health services in areas receiving a UTT intervention in Zambia and South Africa. These cadres included health facility workers (n=478), community health workers (n=159), and a study-specific cadre of community HIV care providers (CHiPs) (n=529). We used linear regression to assess risk factors associated with emotional exhaustion, the only domain with sufficient variation in our sample.ResultsAll groups of health workers reported lower levels of emotional exhaustion than found in previous studies of this type (median scores ranged from 8 to 14 out of 54 across health cadres). Higher emotional exhaustion was associated with higher educational attainment (βadj= 2.24, 95% CI 0.76 to 3.72), greater years providing HIV services (βadj=0.20, 95% CI 0.03 to 0.36), and testing negative for HIV at last HIV test (βadj=-3.88 -95% CI 5.69 to -2.07). Working as a CHW was significantly associated with lower emotional exhaustion (β = -2.52, 95% CI -4.69 to -0.35). Amongst all health workers, irrespective of HIV status, witnessing stigmatizing behaviors towards people living with HIV among their co-workers was associated with significantly increased emotional exhaustion (βadj = 3.38, 95% CI 1.99 to 4.76). ConclusionsThe low levels of emotional exhaustion detected among health workers are reassuring. However, it remains important to assess how UTT may affect levels of emotional exhaustion among health workers, which may impact the quality of HIV services they are able to provide. Interventions to reduce HIV stigma in health facilities may protect against emotional exhaustion among health workers. ClinicalTrials.gov number: NCT01900977.

show abstract

Interrogating concepts of care in the HIV care continuum: ethnographic insights from the implementation of a “Universal Test and Treat” approach in South Africa

Cited by 7 publications

References 27 publications

Comparative assessment of five trials of universal HIV testing and treatment in sub‐Saharan Africa

Comparative assessment of five trials of universal HIV testing and treatment in sub‐Saharan Africa

Prevalence and risk of burnout among HIV service providers in South Africa and Zambia: findings from the HPTN 071 (PopART) trial

Risk of Emotional Exhaustion among HIV Service Providers in South Africa and Zambia: Findings from the HPTN 071 (PopART) Trial

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