Using theories of practice to understand HIV-positive persons varied engagement with HIV services: a qualitative study in six Sub-Saharan African countries

Abstract

ObjectivesThis article considers the potential of ‘theories of practice’ for studying and understanding varied (dis)engagement with HIV care and treatment services and begins to unpack the assemblage of elements and practices that shape the nature and duration of individuals’ interactions with HIV services.MethodsWe obtained data from a multicountry qualitative study that explores the use of HIV care and treatment services, with a focus on examining the social organisation of engagement with care as a practice and as manifested in the lives of people living with HIV in sub-Saharan Africa. The dataset comprised of 356 interviews with participants from six countries.ResultsWe noted fluctuating interactions with HIV services in all countries. In line with theories of practice, we found that such varied engagement can be explained by (1) the availability, absence and connections between requisite ‘materialities’ (eg, health infrastructure, medicines), ‘competencies’ (eg, knowing how to live with HIV) and ‘meanings’ (eg, trust in HIV services, stigma, normalisation of HIV) and (2) a host of other life practices, such as working or parenting. These dynamics either facilitated or inhibited engagement with HIV services and were intrinsically linked to the discursive, cultural, political and economic fabric of the participating countries.ConclusionPractice theory provides HIV researchers and practitioners with a useful vocabulary and analytical tools to understand and steer people’s differentiated HIV service (dis)engagement. Our application of practice theory to engagement in HIV care, as experienced by HIV service users and providers in six sub-Saharan African countries, highlights the need for a practice-based approach in the delivery of differentiated and patient-centred HIV services.

‘I saw it as a second chance’: A qualitative exploration of experiences of treatment failure and regimen change among people living with HIV on second- and third-line antiretroviral therapy in Kenya, Malawi and Mozambique

“…Other researchers have also shown that PLHIV often blame themselves for dis-engaging from care, and that this sense of guilt and fault need to be carefully navigated by health care workers as they move forward in their treatment journeys (Layer et al, 2014). In addition, the precarity of the social transformations that accompany regimen change that we observed echo the findings in Russell and Seeley's research in Uganda among individuals who initiated first-line ART following HIV-related illnesses and recall the complexity of achieving sustained engagement with HIV care and treatment in the context of pervasive stigma and challenging social circumstances Skovdal et al, 2017;Stern, Colvin, Schutz, Burton, & Meintjes, 2017;Wamoyi et al, 2017). Other researchers have also noted apparent contradictions or paradoxes in the experiences of patients who have very long treatment histories, whereby optimism and hope often co-exist alongside new challenges that arise from sustained treatment-taking, and which may risk undermining treatment-taking (Nixon et al, 2018).…”

Understanding reasons for discontinued antiretroviral treatment among clients in test and treat: a qualitative study in Swaziland

“…Reasons for discontinuing ART have been typically described as complex . The thematic analysis revealed similar reasons for disengagement from care to those described by Ware et al.…”

“…Reasons for discontinuing ART have been typically described as complex [22,23]. The thematic analysis revealed similar reasons for disengagement from care to those described by Ware et al who identified competing social and economic demands, violence, lack of family or community support, and dissatisfaction with care [22].…”

Parental obligations, care and HIV treatment: How care for others motivates self-care in Zimbabwe

“…If our interest is to understand what it takes for people living with HIV to join, maintain or defect from engagement with HIV treatment, we need to understand what and how other life practices, such as care, intersect with this particular practice. This insight can be used to form or break, strengthen or weaken links between them ( Blue et al, 2016 ), with the aim of enhancing engagement with HIV treatment ( Skovdal et al, 2017 ).…”