Browsing by Author "Wringe, Alison"

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    Data Resource Profile: Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network)
    (International journal of epidemiology, 2016) Reniers, Georges; Lutalo, Tom; Wamukoya, Marylene; Urassa, Mark; Nakiyingi-Miiro, Jessica; Hosegood, Vicky; Wringe, Alison; Marston, Milly; Maquins, Sewe; Levira, Francis; Zaba, Basia
    The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network) was established in 2005 and aims to: (i) broaden the evidence base on HIV epidemiology for informing policy; (ii) strengthen analytical capacity for HIV research; and (iii) foster collaboration between study sites.1 All of the study sites participating in the ALPHA Network are independently managed and have their own scientific agendas and tailored research methodologies, but share a common interest in HIV epidemiology and its interactions with the socio-demographic characteristics of the populations they cover. The ALPHA Network study sites and their institutional affiliations are described in Table 1, and their geographical distribution is shown in Figure 1. Several of the ALPHA Network study sites have published site-specific profiles that contain more detail.2–10 Most of the ALPHA Network study sites are also members of the INDEPTH Network of demographic surveillance sites [http:// www.indepth-network.org/].
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    “He was no longer listening to me”: A qualitative study in six Sub-Saharan African countries exploring next-of-kin perspectives on caring following the death of a relative from AIDS
    (AIDS Care, 2019) Ssekubugu, Robert; Renju, Jenny; Zaba, Basia; Seeley, Janet; Bukenya, Dominic; Ddaaki, William; Moshabela, Mosa; Wamoyi, Joyce; McLean, Estelle; Ondenge, Kenneth; Skovdal, Morten; Wringe, Alison
    In the era of widespread antiretroviral therapy, few studies have explored the perspectives of the relatives involved in caring for people living with HIV (PLHIV) during periods of ill-health leading up to their demise. In this analysis, we explore the process of care for PLHIV as their death approached, from their relatives’ perspective. We apply Tronto’s care ethics framework that distinguishes between care-receiving among PLHIV on the one hand, and caring about, caring for and care-giving by their relatives on the other. We draw on 44 in-depth interviews conducted with caregivers following the death of their relatives, in seven rural settings in Eastern and Southern Africa. Relatives suggested that prior to the onset of poor health, few of the deceased had disclosed their HIV status and fewer still were relying on anyone for help. This lack of disclosure meant that some caregivers spoke of enduring a long period of worry, and feelings of helplessness as they were unable to translate their concern and “caring about” into “caring for”. This transition often occurred when the deceased became in need of physical, emotional or financial care. The responsibility was often culturally prescribed, rarely questioned and usually fell to women. The move to “care-giving” was characterised by physical acts of providing care for their relative, which lasted until death. Tronto’s conceptualisation of caring relationships highlights how the burden of caring often intensifies as family members’ caring evolves from “caring about”, to “caring for”, and eventually to “giving care” to their relatives. This progression can lead to caregivers experiencing frustration, provoking tensions with their relatives and highlighting the need for interventions to support family members caring for PLHIV. Interventions should also encourage PLHIV to disclose their HIV status and seek early access to HIV care and treatment services.
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    HIV Positive status disclosure to sexual partners: a qualitative study to explore experiences and challenges among clients attending HIV care services in North-Western Tanzania
    (AIDS care, 2021) Sanga, Erica; Nampewo, Zahara; PrayGod, George; Wringe, Alison
    The East and Southern African region bears the highest burden of HIV globally, accounting for 54% of people living with HIV (PLHIV) (UNAIDS, 2019). Despite antiretroviral therapy (ART) scale-up, including “Test and Treat” since 2016, epidemic control has not been reached, with 800,000 new infections in 2018 alone, 9% of which were in the United Republic of Tanzania (UNAIDS, 2019). With 75% of new infections occurring in heterosexual partnerships, interventions that prevent HIV transmission within couples need strengthening (UNAIDS, 2019). Disclosure of HIV status to sexual partners, a goal emphasized by the World Health Organization (WHO), is key for HIV prevention (World Health Organization, 2004). Disclosure can benefit sexual partners by promoting discussion of HIV risks and a desire to access HIV testing and prevention services, including pre-exposure prophylaxis (PrEP) (Evangeli & Wroe, 2017; Yonah et al., 2014). Disclosure within couples also provides an opportunity to discuss and implement risk-reduction strategies and undertake family planning (Conserve et al., 2016; Hallberg et al., 2019).
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    Where are we now? A multicountry qualitative study to explore access to pre-antiretroviral care services: a precursor to antiretroviral therapy initiation
    (Sexually transmitted infections, 2017) Bukenya, Dominic; Wringe, Alison; Moshabela, Mosa; Skovdal, Morten; Ssekubugu, Robert; Paparini, Sara; Renju, Jenny; McLean, Estelle; Bonnington, Oliver; Wamoyi, Joyce; Seeley, Janet
    To explore barriers and facilitators to accessing postdiagnosis HIV care in five sub-Saharan African countries. Methods In-depth interviews were conducted with 77 people living with HIV (PLHIV) in pre-antiretroviral therapy care or not-yet-in care and 46 healthcare workers. Participants were purposely selected from health and demographic surveillance sites in Karonga (Malawi), Manicaland (Zimbabwe), uMkhanyakude (South Africa), Kisesa (Tanzania) and Rakai and Kyamulibwa (Uganda). Thematic content analysis was conducted, guided by the constructs of affordability, availability and acceptability of care.- Results Affordability: Transport and treatment costs were a barrier to HIV care, although some participants travelled to distant clinics to avoid being seen by people who knew them or for specific services. Broken equipment and drug stock-outs in local clinics could also necessitate travel to other facilities. Availability: Some facilities did not offer full HIV care, or only offered all services intermittently. PLHIV who frequently travelled complained that care was seldom available to them in places they visited. Acceptability: Severe pain or sickness was a key driver for accessing postdiagnosis care, whereas asymptomatic PLHIV often delayed care-seeking. A belief in witchcraft was a deterrent to accessing clinical care following diagnosis. Changing antiretroviral therapy guidelines generated uncertainty among PLHIV about when to start treatment and delayed postdiagnosis care. PLHIV reported that healthcare workers’ knowledge, attitudes and behaviours, and their ability to impart health education, also influenced whether they accessed HIV care. Conclusion Despite efforts to decentralise services over the past decade, many barriers to accessing HIV care persist. There is a need to increase sustained access to care for PLHIV not yet on treatment, with initiatives that encompass biomedical aspects of care alongside considerations for individual and collective challenges they faced. A failure to do so may undermine efforts to achieve universal access to antiretroviral therapy.