Households, fluidity, and HIV service delivery in Zambia and South Africa – an exploratory analysis of longitudinal qualitative data from the HPTN 071 (PopART) trial

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dc.contributor.authorHoddinott, Graemeen_ZA
dc.contributor.authorMyburgh, Hanlieen_ZA
dc.contributor.authorDe Villiers, Laingen_ZA
dc.contributor.authorNdubani, Rhodaen_ZA
dc.contributor.authorMantantana, Jabulileen_ZA
dc.contributor.authorThomas, Angeliqueen_ZA
dc.contributor.authorMbewe, Madalitsoen_ZA
dc.contributor.authorAyles, Helenen_ZA
dc.contributor.authorBock, Peteren_ZA
dc.contributor.authorSeeley, Janeten_ZA
dc.contributor.authorShanaube, Kwameen_ZA
dc.contributor.authorHargreaves, Jamesen_ZA
dc.contributor.authorBond, Virginiaen_ZA
dc.contributor.authorReynolds, Lindsey
dc.date.accessioned2020-04-24T21:03:27Z
dc.date.available2020-04-24T21:03:27Z
dc.date.issued2018
dc.descriptionCITATION: Hoddinott, G., et al. 2018. Households, fluidity, and HIV service delivery in Zambia and South Africa – an exploratory analysis of longitudinal qualitative data from the HPTN 071 (PopART) trial. Journal of the International AIDS Society, 21(4):e25135, doi:10.1002/jia2.25135.
dc.descriptionThe original publication is available at https://onlinelibrary.wiley.com
dc.description.abstractIntroduction: Population distributions, family and household compositions, and people’s sense of belonging and social stability in southern Africa have been shaped by tumultuous, continuing large-scale historical disruptions. As a result, many people experience high levels of geographic and social fluidity, which intersect with individual and population-level migration patterns. We describe the complexities of household fluidity and HIV service access in South Africa and Zambia to explore implications for health systems and service delivery in contexts of high household fluidity. Methods: HPTN 071 (PopART) is a three-arm cluster randomized controlled trial implemented in 21 peri-urban study communities in Zambia and South Africa between 2013 and 2018. A qualitative cohort nested in the trial included 148 purposively sampled households. Data collection was informed by ethnographic and participatory research principles. The analysis process was reflexive and findings are descriptive narrative summaries of emergent ideas. Results: Households in southern Africa are extremely fluid, with people having a tenuous sense of security in their social networks. This fluidity intersects with high individual and population mobility. To characterize fluidity, we describe thematic patterns of household membership and residence. We also identify reasons people give for moving around and shifting social ties, including economic survival, fostering interpersonal relationships, participating in cultural, traditional, religious, or familial gatherings, being institutionalized, and maintaining patterns of substance use. High fluidity disrupted HIV service access for some participants. Despite these challenges, many participants were able to regularly access HIV testing services and participants living with HIV were especially resourceful in maintaining continuity of antiretroviral therapy (ART). We identify three key features of health service interactions that facilitated care continuity: disclosure to family members, understanding attitudes among health services staff including flexibility to accommodate clients’ transient pressures, and participants’ agency in ARTrelated decisions. Conclusions: Choices made to manage one’s experiential sense of household fluidity are intentional responses to livelihood and social support constraints. To enhance retention in care for people living with HIV, policy makers and service providers should focus on creating responsive, flexible health service delivery systems designed to accommodate many shifts in client circumstances.en_ZA
dc.description.urihttps://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25135
dc.description.versionPublisher's version
dc.format.extent8 pages
dc.identifier.citationHoddinott, G., et al. 2018. Households, fluidity, and HIV service delivery in Zambia and South Africa – an exploratory analysis of longitudinal qualitative data from the HPTN 071 (PopART) trial. Journal of the International AIDS Society, 21(4):e25135, doi:10.1002/jia2.25135
dc.identifier.issn1758-2652 (online)
dc.identifier.otherdoi:10.1002/jia2.25135
dc.identifier.urihttp://hdl.handle.net/10019.1/107723
dc.language.isoen_ZAen_ZA
dc.publisherWiley Open Access
dc.rights.holderAuthors retain copyright
dc.subjectAntiretroviral therapyen_ZA
dc.subjectAntiretroviral agents -- Southern Africaen_ZA
dc.subjectHIV-positive persons -- Careen_ZA
dc.subjectPopARTen_ZA
dc.subjectHPTN 071en_ZA
dc.subjectHousehold fluidity -- Zambia -- South Africaen_ZA
dc.subjectMigration -- Health aspects -- Southern Africaen_ZA
dc.subjectHIV-infections -- Treatmenten_ZA
dc.titleHouseholds, fluidity, and HIV service delivery in Zambia and South Africa – an exploratory analysis of longitudinal qualitative data from the HPTN 071 (PopART) trialen_ZA
dc.typeArticleen_ZA
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