Landmark studies demonstrating a reduction in onward HIV transmission and improved survival have informed a shift in global antiretroviral therapy policy to a ‘treat all’ approach. Global HIV... Show moreLandmark studies demonstrating a reduction in onward HIV transmission and improved survival have informed a shift in global antiretroviral therapy policy to a ‘treat all’ approach. Global HIV stakeholders have called on countries to urgently scale up their HIV programs, involving responsibilities for various health system actors for accelerating HIV epidemic control. In this article we explore how community members in South Africa who were part of a large-scale ‘Universal Testing and Treatment’ trial made decisions around taking up home-based HIV testing, a major component of the trial's intervention and the entry point to a comprehensive continuum of HIV prevention and care. Drawing on data collected with a qualitative cohort of purposively selected households in the study intervention communities between 2016 and 2018 we describe how the goal of achieving HIV epidemic control was internalized, enacted, and potentially transformed in the interactions between community members and health workers in high HIV burden community settings. Further, we consider the implications for how community members related to their individual health and a collective responsibility to a broader public health good (in this case HIV epidemic control). Our findings suggest that in contexts of precarity – where there is low social cohesion – a community-wide health intervention can create an avenue for people to perform being good, moral citizens. Our findings reveal how complex community and social dynamics inform decisions to take up health interventions, rather than purely ‘rational’ understandings of individual and collective health benefit. Show less
Drug-resistant (DR) strains of Mycobacterium tuberculosis (M. tb) are increasingly recognised as a threat to global tuberculosis (TB) control efforts. Identifying people with DR-TB exposure/... Show moreDrug-resistant (DR) strains of Mycobacterium tuberculosis (M. tb) are increasingly recognised as a threat to global tuberculosis (TB) control efforts. Identifying people with DR-TB exposure/ infection and providing TB preventive therapy (TPT) is a public health priority. TB guidelines advise the evaluation of household contacts of newly diagnosed TB cases, with the provision of TPT to vulnerable populations, including young children (<5 years). Many children become infected with TB through exposure in their household. Levofloxacin is under evaluation as TPT in children exposed to M. tb strains with resistance to rifampicin and isoniazid (multidrug-resistant TB; MDR-TB). Prior to opening a phase 3 prevention trial in children <5 years exposed to MDR-TB, the pharmacokinetics and safety of a novel formulation of levofloxacin given daily was evaluated as part of a lead-in study. We conducted an exploratory qualitative study of 10 caregivers’ experiences of administering this formulation. We explored how the acceptability of levofloxacin as TPT is shaped by the broader impacts of MDR-TB on the overall psychological, social, and financial wellbeing of caregivers, many of whom also had experienced MDR-TB. Caregivers reported that the novel levofloxacin formulation was acceptable. However, caregivers described significant psychosocial challenges in the process of incorporating TPT administration to their children into their daily lives, including financial instability, withdrawal of social support and stigma. When caregivers themselves were sick, these challenges became even more acute. Although new child-friendly formulations can ameliorate some of the pragmatic challenges related to TPT preparation and administration, the overall psychosocial burden on caregivers responsible for administering TPT remains a major determinant of effective MDR-TB prevention in children. Show less
Allwood, B.; Zalm, M. van der; Makanda, G.; Mortimer, K.; Amaral, A.F.S.; Egere, U.; ... ; First Int Post-TB Symposium 2019
