A qualitative study of community home-based care and antiretroviral adherence in Swaziland

Introduction Antiretroviral therapy (ART) has rendered HIV and AIDS a chronic condition for individuals in many parts of the world. Adherence, however, is integral to achieving chronicity. Studies have shown both relatively high ART adherence rates in sub-Saharan Africa and the importance of community home-based care (CHBC) to facilitating this process. In light of diminished HIV and AIDS funding globally and increased reliance on CHBC throughout Africa, a better understanding of how CHBC may strengthen ART adherence is essential to improving patients’ quality of life, tending to the needs of care supporters and achieving healthier populations. Methods This article reports findings from a qualitative study of a CHBC organiztion serving an estimated 2500 clients in rural Swaziland. Semi-structured questionnaires with 79 HIV-positive clients [people living with HIV and AIDS (PLWHA)] yielded data on diverse aspects of being HIV positive, including insights on whether and how PLWHA perceived care supporters to facilitate ART adherence in a high stigma and structurally impoverished setting. Results Ninety-two percent of participants said their health had improved since care supporters came into their lives. A major finding was that an estimated 53% of participants said they would have died, a few from suicide had the care supporter never intervened. More than one in four participants (27.9%) sought HIV testing after a care supporter began visiting them. Nearly a third (31%) commenced ART after and largely as a consequence of care supporter intervention. Approximately one in four (23%) reported that their care supporter had helped them to disclose their HIV-positive status to family members. Twenty-seven percent said they had felt discouraged or had been discouraged from taking ART by members of their family or community. Discussion General inductive analysis of participant reports suggested two social mechanisms of CHBC impact on ART adherence: (i) cultivating client-care supporter “talk” to enhance treatment uptake and literacy, reduce felt stigma and challenge social pressures to desist from ART and (ii) real-time interactions between clients and care supporters whereby the care “relationship” was itself the “intervention,” providing lay counsel, material and financial assistance, and encouragement when clients suffered stigma, side effects and other obstacles to adherence. These social dynamics of adherence generally fall outside the purview of conventional clinical and public health research. Conclusions PLWHA reports of care supporter practices that enabled ART adherence demonstrated the pivotal role that CHBC plays in many PLWHA lives, especially in hard to reach areas. Relative to clinic personnel, care supporters are often intensely engaged in clients’ experiences of sickness, stigma and poverty, rendering them influential in individuals’ decision-making. This influence must be matched with on-going training and support of care supporters, as well as a clear articulation with the formal and informal health sectors, to ensure that PLWHA are correctly counselled and care supporters themselves supported. Overall, findings showed that PLWHA experiences of CHBC should be captured and incorporated into any programme aimed at successfully implementing the Joint United Nations Programme on HIV and AIDS (UNAIDS) Treatment 2.0 agenda Pillar 4 (increasing HIV testing uptake and care linkages) and Pillar 5 (strengthening community mobilization)

P-06 Cuilcagh Mountain Regional Research Project, Ireland

During May and June of this past summer (2017) Professors Ariel Solis, Robin Johnson, and Rhonda Root began a faculty research project that started recording and investigating traditional Irish cottages (post-famine) along the border between Northern Ireland and the Republic of Ireland. This project is affiliated with the Marble Arch Caves UNESCO Global Geopark, which is within the Cuilcagh Mountain Region along the border between Northern Ireland and the Republic of Ireland. While in Ireland our research focused on three sites: Moneygashel Cashel (Co Cavan), located in the Republic of Ireland, and Gortmaconnell and Legnabrocky (Co Fermanagh) in Northern Ireland. Documenting of the sites involved recording the architecture by using photographs, drone flights, laser and tape measuring, hand-graphed field sketches of plans, elevations, perspectives, and details of various features. Photographs and drone images will also be used to create non-invasive photogrammetry models. Back on campus, work continued on researching precedent of architectural features and details; producing hand drafted and digital architectural renderings; restoration images of the ruined cottages; illustrative watercolors; and compiling a writing record on the history and culture of the region (this history is the work of our Irish team member, Gaby Burns, a local historian)

P-04 Cavan Burren 2015 Project

The Cavan Burren is a plantation forest within the Marble Arch Caves UNESCO Global Geopark overlay along the Republic of Ireland and Northern Ireland border. The exposure of Cavan Burren’s relict landscape resulted from a 2012 partial clear fell. Our multidisciplinary team of researchers in architecture, technology, ecology, fine arts, and archaeology investigated domestic architecture reflected in three stone configurations: circular/semicircular sites, rectangular sites, and tomb structures. We also investigated human action on pedestal boulders (PBs), which had been modified by sculpting, splitting, and cutting away. Our first goal was to show human action on structures by using three-dimensional (3D) analyses to investigate relationships among cast-off pieces and resulting modified boulders. Our second goal was to compare our findings with those from Ancient Near East regions, particularly Cisjordan and Transjordan, to explore possible sociocultural parallels. Photographs of artifacts were taken from different angles, organized sequentially, and stitched together via specialized software to create 3D models with photorealistic textures. We also used fine-art (drawing/painting) techniques to render objects in situ, to gain deeper detail than obtained by modern photography alone. We digitally manipulated 3D images to test-fit cast-off remains with split-pedestal boulders and to understand how monuments were made, worked, and assembled. Digital analyses suggest that certain matched sets of boulder parts, previously split and exposed to the same weathering effects, were worked by human action. Comparative analyses suggest that small, circular rings of moderate-sized stones, designated on mapping as Hut Sites, were likely places of cultic activity near tomb structures

Reckoning HIV/AIDS care : a longitudinal study of community home-based caregivers and clients in Swaziland

The article is a descriptive case study of a community home-based care (CHBC) organisation in Swaziland that depicts the convergence of CHBC expansion with substantially improved health outcomes. Comprised of 993 care supporters who tend to 3 839 clients in 37 communities across southern Swaziland, Shiselweni Home-based Care (SHBC) is illustrative of many resource-limited communities throughout Africa that have mobilised, at varying degrees of formality, to address the individual and household suffering associated with HIV/AIDS. To better understand the potential significance of global and national health policy/programming reliance on community health workers (task shifting), we analysed longitudinal data on both care supporter and client cohorts from 2008 to 2013. Most CHBC studies report data from only one cohort. Foremost, our analysis demonstrated a dramatic decline (71.4%) among SHBC clients in overall mortality from 32.2% to 9.2% between 2008 and 2013. Although the study was not designed to establish statistical significance or causality between SHBC expansion and health impact, our findings detail a compelling convergence among CHBC, improved HIV health practices, and declines in client mortality. Our analysis indicated (1) the potential contributions of community health workers to individual and community wellbeing, (2) the challenges of task-shifting agendas, above all comprehensive support of community health workers/care supporters, and (3) the importance of data collection to monitor and strengthen the critical health services assigned to CHBC. Detailed study of CHBC operations and practices is helpful also for advancing government and donor HIV/AIDS strategies, especially with respect to health services decentralisation, in Swaziland and similarly profiled settings.http://www.tandfonline.com/loi/raar202016-08-20hb201

“We smoke the same pipe”: religion and community home-based care for PLWH in rural Swaziland

We draw on a study of a church-run community home-based care organization in Swaziland to explore how individuals living with HIV perceived caregivers‘ impact on well-being. Our primary concern was to examine how religion, as a heuristic practice of Christian-based caregiving, was felt to be consequential in a direly underserved region. Part of a larger medical anthropological project, we conducted semi-structured interviews with 79 community home-based care clients, of whom half (53%) said they would have died, some from suicide, without its services. We utilized a critical phenomenological approach to interpret semantic and latent themes, and explicated these themes within a ‗healthworld‘ framework. Participants were resolute that caregivers be Christian, less for ideological positioning than for perceived ontological sameness and ascribed traits: ―telling the truth‖ about treatment, confidentiality, and an ethos of unconditional love that restored clients‘ desire to live and adhere to treatment. Findings are intended to help theorize phenomenological meanings of care, morality, health, and sickness, and to interrogate authoritative biomedically based rationalities that underwrite most HIV-related global health policy.http://www.tandfonline.com/toc/gmea202018-05-31hb2017Science of Religion and Missiolog

Topical application of entry inhibitors as "virustats" to prevent sexual transmission of HIV infection

With the continuing march of the AIDS epidemic and little hope for an effective vaccine in the near future, work to develop a topical strategy to prevent HIV infection is increasingly important. This stated, the track record of large scale "microbicide" trials has been disappointing with nonspecific inhibitors either failing to protect women from infection or even increasing HIV acquisition. Newer strategies that target directly the elements needed for viral entry into cells have shown promise in non-human primate models of HIV transmission and as these agents have not yet been broadly introduced in regions of highest HIV prevalence, they are particularly attractive for prophylaxis. We review here the agents that can block HIV cellular entry and that show promise as topical strategies or "virustats" to prevent mucosal transmission of HIV infectio

Food insecurity and ART adherence in Swaziland : the case for coordinated faith-based and multi-sectoral action

Faith-based organisations (FBOs) have long been involved in HIV and AIDS impact mitigation and humanitarian relief, but most are not equipped to intervene in the structural drivers of food insecurity and attendant health inequities. Acknowledging limitations is as paramount a task for organisational effectiveness as maximising strengths. This article reports findings from a study of HIV-positive care supporters who volunteer with a church-run home-based care organisation in Swaziland. The article seeks to assess the impact of chronic food insecurity on antiretroviral adherence practices and how these individuals manage daily food shortages. Findings highlight the limited capacities of FBOs in highly vulnerable settings and the imperative for international and governmental coordination.Les organisations confessionnelles sont depuis longtemps impliquées dans l'atténuation de l'impact du VIH/sida et dans l'aide humanitaire associée, mais la plupart d'entre elles ne sont pas équipées pour intervenir sur les facteurs structurels de l'insécurité alimentaire et les inégalités de santé qui en découlent. Du point de vue de l'efficience organisationnelle, la reconnaissance de ces limites est aussi primordiale que la maximisation des forces. Cet article présente les résultats d'une étude au Swaziland sur les aidants concernant les soins du VIH qui agissent bénévolement dans une structure de soins à domicile, dirigée par une église. L'article tente d'évaluer l'impact de l'insécurité alimentaire chronique sur l'observance des traitements antirétroviraux et examine comment les personnes concernées gèrent les pénuries alimentaires quotidiennes. Les résultats mettent l'accent sur les capacités limitées des organisations confessionnelles dans des environnements à forte vulnérabilité et sur l'urgente nécessité de la mise en place d'une coordination internationale et gouvernementale.Desde hace mucho tiempo, las organizaciones basadas en la fe (obf) han dedicado sus esfuerzos a mitigar los efectos provocados por el vih/sida y a prestar ayuda humanitaria. Sin embargo, en su mayoría las mismas no están preparadas para actuar sobre los factores estructurales de la inseguridad alimentaria ni sobre las desigualdades de salud asociadas a estos. En términos de la eficacia de dichas organizaciones, el reconocimiento de ese tipo de limitaciones constituye una tarea tan importante como la de potenciar sus fortalezas. El presente artículo da cuenta de los resultados surgidos de un estudio sobre una organización de fe que, a través del trabajo voluntario de acompañantes seropositivos, presta cuidados de salud en distintos hogares de Suazilandia. En este sentido, el artículo se propuso valorar el impacto que la inseguridad alimentaria crónica tiene en el acatamiento del régimen de tratamientos antirretrovirales por parte de personas seropositivas, así como evaluar la forma en que estas personas resuelven diariamente la escasez de alimentos. Los hallazgos al respecto subrayan la escasa capacidad que asiste a las obf en situaciones de alta vulnerabilidad, además de la imperiosa necesidad de que exista coordinación a nivel internacional y gubernamental.http://www.tandfonline.com/loi/cdip202019-01-21hj2018Science of Religion and Missiolog

Crystal Structure and Size-Dependent Neutralization Properties of HK20, a Human Monoclonal Antibody Binding to the Highly Conserved Heptad Repeat 1 of gp41

The human monoclonal antibody (mAb) HK20 neutralizes a broad spectrum of primary HIV-1 isolates by targeting the highly conserved heptad repeat 1 (HR1) of gp41, which is transiently exposed during HIV-1 entry. Here we present the crystal structure of the HK20 Fab in complex with a gp41 mimetic 5-Helix at 2.3 Å resolution. HK20 employs its heavy chain CDR H2 and H3 loops to bind into a conserved hydrophobic HR1 pocket that is occupied by HR2 residues in the gp41 post fusion conformation. Compared to the previously described HR1-specific mAb D5, HK20 approaches its epitope with a different angle which might favor epitope access and thus contribute to its higher neutralization breadth and potency. Comparison of the neutralization activities of HK20 IgG, Fab and scFv employing both single cycle and multiple cycle neutralization assays revealed much higher potencies for the smaller Fab and scFv over IgG, implying that the target site is difficult to access for complete antibodies. Nevertheless, two thirds of sera from HIV-1 infected individuals contain significant titers of HK20-inhibiting antibodies. The breadth of neutralization of primary isolates across all clades, the higher potencies for C-clade viruses and the targeting of a distinct site as compared to the fusion inhibitor T-20 demonstrate the potential of HK20 scFv as a therapeutic tool

A many-analysts approach to the relation between religiosity and well-being

The relation between religiosity and well-being is one of the most researched topics in the psychology of religion, yet the directionality and robustness of the effect remains debated. Here, we adopted a many-analysts approach to assess the robustness of this relation based on a new cross-cultural dataset (N=10,535 participants from 24 countries). We recruited 120 analysis teams to investigate (1) whether religious people self-report higher well-being, and (2) whether the relation between religiosity and self-reported well-being depends on perceived cultural norms of religion (i.e., whether it is considered normal and desirable to be religious in a given country). In a two-stage procedure, the teams first created an analysis plan and then executed their planned analysis on the data. For the first research question, all but 3 teams reported positive effect sizes with credible/confidence intervals excluding zero (median reported β=0.120). For the second research question, this was the case for 65% of the teams (median reported β=0.039). While most teams applied (multilevel) linear regression models, there was considerable variability in the choice of items used to construct the independent variables, the dependent variable, and the included covariates

A Many-analysts Approach to the Relation Between Religiosity and Well-being

The relation between religiosity and well-being is one of the most researched topics in the psychology of religion, yet the directionality and robustness of the effect remains debated. Here, we adopted a many-analysts approach to assess the robustness of this relation based on a new cross-cultural dataset (N = 10, 535 participants from 24 countries). We recruited 120 analysis teams to investigate (1) whether religious people self-report higher well-being, and (2) whether the relation between religiosity and self-reported well-being depends on perceived cultural norms of religion (i.e., whether it is considered normal and desirable to be religious in a given country). In a two-stage procedure, the teams first created an analysis plan and then executed their planned analysis on the data. For the first research question, all but 3 teams reported positive effect sizes with credible/confidence intervals excluding zero (median reported β = 0.120). For the second research question, this was the case for 65% of the teams (median reported β = 0.039). While most teams applied (multilevel) linear regression models, there was considerable variability in the choice of items used to construct the independent variables, the dependent variable, and the included covariates