IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v69y2009i8p1177-1185.html
   My bibliography  Save this article

Public-sector ART in the Free State Province, South Africa: Community support as an important determinant of outcome

Author

Listed:
  • Wouters, Edwin
  • Van Damme, Wim
  • Van Loon, Francis
  • van Rensburg, Dingie
  • Meulemans, Herman

Abstract

The treatment outcomes for large-scale public antiretroviral therapy (ART) programs in developing countries, although promising, are still preliminary. The scaling-up of ART in resource-limited settings is inevitably hampered by human resource shortages. Therefore, community support for ART patients may play an important role in achieving favorable treatment outcomes. This study aimed to extend the current literature by investigating how immunological and virological responses to ART, measured at three points in time (after six, 12, and 24 months of ART), are influenced by patient characteristics (age, sex), health literacy (educational level and knowledge about HIV/AIDS), baseline CD4 cell count, baseline viral load, and three forms of community support (treatment buddy, community health worker [CHW], and HIV/AIDS support group). Cross-lagged regression analysis was used to test these relationships in a sample of 268 patients enrolled in the public-sector ART program of the Free State Province of South Africa (2004-2007). After 24 months of ART, 76.4% of patients were classified as treatment successes (viral load = 200 cells/[mu]L), compared with 64.1% at 12 months and 46.1% at six months. When we examined the predictors of ART success, baseline health and all three community support initiatives had a positive effect on ART outcomes after six months, whereas patient characteristics had little effect. Six months later, patients with the support of a treatment buddy, CHW, or support group had better ART outcomes, whereas the impact of baseline health had diminished. After two years of treatment, community support again emerged as the most important predictor of treatment success. This study confirms that the ART provided by South African public-sector health services is effective. These results provide evidence from the field that communities can be mobilized to sustain these favorable outcomes under conditions of limited human resources for healthcare.

Suggested Citation

  • Wouters, Edwin & Van Damme, Wim & Van Loon, Francis & van Rensburg, Dingie & Meulemans, Herman, 2009. "Public-sector ART in the Free State Province, South Africa: Community support as an important determinant of outcome," Social Science & Medicine, Elsevier, vol. 69(8), pages 1177-1185, October.
    • Handle: RePEc:eee:socmed:v:69:y:2009:i:8:p:1177-1185
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(09)00491-2
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Standing, H. & Chowdhury, A. Mushtaque R., 2008. "Producing effective knowledge agents in a pluralistic environment: What future for community health workers?," Social Science & Medicine, Elsevier, vol. 66(10), pages 2096-2107, May.
    2. Van Damme, Wim & Kober, Katharina & Kegels, Guy, 2008. "Scaling-up antiretroviral treatment in Southern African countries with human resource shortage: How will health systems adapt?," Social Science & Medicine, Elsevier, vol. 66(10), pages 2108-2121, May.
    3. Nutbeam, Don, 2008. "The evolving concept of health literacy," Social Science & Medicine, Elsevier, vol. 67(12), pages 2072-2078, December.
    4. Pronyk, Paul M. & Harpham, Trudy & Busza, Joanna & Phetla, Godfrey & Morison, Linda A. & Hargreaves, James R. & Kim, Julia C. & Watts, Charlotte H. & Porter, John D., 2008. "Can social capital be intentionally generated? A randomized trial from rural South Africa," Social Science & Medicine, Elsevier, vol. 67(10), pages 1559-1570, November.
    5. Rose, Richard, 2000. "How much does social capital add to individual health?A survey study of Russians," Social Science & Medicine, Elsevier, vol. 51(9), pages 1421-1435, November.
    6. Pronyk, Paul M. & Harpham, Trudy & Morison, Linda A. & Hargreaves, James R. & Kim, Julia C. & Phetla, Godfrey & Watts, Charlotte H. & Porter, John D., 2008. "Is social capital associated with HIV risk in rural South Africa?," Social Science & Medicine, Elsevier, vol. 66(9), pages 1999-2010, May.
    7. Lee, Shoou-Yih D. & Arozullah, Ahsan M. & Cho, Young Ik, 2004. "Health literacy, social support, and health: a research agenda," Social Science & Medicine, Elsevier, vol. 58(7), pages 1309-1321, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Wouters, Edwin & Masquillier, Caroline & Ponnet, Koen & le Roux Booysen, Frederik, 2014. "A peer adherence support intervention to improve the antiretroviral treatment outcomes of HIV patients in South Africa: The moderating role of family dynamics," Social Science & Medicine, Elsevier, vol. 113(C), pages 145-153.
    2. Helmut Beichler & Igor Grabovac & Thomas E. Dorner, 2023. "Integrated Care as a Model for Interprofessional Disease Management and the Benefits for People Living with HIV/AIDS," IJERPH, MDPI, vol. 20(4), pages 1-15, February.
    3. Robertson, Laura & Mushati, Phyllis & Skovdal, Morten & Eaton, Jeffrey W. & Makoni, Jeremiah C. & Crea, Tom & Mavise, Gideon & Dumba, Lovemore & Schumacher, Christina & Sherr, Lorraine & Nyamukapa, Co, 2014. "Involving Communities in the Targeting of Cash Transfer Programs for Vulnerable Children: Opportunities and Challenges," World Development, Elsevier, vol. 54(C), pages 325-337.
    4. Tulloch, Olivia & Taegtmeyer, Miriam & Ananworanich, Jintanat & Chasombat, Sanchai & Kosalaraksa, Pope & Theobald, Sally, 2015. "What can volunteer co-providers contribute to health systems? The role of people living with HIV in the Thai paediatric HIV programme," Social Science & Medicine, Elsevier, vol. 145(C), pages 184-192.
    5. Kerry E Uebel & Gina Joubert & Edwin Wouters & Willie F Mollentze & Dingie H C J van Rensburg, 2013. "Integrating HIV Care into Primary Care Services: Quantifying Progress of an Intervention in South Africa," PLOS ONE, Public Library of Science, vol. 8(1), pages 1-8, January.
    6. Mosa Moshabela & Shira Gitomer & Bongiwe Qhibi & Helen Schneider, 2013. "Development of Non-Profit Organisations Providing Health and Social Services in Rural South Africa: A Three-Year Longitudinal Study," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-1, December.
    7. Boyer, Sylvie & Clerc, Isabelle & Bonono, Cécile-Renée & Marcellin, Fabienne & Bilé, Paule-Christiane & Ventelou, Bruno, 2011. "Non-adherence to antiretroviral treatment and unplanned treatment interruption among people living with HIV/AIDS in Cameroon: Individual and healthcare supply-related factors," Social Science & Medicine, Elsevier, vol. 72(8), pages 1383-1392, April.
    8. Fabien Taieb & Yoann Madec & Amandine Cournil & Eric Delaporte, 2017. "Virological success after 12 and 24 months of antiretroviral therapy in sub-Saharan Africa: Comparing results of trials, cohorts and cross-sectional studies using a systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-28, April.
    9. Ilona Sips & Ahmad Haeri Mazanderani & Helen Schneider & Minrie Greeff & Francoise Barten & Mosa Moshabela, 2014. "Community Care Workers, Poor Referral Networks and Consumption of Personal Resources in Rural South Africa," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-7, April.
    10. Caroline Masquillier & Edwin Wouters & Dimitri Mortelmans & Brian Van Wyk, 2015. "On the Road to HIV/AIDS Competence in the Household: Building a Health-Enabling Environment for People Living with HIV/AIDS," IJERPH, MDPI, vol. 12(3), pages 1-29, March.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Agampodi, Thilini Chanchala & Agampodi, Suneth Buddhika & Glozier, Nicholas & Siribaddana, Sisira, 2015. "Measurement of social capital in relation to health in low and middle income countries (LMIC): A systematic review," Social Science & Medicine, Elsevier, vol. 128(C), pages 95-104.
    2. Chinn, Deborah, 2011. "Critical health literacy: A review and critical analysis," Social Science & Medicine, Elsevier, vol. 73(1), pages 60-67, July.
    3. Bas Geboers & Sijmen A. Reijneveld & Jaap A. R. Koot & Andrea F. De Winter, 2018. "Moving towards a Comprehensive Approach for Health Literacy Interventions: The Development of a Health Literacy Intervention Model," IJERPH, MDPI, vol. 15(6), pages 1-11, June.
    4. Kumar, Santosh & Calvo, Rocio & Avendano, Mauricio & Sivaramakrishnan, Kavita & Berkman, Lisa F., 2012. "Social support, volunteering and health around the world: Cross-national evidence from 139 countries," Social Science & Medicine, Elsevier, vol. 74(5), pages 696-706.
    5. Haribondhu Sarma & Ishrat Jabeen & Sharmin Khan Luies & Md Fakhar Uddin & Tahmeed Ahmed & Thomas J Bossert & Cathy Banwell, 2020. "Performance of volunteer community health workers in implementing home-fortification interventions in Bangladesh: A qualitative investigation," PLOS ONE, Public Library of Science, vol. 15(4), pages 1-20, April.
    6. Oasis Kodila-Tedika & Julius Agbor, 2016. "Does Trust Matter for Entrepreneurship: Evidence from a Cross-Section of Countries," Economies, MDPI, vol. 4(1), pages 1-17, March.
    7. Maricel G. Santos & Anu L. Gorukanti & Lina M. Jurkunas & Margaret A. Handley, 2018. "The Health Literacy of U.S. Immigrant Adolescents: A Neglected Research Priority in a Changing World," IJERPH, MDPI, vol. 15(10), pages 1-18, September.
    8. Leonard, David K. & Bloom, Gerald & Hanson, Kara & O’Farrell, Juan & Spicer, Neil, 2013. "Institutional Solutions to the Asymmetric Information Problem in Health and Development Services for the Poor," World Development, Elsevier, vol. 48(C), pages 71-87.
    9. Zihan Cai & Ming Lu, 2018. "Social Integration Measurement of Inhabitants in Historic Blocks: The Case of Harbin, China," Sustainability, MDPI, vol. 10(8), pages 1-19, August.
    10. Maria Pavlova & Rainer Silbereisen & Kamil Sijko, 2014. "Social Participation in Poland: Links to Emotional Well-Being and Risky Alcohol Consumption," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 117(1), pages 29-44, May.
    11. Apiradee Nantsupawat & Orn‐Anong Wichaikhum & Kulwadee Abhicharttibutra & Wipada Kunaviktikul & Mohd Said Bin Nurumal & Lusine Poghosyan, 2020. "Nurses' knowledge of health literacy, communication techniques, and barriers to the implementation of health literacy programs: A cross‐sectional study," Nursing & Health Sciences, John Wiley & Sons, vol. 22(3), pages 577-585, September.
    12. Barış Alpaslan & Julide Yildirim, 2020. "The Missing Link: Are Individuals with More Social Capital in Better Health? Evidence from India," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 150(3), pages 811-834, August.
    13. Chiao Ling Huang & Shu-Ching Yang & Chia-Hsun Chiang, 2020. "The Associations between Individual Factors, eHealth Literacy, and Health Behaviors among College Students," IJERPH, MDPI, vol. 17(6), pages 1-13, March.
    14. Ryuichi Ohta & Koichi Maiguma & Akiko Yata & Chiaki Sano, 2022. "Rebuilding Social Capital through Osekkai Conferences in Rural Communities: A Social Network Analysis," IJERPH, MDPI, vol. 19(13), pages 1-10, June.
    15. Ball, Kylie & Cleland, Verity J. & Timperio, Anna F. & Salmon, Jo & Giles-Corti, Billie & Crawford, David A., 2010. "Love thy neighbour? Associations of social capital and crime with physical activity amongst women," Social Science & Medicine, Elsevier, vol. 71(4), pages 807-814, August.
    16. Sirven, Nicolas, 2006. "Endogenous social capital and self-rated health: Cross-sectional data from rural areas of Madagascar," Social Science & Medicine, Elsevier, vol. 63(6), pages 1489-1502, September.
    17. Maru, Yiheyis & Sparrow, Ashley & Stirzaker, Richard & Davies, Jocelyn, 2018. "Integrated agricultural research for development (IAR4D) from a theory of change perspective," Agricultural Systems, Elsevier, vol. 165(C), pages 310-320.
    18. Yuji Kanejima & Kazuhiro P. Izawa & Masahiro Kitamura & Kodai Ishihara & Asami Ogura & Ikko Kubo & Hitomi Nagashima & Hideto Tawa & Daisuke Matsumoto & Ikki Shimizu, 2022. "Health Literacy Is Associated with Activities of Daily Living of Patients Participating in Cardiac Rehabilitation: A Multicenter Clinical Study," IJERPH, MDPI, vol. 19(24), pages 1-10, December.
    19. Yang Xiao & Yanjie Bian & Lei Zhang, 2020. "Mental Health of Chinese Online Networkers under COVID-19: A Sociological Analysis of Survey Data," IJERPH, MDPI, vol. 17(23), pages 1-17, November.
    20. Constanze Hübner & Mariya Lorke & Annika Buchholz & Stefanie Frech & Laura Harzheim & Sabine Schulz & Saskia Jünger & Christiane Woopen, 2022. "Health Literacy in the Context of Implant Care—Perspectives of (Prospective) Implant Wearers on Individual and Organisational Factors," IJERPH, MDPI, vol. 19(12), pages 1-36, June.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:69:y:2009:i:8:p:1177-1185. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.