Adherence to HIV antiretroviral therapy (ART) is a crucial factor in health outcomes for people living with HIV (PLWH). Interventions to support ART adherence are increasingly focused on the household as a source of social support. This review aims to examine the social and structural determinants of support for ART adherence within households and families in low- and middle-income countries (LMICs). The review methodology followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seven databases were searched for peer-reviewed literature. The terms searched thematically covered (1) ART adherence, (2) household and family and (3) support and care. Thirty-three studies conducted in 15 LMICs were selected and a mixed methods synthesis was undertaken. Social and structural determinants affected the type, quality and amount of support for PLWH of all ages, which affected PLWH’s ART adherence. Gender norms affected the type of support that household members give to PLWH. Education moderated household support for ART adherence through literacy and language skills. Cultural context, religious beliefs, and social norms reinforced or undermined household support for ART adherence. Stigma affected disclosure, generated secrecy around giving medication and impeded access to support from the community. Supporting PLWH exacerbated economic hardship for household members. Health system dysfunction negatively impacted trust and communication between household members and health professionals. Intersecting social and structural determinants particularly affected the care given by household members who were older, female, with little education and low socioeconomic status. Household members were able to overcome some of these barriers when they received support themselves. Household interventions to support PLWH’s ART adherence should take structural factors into account to have maximum impact.
Active labour market policies, like training, aim to increase the employability of unemployed population subgroups. Research indicates that the most vulnerable groups—such as women of migrant origin—are less likely to participate in the most effective programmes. Prior studies have established that household composition affects the labour market outcomes of women without and with a migration background. In contrast, research has not addressed the potential relevance of household composition in relation to women’s training uptake. Using hazard models and longitudinal microdata from the employment office and social security registers, we analyse the extent to which women’s household composition such as the presence and the origin of their partner or the presence of children is associated with the uptake of occupation‐specific training in Flanders (Belgium). Our results suggest that, even when we control for previously identified determinants of training uptake such as the human capital of unemployed women, training uptake in most groups varies by household composition. More specifically, the results suggest that women with a partner of non‐migrant origin show higher cumulative uptake than women with a migrant origin partner or single women, and that the presence of children in the household reduces women’s training participation. Furthermore, household composition is found to be a stronger differentiating factor in uptake for migrant origin women than for non‐migrant origin women.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.