Role of Community-Level Factors Across the Treatment Cascade

Abstract

Addressing community-level factors (CLFs) is integral to the ongoing effort to design multilevel, effective, and sustainable interventions to address each element of the HIV/AIDS treatment cascade. This review, the first critical review of this topic, identified 100 articles that (1) assessed CLFs in relation to the HIV/AIDS treatment cascade, (2) had been peer-reviewed, and (3) were based on studies conducted in low- or middle-income countries. Social support and social networks, cultural norms, gender norms, and stigma were the key CLFs associated with treatment and care. This extensive review found only 5 evaluations of interventions designed to affect CLFs, reflecting a major gap in the literature. All were communication interventions designed to create a more positive environment for HIV testing and access to treatment and care, thus pointing to some of the potential extraindividual effects of communication interventions. The qualitative data are rich and vital for understanding the context; yet, more quantitative analysis to provide evidence regarding the distribution of these factors is essential, as only 19 of the studies were quantitative. There is a pressing need to (1) collect community-level data, (2) validate social and gender norm scales, and (3) better use available data regarding social norms, gender norms, and other CLFs. These data could be aggregated at the cluster, neighborhood, or community levels and incorporated into multilevel analysis to help clarify the pathways to enhanced outcomes across the treatment cascade and thereby mitigate HIV sequelae.

Individual and Community Factors Associated With Geographic Clusters of Poor HIV Care Retention and Poor Viral Suppression

“…3,11 As monitoring of HIV infection increasingly focuses on the HIV care continuum 11–14 , analyses of public health surveillance data may reveal geographic patterns that vary at each step. 15,16 Moreover, a better understanding of the structural and community-level factors that influence or impede completion of HIV care continuum steps is needed 17–23 .…”

The biopolitics of engagement and the HIV cascade of care: a synthesis of the literature on patient citizenship and antiretroviral therapy

“…Discourses of the care cascade imply certain kinds of patient expectation and responsibility. An extensive body of extant literature accentuates how social and environmental factors shape HIV treatment provision and engagement (Gari et al, 2013;Merten et al, 2010;Underwood, Hendrickson, Van Lith, Kunda, and Mallalieu, 2014). Additionally, critical perspectives in the social sciences have reflected upon HIV and its care as constituted through situated health practices, identities and subjectivities, with implications for different social and political contexts Whyte, 2009).…”

Mobilising faith-based and lay leaders to address antenatal care outcomes in northern Ghana

“…Socio-cultural factors have also been shown to be important determinants of MNCH behaviours in SSA, including ANC attendance (Ahmed et al 2010;Hiarlaithe et al 2014;Pell et al 2013;Simkhada et al 2008;Underwood et al 2014). A study on facility delivery in northern Ghana, for example, found that traditional power hierarchies in the household and communities influenced the uptake of key health-seeking behaviours, and that often "someone must give the order", potentially hindering uptake of essential MNCH behaviours (Moyer et al 2014).…”

“…Ghana instituted its National Health Insurance Scheme (NHIS) in 2003 -with a primary objective to limit cost as a barrier to accessing MNCH services. A recent study in northern Ghana illustrated that enrolment in the NHIS had a positive association with uptake of institutional delivery; however, there was no effect on women's attendance of four or more ANC visits (Singh et al 2015).Socio-cultural factors have also been shown to be important determinants of MNCH behaviours in SSA, including ANC attendance (Ahmed et al 2010;Hiarlaithe et al 2014;Pell et al 2013;Simkhada et al 2008;Underwood et al 2014). A study on facility delivery in northern Ghana, for example, found that traditional power hierarchies in the household and communities influenced the uptake of key health-seeking behaviours, and that often "someone must give the order", potentially hindering uptake of essential MNCH behaviours (Moyer et al 2014).…”