Nora Engel | Maastricht University (original) (raw)

Books by Nora Engel

Global Health is increasingly becoming a political, professional, and academic field of its own. ... more Global Health is increasingly becoming a political, professional, and academic field of its own. New players and cross-border collaborations have emerged to solve some of the world's most daunting public health problems, resulting in a multitude of global health care innovations across different institutional and cultural settings. With these innovations often comes the underlying assumption that we can find universal solutions if only we can overcome the challenges posed by different contexts. Making Global Health Care Innovations Work is the first book that studies this tension between universal and localized health care innovations and provides a diverse account on how global health care innovations are and can be connected to local practices. Using approaches from science and technology studies (STS), innovation studies, development studies, and public health, the book contributes to the discussion on standardization and localization of global health innovations.

Papers by Nora Engel

Palgrave Macmillan US eBooks, 2014

Global health is becoming an increasingly political, professional, and academic field of its own.... more Global health is becoming an increasingly political, professional, and academic field of its own. New actors and forms of collaboration across borders have emerged to solve some of the world’s most daunting public health problems. Central among these efforts are a multitude of global health care innovations (drugs, diagnostics, and vaccines as well as policy initiatives and service delivery strategies) designed, developed, and implemented by a range of actors across very different institutional and cultural settings. Underlying these innovations is the common assumption that universal solutions can be found and brought to scale if implementation challenges of different contexts are overcome (e.g., function in weak health care systems where infrastructure, staff, and capacities might be absent). Standardized drug delivery programs are such a universal solution that allows participants to use the same training modules, delivery strategies, technologies, and logistics across very different contexts. These programs promise efficiency and the ability to reach large populations quickly while generating comparable global data through the same reporting and recording guidelines and standards. These are clearly beneficial aspects of universal solutions, and the belief in such magic silver bullets persists; however, global health technologies and solutions are not easily transferred to different local contexts.

Palgrave Macmillan US eBooks, 2014

The chapters that form this edition have been selected from the best master theses from the last ... more The chapters that form this edition have been selected from the best master theses from the last three years of the Masters of Global Health at Maastricht University. Students from various disciplines, backgrounds, and corners of the globe meet to study how trends in globalization impact the health of communities across the globe. Throughout the year, they learn how to critically analyze the latest approaches, policies, and innovations in biomedicine, health care, and health promotion and to understand how these interact with local and global conditions that impact life, work, and health in a myriad of ways. Functioning in international and multidisciplinary settings is yet another skill students acquire as they work on real life assignments in collaboration with peers from partner universities in India (Manipal University), Thailand (Thammasat University), and Canada (McMaster University). They collaborate in online, transcontinental study teams or when they take electives at one of the partnering universities. They also apply some of these theories, approaches, and methodologies to their own research studies. Some combine their educational and geographic backgrounds to explore topics that they had pondered for a long time; others plunge into new disciplines, geographies, and problems. The overall theme of the book is the result of a unique focus on innovation for global health and questions of design, transferability, and implementation of global health innovations in the Global Health Master Program. These questions are addressed throughout the program, but are especially addressed in an elective track on implementing innovations that explicitly asks, in several modules, how to transfer innovations and how to make them work in different contexts. We approach these questions by using insights from innovation and implementation studies, Science and Technology Studies, and practical examples of global health innovations. Several of the authors conducted their research through these questions, puzzles, and approaches, while others brought in refreshing contrasting perspectives onto the questions of innovation, standardization, and localization in global health. As such,

Point of care (POC) testing in communities, home settings, and primary healthcare centers is beli... more Point of care (POC) testing in communities, home settings, and primary healthcare centers is believed to have tremendous potential in reducing delays in diagnosing and initiating treatment for diseases such as HIV, tuberculosis, syphilis, and malaria. Quick diagnosis and further management decisions completed in the same clinical encounter or at least the same day, while the patient waits, promise to overcome delays associated with conventional laboratory-based testing. However, the availability of cheap, simple, and rapid tests that can be conducted outside laboratories does not automatically ensure successful POC testing. In order to understand the new roles and challenges medical devices such as these encounter, we need to study how diagnostics are used at the POC and integrated into workflow and patient pathways. This chapter reviews selected results from a qualitative research project on barriers to POC testing in India and South Africa and discusses them comparatively. The pro...

Poster Presentations, 2019

BMJ Global Health, 2018

Management of chronic conditions is a challenge for healthcare delivery systems world over and es... more Management of chronic conditions is a challenge for healthcare delivery systems world over and especially for low/middle-income countries (LMIC). Redesigning primary care to deliver quality care for chronic conditions is a need of the hour. However, much of the literature is from the experience of high-income countries. We conducted a synthesis of qualitative findings regarding care for chronic conditions at primary care facilities in LMICs. The themes identified were used to adapt the existing chronic care model (CCM) for application in an LMIC using the ‘best fit’ framework synthesis methodology. Primary qualitative research studies were systematically searched and coded using themes of the CCM. The results that could not be coded were thematically analysed to generate themes to enrich the model. Search strategy keywords were: primary health care, diabetes mellitus type 2, hypertension, chronic disease, developing countries, low, middle-income countries and LMIC country names as c...

Science and technology studies, Sep 5, 2017

International Journal for Equity in Health

Background Ensuring patient rights is an extension of applying human rights principles to health ... more Background Ensuring patient rights is an extension of applying human rights principles to health care. A critical examination of how the notion of patient rights is perceived and enacted by various actors through critical discourse analysis (CDA) can help understand the impediments to its realization in practice. Methods We studied the discourses and discursive practices on patient rights in subnational policies and in ten health facilities in southern Karnataka, India. We conducted interviews (78), focus group discussions (3) with care-seeking individuals, care-providers, health care administrators and public health officials. We also conducted participant observation in selected health facilities and examined subnational policy documents of Karnataka pertaining to patient rights. We analyzed the qualitative data for major and minor themes. Results Patient rights discourses were not based upon human rights notions. In the context of neoliberalism, they were predominantly embedded w...

BMJ Global Health

BackgroundPatient rights aim to protect the dignity of healthcare-seeking individuals. Realisatio... more BackgroundPatient rights aim to protect the dignity of healthcare-seeking individuals. Realisation of these rights is predicated on effective grievance redressal for the victims of patient rights violations.MethodsWe used a critical case (that yields the most information) of patient rights violations reported in Karnataka state (South India) to explore the power dynamics involved in resolving grievances raised by healthcare-seeking individuals. Using interviews, media reports and other documents pertaining to the case, we explored the ‘governmentality’ of grievance redressal for patient rights violations, that is, the interaction of micropractices and techniques of power employed by actors to govern the processes and outcomes. We also examined whether existing governmentality ensured procedural and substantive justice to care-seeking individuals.ResultsCollective action was necessary by the aggrieved women in terms of protests, media engagement, petitions and follow-up to ensure tha...

Cochrane Database of Systematic Reviews

BMJ Open, 2020

BackgroundChronic conditions are a leading cause of death and disability worldwide. Low-income an... more BackgroundChronic conditions are a leading cause of death and disability worldwide. Low-income and middle-income countries such as India bear a significant proportion of this global burden. Redesigning primary care from an acute-care model to a model that facilitates chronic care is a challenge and requires interventions at multiple levels.ObjectivesIn this intervention study, we aimed to strengthen primary care for diabetes and hypertension at publicly funded primary healthcare centres (PHCs) in rural South India.Design and methodsThe complexities of transforming the delivery of primary care motivated us to use a ‘theory of change’ approach to design, implement and evaluate the interventions. We used both quantitative and qualitative data collection methods. Data from patient records regarding processes of care, glycaemic and blood pressure control, interviews with patients, observations and field notes were used to analyse what changes occurred and why.InterventionsWe implemented ...

Health Policy and Planning, 2021

The notion of patient rights encompasses the obligations of the state and healthcare providers to... more The notion of patient rights encompasses the obligations of the state and healthcare providers to respect the dignity, autonomy and equality of care-seeking individuals in healthcare processes. Functional patient grievance redressal systems are key to ensuring that the rights of individuals seeking healthcare are protected. We critically examined the published literature from high-income and upper-middle-income countries to establish an analytical framework on grievance redressal for patient rights violations in health facilities. We then used lawsuits on patient rights violations from the Supreme Court of India to analyse the relevance of the developed framework to the Indian context. With market perspectives pervading the health sector, there is an increasing trend of adopting a consumerist approach to protecting patient rights. In this line, avenues for grievance redressal for patient rights violations are gaining traction. Some of the methods and instruments for patient rights i...

Cochrane Database of Systematic Reviews, 2021

This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: To synthes... more This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: To synthesize end-user and professional user perspectives and experiences with low-complexity nucleic acid amplification tests (NAATs) for detection of tuberculosis and tuberculosis drug resistance. Review question What are the perspectives and experiences of people providing and receiving low-complexity NAATs to diagnose tuberculosis and tuberculosis drug resistance? Answering this question will allow us to identify the implications for e ective implementation and health equity.

The International Journal of Tuberculosis and Lung Disease, 2020

letter to edito

Frontiers in Sociology, 2020

Point-of-care testing promises laboratory-based precision in settings that do not have easy acces... more Point-of-care testing promises laboratory-based precision in settings that do not have easy access to laboratories or where processing tests takes too long or is too costly. Developers and global health actors stress values and norms such as simplicity, rapidity and accuracy for realizing diagnostic innovations that work at point of care and are aligned to the specific requirements of point-of-care settings. This paper uses fieldwork among diagnostic manufacturers, scientists, donors, members of civil society, industry consultants, international organizations, regulators, policymakers, programme officers, lab technicians, and clinicians involved in development and implementation of tuberculosis and HIV diagnostics, to examine how norms and values of what constitutes a good point-of-care diagnostic are operating in practice through both top-down and bottom-up dynamics. It draws the link between design, evidence and adoption of diagnostics and how the different actors interpret the values underpinning the new practice. The analysis draws on literature on valuation practices, evidence-making and technology design in science and technology studies and medical sociology. The findings reveal how these values constitute innovation, implementation, and evaluation practices across global and local (India) sites, with important consequences for funding of health infrastructure, capacity, and training resources for addressing some of the existing structural inequalities. Dominant values currently defining point of care diagnostics risk exacerbating health inequalities between those who do and do not have the necessary social and financial resources to access better equipped and functioning healthcare facilities, especially in resource constrained settings.

BMC Health Services Research, 2019

Background: Chronic diseases have emerged as the leading cause of death globally, and 20% of Indi... more Background: Chronic diseases have emerged as the leading cause of death globally, and 20% of Indians are estimated to suffer from a chronic condition. Care for chronic diseases poses a major public health challenge, especially when health care delivery has been geared traditionally towards acute care. In this study, we aimed to better understand how primary care for diabetes and hypertension is currently organised in first-line health facilities in rural India, and propose evidence-based ways forward for strengthening local health systems to address chronic problems. Methods: We used qualitative and quantitative methods to gain insight into how care is organised and how patients and providers manage within this delivery system. We conducted in-depth interviews with the medical doctors working in three private clinics and in three public primary health centres. We also interviewed 24 patients with chronic diseases receiving care in the two sub-sectors. Non-participant observations and facility assessments were performed to triangulate the findings from the interviews. Results: The current delivery system has many problems impeding the delivery of quality care for chronic conditions. In both the public and private facilities studied, the care processes are very doctor-centred, with little room for other health centre staff. Doctors face very high workloads, especially in the public sector, jeopardising proper communication with patients and adequate counselling. In addition, the health information system is fragmented and provides little or no support for patient follow-up and selfmanagement. The patient is largely left on their own in trying to make sense of their condition and in finding their way in a complex and scattered health care landscape. Conclusions: The design and organisation of care for persons with chronic diseases in India needs to be rethought. More space and responsibility should be given to the primary care level, and relatively less to the more specialised hospital level. Furthermore, doctors should consider delegating some of their tasks to other staff in the first-line health facility to significantly reduce their workload and increase time available for communication. The health information system needs to be adapted to better ensure continuity of care and support self-management by patients.

Open Forum Infectious Diseases, 2018

Background HIV self-testing (HIVST) offers a potential for expanded test access; challenges remai... more Background HIV self-testing (HIVST) offers a potential for expanded test access; challenges remain in operationalizing rapid personalized linkages and referrals to care. We investigated if an app-optimized personalized HIVST strategy improved referrals, detected new infections and expedited linkages to care and treatment. Methods In an ongoing cohort study (n = 2,000) based in South Africa, from November 2016 to January 2018, to participants presenting to self-test at community township based clinics, we offered a choice of the following strategies: (a) unsupervised HIVST; (b) supervised HIVST. We also observed participants opting for conventional HIV testing (ConvHT) in geographically separated clinics. We observed outcomes (i.e., linkage initiation, referrals, disease detection) and compared it between the two (HIVST vs. ConvHT) for the same duration. Results Of 2,000 participants, 1,000 participants were on HIVST, 599 (59.9%) chose unsupervised HIVST, 401 (40.1%) on supervised HI...

Global Health is increasingly becoming a political, professional, and academic field of its own. ... more Global Health is increasingly becoming a political, professional, and academic field of its own. New players and cross-border collaborations have emerged to solve some of the world's most daunting public health problems, resulting in a multitude of global health care innovations across different institutional and cultural settings. With these innovations often comes the underlying assumption that we can find universal solutions if only we can overcome the challenges posed by different contexts. Making Global Health Care Innovations Work is the first book that studies this tension between universal and localized health care innovations and provides a diverse account on how global health care innovations are and can be connected to local practices. Using approaches from science and technology studies (STS), innovation studies, development studies, and public health, the book contributes to the discussion on standardization and localization of global health innovations.

Palgrave Macmillan US eBooks, 2014

Global health is becoming an increasingly political, professional, and academic field of its own.... more Global health is becoming an increasingly political, professional, and academic field of its own. New actors and forms of collaboration across borders have emerged to solve some of the world’s most daunting public health problems. Central among these efforts are a multitude of global health care innovations (drugs, diagnostics, and vaccines as well as policy initiatives and service delivery strategies) designed, developed, and implemented by a range of actors across very different institutional and cultural settings. Underlying these innovations is the common assumption that universal solutions can be found and brought to scale if implementation challenges of different contexts are overcome (e.g., function in weak health care systems where infrastructure, staff, and capacities might be absent). Standardized drug delivery programs are such a universal solution that allows participants to use the same training modules, delivery strategies, technologies, and logistics across very different contexts. These programs promise efficiency and the ability to reach large populations quickly while generating comparable global data through the same reporting and recording guidelines and standards. These are clearly beneficial aspects of universal solutions, and the belief in such magic silver bullets persists; however, global health technologies and solutions are not easily transferred to different local contexts.

Palgrave Macmillan US eBooks, 2014

The chapters that form this edition have been selected from the best master theses from the last ... more The chapters that form this edition have been selected from the best master theses from the last three years of the Masters of Global Health at Maastricht University. Students from various disciplines, backgrounds, and corners of the globe meet to study how trends in globalization impact the health of communities across the globe. Throughout the year, they learn how to critically analyze the latest approaches, policies, and innovations in biomedicine, health care, and health promotion and to understand how these interact with local and global conditions that impact life, work, and health in a myriad of ways. Functioning in international and multidisciplinary settings is yet another skill students acquire as they work on real life assignments in collaboration with peers from partner universities in India (Manipal University), Thailand (Thammasat University), and Canada (McMaster University). They collaborate in online, transcontinental study teams or when they take electives at one of the partnering universities. They also apply some of these theories, approaches, and methodologies to their own research studies. Some combine their educational and geographic backgrounds to explore topics that they had pondered for a long time; others plunge into new disciplines, geographies, and problems. The overall theme of the book is the result of a unique focus on innovation for global health and questions of design, transferability, and implementation of global health innovations in the Global Health Master Program. These questions are addressed throughout the program, but are especially addressed in an elective track on implementing innovations that explicitly asks, in several modules, how to transfer innovations and how to make them work in different contexts. We approach these questions by using insights from innovation and implementation studies, Science and Technology Studies, and practical examples of global health innovations. Several of the authors conducted their research through these questions, puzzles, and approaches, while others brought in refreshing contrasting perspectives onto the questions of innovation, standardization, and localization in global health. As such,

Point of care (POC) testing in communities, home settings, and primary healthcare centers is beli... more Point of care (POC) testing in communities, home settings, and primary healthcare centers is believed to have tremendous potential in reducing delays in diagnosing and initiating treatment for diseases such as HIV, tuberculosis, syphilis, and malaria. Quick diagnosis and further management decisions completed in the same clinical encounter or at least the same day, while the patient waits, promise to overcome delays associated with conventional laboratory-based testing. However, the availability of cheap, simple, and rapid tests that can be conducted outside laboratories does not automatically ensure successful POC testing. In order to understand the new roles and challenges medical devices such as these encounter, we need to study how diagnostics are used at the POC and integrated into workflow and patient pathways. This chapter reviews selected results from a qualitative research project on barriers to POC testing in India and South Africa and discusses them comparatively. The pro...

Poster Presentations, 2019

BMJ Global Health, 2018

Management of chronic conditions is a challenge for healthcare delivery systems world over and es... more Management of chronic conditions is a challenge for healthcare delivery systems world over and especially for low/middle-income countries (LMIC). Redesigning primary care to deliver quality care for chronic conditions is a need of the hour. However, much of the literature is from the experience of high-income countries. We conducted a synthesis of qualitative findings regarding care for chronic conditions at primary care facilities in LMICs. The themes identified were used to adapt the existing chronic care model (CCM) for application in an LMIC using the ‘best fit’ framework synthesis methodology. Primary qualitative research studies were systematically searched and coded using themes of the CCM. The results that could not be coded were thematically analysed to generate themes to enrich the model. Search strategy keywords were: primary health care, diabetes mellitus type 2, hypertension, chronic disease, developing countries, low, middle-income countries and LMIC country names as c...

Science and technology studies, Sep 5, 2017

International Journal for Equity in Health

Background Ensuring patient rights is an extension of applying human rights principles to health ... more Background Ensuring patient rights is an extension of applying human rights principles to health care. A critical examination of how the notion of patient rights is perceived and enacted by various actors through critical discourse analysis (CDA) can help understand the impediments to its realization in practice. Methods We studied the discourses and discursive practices on patient rights in subnational policies and in ten health facilities in southern Karnataka, India. We conducted interviews (78), focus group discussions (3) with care-seeking individuals, care-providers, health care administrators and public health officials. We also conducted participant observation in selected health facilities and examined subnational policy documents of Karnataka pertaining to patient rights. We analyzed the qualitative data for major and minor themes. Results Patient rights discourses were not based upon human rights notions. In the context of neoliberalism, they were predominantly embedded w...

BMJ Global Health

BackgroundPatient rights aim to protect the dignity of healthcare-seeking individuals. Realisatio... more BackgroundPatient rights aim to protect the dignity of healthcare-seeking individuals. Realisation of these rights is predicated on effective grievance redressal for the victims of patient rights violations.MethodsWe used a critical case (that yields the most information) of patient rights violations reported in Karnataka state (South India) to explore the power dynamics involved in resolving grievances raised by healthcare-seeking individuals. Using interviews, media reports and other documents pertaining to the case, we explored the ‘governmentality’ of grievance redressal for patient rights violations, that is, the interaction of micropractices and techniques of power employed by actors to govern the processes and outcomes. We also examined whether existing governmentality ensured procedural and substantive justice to care-seeking individuals.ResultsCollective action was necessary by the aggrieved women in terms of protests, media engagement, petitions and follow-up to ensure tha...

Cochrane Database of Systematic Reviews

BMJ Open, 2020

BackgroundChronic conditions are a leading cause of death and disability worldwide. Low-income an... more BackgroundChronic conditions are a leading cause of death and disability worldwide. Low-income and middle-income countries such as India bear a significant proportion of this global burden. Redesigning primary care from an acute-care model to a model that facilitates chronic care is a challenge and requires interventions at multiple levels.ObjectivesIn this intervention study, we aimed to strengthen primary care for diabetes and hypertension at publicly funded primary healthcare centres (PHCs) in rural South India.Design and methodsThe complexities of transforming the delivery of primary care motivated us to use a ‘theory of change’ approach to design, implement and evaluate the interventions. We used both quantitative and qualitative data collection methods. Data from patient records regarding processes of care, glycaemic and blood pressure control, interviews with patients, observations and field notes were used to analyse what changes occurred and why.InterventionsWe implemented ...

Health Policy and Planning, 2021

The notion of patient rights encompasses the obligations of the state and healthcare providers to... more The notion of patient rights encompasses the obligations of the state and healthcare providers to respect the dignity, autonomy and equality of care-seeking individuals in healthcare processes. Functional patient grievance redressal systems are key to ensuring that the rights of individuals seeking healthcare are protected. We critically examined the published literature from high-income and upper-middle-income countries to establish an analytical framework on grievance redressal for patient rights violations in health facilities. We then used lawsuits on patient rights violations from the Supreme Court of India to analyse the relevance of the developed framework to the Indian context. With market perspectives pervading the health sector, there is an increasing trend of adopting a consumerist approach to protecting patient rights. In this line, avenues for grievance redressal for patient rights violations are gaining traction. Some of the methods and instruments for patient rights i...

Cochrane Database of Systematic Reviews, 2021

This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: To synthes... more This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: To synthesize end-user and professional user perspectives and experiences with low-complexity nucleic acid amplification tests (NAATs) for detection of tuberculosis and tuberculosis drug resistance. Review question What are the perspectives and experiences of people providing and receiving low-complexity NAATs to diagnose tuberculosis and tuberculosis drug resistance? Answering this question will allow us to identify the implications for e ective implementation and health equity.

The International Journal of Tuberculosis and Lung Disease, 2020

letter to edito

Frontiers in Sociology, 2020

Point-of-care testing promises laboratory-based precision in settings that do not have easy acces... more Point-of-care testing promises laboratory-based precision in settings that do not have easy access to laboratories or where processing tests takes too long or is too costly. Developers and global health actors stress values and norms such as simplicity, rapidity and accuracy for realizing diagnostic innovations that work at point of care and are aligned to the specific requirements of point-of-care settings. This paper uses fieldwork among diagnostic manufacturers, scientists, donors, members of civil society, industry consultants, international organizations, regulators, policymakers, programme officers, lab technicians, and clinicians involved in development and implementation of tuberculosis and HIV diagnostics, to examine how norms and values of what constitutes a good point-of-care diagnostic are operating in practice through both top-down and bottom-up dynamics. It draws the link between design, evidence and adoption of diagnostics and how the different actors interpret the values underpinning the new practice. The analysis draws on literature on valuation practices, evidence-making and technology design in science and technology studies and medical sociology. The findings reveal how these values constitute innovation, implementation, and evaluation practices across global and local (India) sites, with important consequences for funding of health infrastructure, capacity, and training resources for addressing some of the existing structural inequalities. Dominant values currently defining point of care diagnostics risk exacerbating health inequalities between those who do and do not have the necessary social and financial resources to access better equipped and functioning healthcare facilities, especially in resource constrained settings.

BMC Health Services Research, 2019

Background: Chronic diseases have emerged as the leading cause of death globally, and 20% of Indi... more Background: Chronic diseases have emerged as the leading cause of death globally, and 20% of Indians are estimated to suffer from a chronic condition. Care for chronic diseases poses a major public health challenge, especially when health care delivery has been geared traditionally towards acute care. In this study, we aimed to better understand how primary care for diabetes and hypertension is currently organised in first-line health facilities in rural India, and propose evidence-based ways forward for strengthening local health systems to address chronic problems. Methods: We used qualitative and quantitative methods to gain insight into how care is organised and how patients and providers manage within this delivery system. We conducted in-depth interviews with the medical doctors working in three private clinics and in three public primary health centres. We also interviewed 24 patients with chronic diseases receiving care in the two sub-sectors. Non-participant observations and facility assessments were performed to triangulate the findings from the interviews. Results: The current delivery system has many problems impeding the delivery of quality care for chronic conditions. In both the public and private facilities studied, the care processes are very doctor-centred, with little room for other health centre staff. Doctors face very high workloads, especially in the public sector, jeopardising proper communication with patients and adequate counselling. In addition, the health information system is fragmented and provides little or no support for patient follow-up and selfmanagement. The patient is largely left on their own in trying to make sense of their condition and in finding their way in a complex and scattered health care landscape. Conclusions: The design and organisation of care for persons with chronic diseases in India needs to be rethought. More space and responsibility should be given to the primary care level, and relatively less to the more specialised hospital level. Furthermore, doctors should consider delegating some of their tasks to other staff in the first-line health facility to significantly reduce their workload and increase time available for communication. The health information system needs to be adapted to better ensure continuity of care and support self-management by patients.

Open Forum Infectious Diseases, 2018

Background HIV self-testing (HIVST) offers a potential for expanded test access; challenges remai... more Background HIV self-testing (HIVST) offers a potential for expanded test access; challenges remain in operationalizing rapid personalized linkages and referrals to care. We investigated if an app-optimized personalized HIVST strategy improved referrals, detected new infections and expedited linkages to care and treatment. Methods In an ongoing cohort study (n = 2,000) based in South Africa, from November 2016 to January 2018, to participants presenting to self-test at community township based clinics, we offered a choice of the following strategies: (a) unsupervised HIVST; (b) supervised HIVST. We also observed participants opting for conventional HIV testing (ConvHT) in geographically separated clinics. We observed outcomes (i.e., linkage initiation, referrals, disease detection) and compared it between the two (HIVST vs. ConvHT) for the same duration. Results Of 2,000 participants, 1,000 participants were on HIVST, 599 (59.9%) chose unsupervised HIVST, 401 (40.1%) on supervised HI...

Sociology of Health & Illness, 2021

Mobile health (mHealth) technologies for HIV care are developed to provide diagnostic support, he... more Mobile health (mHealth) technologies for HIV care are developed to provide diagnostic support, health education, risk assessment and self‐monitoring. They aim to either improve or replace part of the therapeutic relationship. Part of the therapeutic relationship is affective, with the emergence of feelings and emotion, yet little research on mHealth for HIV care focuses on affect and HIV testing practices. Furthermore, most of the literature exploring affect and care relations with the introduction of mHealth is limited to the European and Australian context. This article explores affective dimensions of HIV self‐testing using a smartphone app strategy in Cape Town, South Africa and Montréal, Canada. This study is based on observation notes, 41 interviews and 1 focus group discussion with study participants and trained HIV healthcare providers from two quantitative studies evaluating the app‐based self‐test strategy. Our paper reveals how fear, apathy, judgement, frustration and com...