Data were drawn from a qualitative study that was part of a social science research agenda within the ANRS 12249 TasP trial. The trial was undertaken in Hlabisa, a sub-district in KwaZulu-Natal Province, South Africa, with a population of 228,000, an adult HIV prevalence of 29%, and a network of 17 primary health centres (PHCs) that also offer HIV testing and treatment to eligible people. Implementation of the trial took a phased approach, starting with 4 clusters in March 2012, then adding 6 in January 2013, and another 12 in June 2014. Follow-up in all clusters was planned to run until June 2016 (a fuller description of the trial is provided in Orne-Gliemann, 2016 (link)).
Data were collected in the four initial trial clusters using in-depth interviews (IDI) and focus group discussions (FGD). Participants were varied to capture diverse perspectives. Four FGDs were constituted as follows: younger people identified by randomly approaching households; traditional healers (THP) identified through their peers; older people recruited with help from a community caregiver [C-CG]; and a “mixed” group – comprising young and old men and women, and two THPs – recruited with assistance from a community member. Fewer men were recruited because they were either absent or unable to commit to participating. Four repeat sessions were conducted per group, each focusing on a specific topic and lasting 45–120 minutes. Venues for FGDs were school and community halls, a community tuckshop, and a faith-based organisation’s premises. For IDIs, 20 participants (10 men, 10 women; age range 17–64) were recruited based on criteria age ≥16 years and residence in the four clusters. Recruitment entailed directly approaching homesteads, or announcing the study in the waiting area of one of the trial clinics before engaging interested potential participants individually. Household-recruited participants’ HIV status was unknown unless it had, without solicitation, been disclosed during an interview. Clinic-recruited participants’ HIV status was known. Initial interviews were done in January–March 2013 and lasted 30–60 minutes. Ten of the IDI participants, who were varied by distance from health facility, gender, and HIV status, were selected to participate in two consecutive repeat interviews each in July–November 2013. Venues for IDIs were participants’ homes or TasP clinics. An overview of the sample and research process is presented inTable 1 , and additional details about the sample are provided in a related paper (Orne-Gliemann, 2016 (link)).
A social scientist fluent in the local language facilitated the FGDs and conducted the interviews, and these were recorded, transcribed, translated into English, and then analysed collaboratively by two independent social scientists. Transcripts were entered into Nvivo v10 qualitative data analysis software (QSR, Melbourne, Australia), and coded inductively and deductively. The coding frame was developed initially from three thematic areas of prior interest, namely barriers to HIV testing, acceptability of early ART for treatment and prevention, and partner influence on beliefs and practices. Codes were then refined by being iteratively broken down and reconnected through theoretical coding to form higher-level thematic categories (Morgan, Krueger, & King, 1998 ; Strauss & Corbin, 1990 ). Emerging themes were consolidated through re-reading and contextually interpreting data in the transcripts until saturation (Marshall, 1996 (link)) was achieved. Issues pertaining to gender relations and masculinity emerged as a central theme, and given prior knowledge that masculinity affects engagement with healthcare, we were then curious to explore further the manifestation of this relationship in the novel context of a UTT and TasP trial. Data pertaining to this theme were pulled out and read further to identify salient sub-themes, which are presented in this paper and illustrated with supporting quotes. The Biomedical Research Ethics Committee of the University of KwaZulu-Natal approved the study (Approval Number BCF104/11) as part of the trial’s social science programme. Informed consent was obtained from each participant, and confidentiality and anonymity were ensured.
Data were collected in the four initial trial clusters using in-depth interviews (IDI) and focus group discussions (FGD). Participants were varied to capture diverse perspectives. Four FGDs were constituted as follows: younger people identified by randomly approaching households; traditional healers (THP) identified through their peers; older people recruited with help from a community caregiver [C-CG]; and a “mixed” group – comprising young and old men and women, and two THPs – recruited with assistance from a community member. Fewer men were recruited because they were either absent or unable to commit to participating. Four repeat sessions were conducted per group, each focusing on a specific topic and lasting 45–120 minutes. Venues for FGDs were school and community halls, a community tuckshop, and a faith-based organisation’s premises. For IDIs, 20 participants (10 men, 10 women; age range 17–64) were recruited based on criteria age ≥16 years and residence in the four clusters. Recruitment entailed directly approaching homesteads, or announcing the study in the waiting area of one of the trial clinics before engaging interested potential participants individually. Household-recruited participants’ HIV status was unknown unless it had, without solicitation, been disclosed during an interview. Clinic-recruited participants’ HIV status was known. Initial interviews were done in January–March 2013 and lasted 30–60 minutes. Ten of the IDI participants, who were varied by distance from health facility, gender, and HIV status, were selected to participate in two consecutive repeat interviews each in July–November 2013. Venues for IDIs were participants’ homes or TasP clinics. An overview of the sample and research process is presented in
A social scientist fluent in the local language facilitated the FGDs and conducted the interviews, and these were recorded, transcribed, translated into English, and then analysed collaboratively by two independent social scientists. Transcripts were entered into Nvivo v10 qualitative data analysis software (QSR, Melbourne, Australia), and coded inductively and deductively. The coding frame was developed initially from three thematic areas of prior interest, namely barriers to HIV testing, acceptability of early ART for treatment and prevention, and partner influence on beliefs and practices. Codes were then refined by being iteratively broken down and reconnected through theoretical coding to form higher-level thematic categories (Morgan, Krueger, & King, 1998 ; Strauss & Corbin, 1990 ). Emerging themes were consolidated through re-reading and contextually interpreting data in the transcripts until saturation (Marshall, 1996 (link)) was achieved. Issues pertaining to gender relations and masculinity emerged as a central theme, and given prior knowledge that masculinity affects engagement with healthcare, we were then curious to explore further the manifestation of this relationship in the novel context of a UTT and TasP trial. Data pertaining to this theme were pulled out and read further to identify salient sub-themes, which are presented in this paper and illustrated with supporting quotes. The Biomedical Research Ethics Committee of the University of KwaZulu-Natal approved the study (Approval Number BCF104/11) as part of the trial’s social science programme. Informed consent was obtained from each participant, and confidentiality and anonymity were ensured.
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