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Evaluating Outcomes of the Antiretroviral Intervention in South Africa: A Systems Thinking Research Framework

  • Johanna Ledwaba
  • Kambidima Wotela
Chapter

Abstract

Background and Significance of the topic: HIV has become one of the most serious health and social development challenges in the world. Sub-Saharan Africa accounts for two-thirds of global HIV infections and almost half of these are in Southern Africa. Within the region, South Africa has the largest number (7.1 million) of people infected with HIV. The antiretroviral treatment intervention aims to reduce HIV transmission, improve the quality of life of people living with HIV, and to prolong life expectancy. To date, 3.4 million HIV-infected people receive antiretroviral treatment in South Africa. Notable literature is available on the outcomes of this intervention at country level and key urban areas. However, there is little, if any, knowledge on the outcomes in rural areas. Ultimately, this research intends to assess the outcomes of the antiretroviral treatment intervention in a South African rural setting called Mankweng in Limpopo Province using data abstracted from medical records to track viral load trends and to identify factors that affect virus suppression. The main focus of this paper is to propose a conceptual framework that should guide such an assessment. Methodology: We apply systems thinking approach to derive the theoretical framework and more importantly the conceptual framework in preparation for an empirical assessment of the antiretroviral intervention (ART) in a South African rural setting. Further, we then rely on summative content analysis to interrogate the academic and non-academic literature. Application/Relevance to systems analysis: The system thinking provides for a general approach that emphasises the product (theoretical and conceptual framework) rather than the process (literature review). More specifically, it allows us to integrate more meaningfully both the physical and academic context to deriving the theoretical and conceptual framework. Policy and/or practice implications: In general, development interventions established elsewhere must be contextualised for the African continent and its sub-regions in order to achieve the best outcomes. Discussion and conclusion: Prominent in our interrogation of literature on outcomes of HIV interventions is the lack of a theory of change when undertaking summative evaluations. More specifically, the outcomes of the antiretroviral treatment interventions in rural areas remain unreported.

Keywords

HIV Viral load Antiretroviral treatment Knowledge gap Interpretive framework Theoretical framework Conceptual framework 

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Authors and Affiliations

  1. 1.WITS Graduate School of GovernanceUniversity of the Witwatersrand (WITS)JohannesburgSouth Africa

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