Antiretroviral therapy (ART) adherence among people living with HIV/AIDS (PLHIV) in the north of Vietnam : a multi-method approach

The antiretroviral therapy (ART) program for People Living with HIV/AIDS (PLHIV) in Vietnam has been scaled up rapidly in recent years (from 50 clients in 2003 to almost 38,000 in 2009). ART success is highly dependent on the ability of the patients to fully adhere to the prescribed treatment regimen. Despite the remarkable extension of ART programs in Vietnam, HIV/AIDS program managers still have little reliable data on levels of ART adherence and factors that might promote or reduce adherence. Several previous studies in Vietnam estimated extremely high levels of ART adherence among their samples, although there are reasons to question the veracity of the conclusion that adherence is nearly perfect. Further, no study has quantitatively assessed the factors influencing ART adherence. In order to reduce these gaps, this study was designed to include several phases and used a multi-method approach to examine levels of ART non-adherence and its relationship to a range of demographic, clinical, social and psychological factors. The study began with an exploratory qualitative phase employing four focus group discussions and 30 in-depth interviews with PLHIV, peer educators, carers and health care providers (HCPs). Survey interviews were completed with 615 PLHIV in five rural and urban out-patient clinics in northern Vietnam using an Audio Computer Assisted Self-Interview (ACASI) and clinical records extraction. The survey instrument was carefully developed through a systematic procedure to ensure its reliability and validity. Cultural appropriateness was considered in the design and implementation of both the qualitative study and the cross sectional survey. The qualitative study uncovered several contrary perceptions between health care providers and HIV/AIDS patients regarding the true levels of ART adherence. Health care providers often stated that most of their patients closely adhered to their regimens, while PLHIV and their peers reported that “it is not easy” to do so. The quantitative survey findings supported the PLHIV and their peers’ point of view in the qualitative study, because non-adherence to ART was relatively common among the study sample. Using the ACASI technique, the estimated prevalence of onemonth non-adherence measured by the Visual Analogue Scale (VAS) was 24.9% and the prevalence of four-day not-on-time-adherence using the modified Adult AIDS Clinical Trials Group (AACTG) instrument was 29%. Observed agreement between the two measures was 84% and kappa coefficient was 0.60 (SE=0.04 and p<0.0001). The good agreement between the two measures in the current study is consistent with those found in previous research and provides evidence of cross-validation of the estimated adherence levels. The qualitative study was also valuable in suggesting important variables for the survey conceptual framework and instrument development. The survey confirmed significant correlations between two measures of ART adherence (i.e. dose adherence and time adherence) and many factors identified in the qualitative study, but failed to find evidence of significant correlations of some other factors and ART adherence. Non-adherence to ART was significantly associated with untreated depression, heavy alcohol use, illicit drug use, experiences with medication side-effects, chance health locus of control, low quality of information from HCPs, low satisfaction with received support and poor social connectedness. No multivariate association was observed between ART adherence and age, gender, education, duration of ART, the use of adherence aids, disclosure of ART, patients’ ability to initiate communication with HCPs or distance between clinic and patients’ residence. This is the largest study yet reported in Asia to examine non-adherence to ART and its possible determinants. The evidence strongly supports recent calls from other developing nations for HIV/AIDS services to provide screening, counseling and treatment for patients with depressive symptoms, heavy use of alcohol and substance use. Counseling should also address fatalistic beliefs about chance or luck determining health outcomes. The data suggest that adherence could be enhanced by regularly providing information on ART and assisting patients to maintain social connectedness with their family and the community. This study highlights the benefits of using a multi-method approach in examining complex barriers and facilitators of medication adherence. It also demonstrated the utility of the ACASI interview method to enhance open disclosure by people living with HIV/AIDS and thus, increase the veracity of self-reported data.

Autoethnography : critical appreciation of an emerging art

In this article, the author discusses how she applied autoethnography in a study of the design of hypermedia educational resources and shows how she addressed problematic issues related to autoethnographic legitimacy and representation. The study covered a 6-year period during which the practitioner’s perspective on the internal and external factors influencing the creation of three hypermedia CD-ROMs contributed to an emerging theory of design. The author highlights the interrelationship between perception and reality as vital to qualitative approaches and encourages researchers to investigate their reality more fully by practicing the art of autoethnography.

The lens of ludic engagement : evaluating participation in interactive art installations

Designers and artists have integrated recent advances in interactive, tangible and ubiquitous computing technologies to create new forms of interactive environments in the domains of work, recreation, culture and leisure. Many designs of technology systems begin with the workplace in mind, and with function, ease of use, and efficiency high on the list of priorities. [1] These priorities do not fit well with works designed for an interactive art environment, where the aims are many, and where the focus on utility and functionality is to support a playful, ambiguous or even experimental experience for the participants. To evaluate such works requires an integration of art-criticism techniques with more recent Human Computer Interaction (HCI) methods, and an understanding of the different nature of engagement in these environments. This paper begins a process of mapping a set of priorities for amplifying engagement in interactive art installations. I first define the concept of ludic engagement and its usefulness as a lens for both design and evaluation in these settings. I then detail two fieldwork evaluations I conducted within two exhibitions of interactive artworks, and discuss their outcomes and the future directions of this research.

Microwave International Media Art Festival

An international festival that champions a pioneer role in promoting media/digital art in Hong Kong. Apart from organising international video screenings in which the latest media art with the most recent trend and development being introduced, a series of artist-in-resident workshops, exhibitions, seminars and symposiums were also hosted with a view to enhancing culture exchange and stimulating media art creation among overseas and local artists

On medium specificity and discipline crossovers in modern art : An interview with Jacques Ranciére on Medium-Specificity and Discipline Crossovers in Modern Art

Jacques Ranciere's work on aesthetics has received a great deal of attention recently. Given his work has enormous range – taking in art and literature, political theory, historiography, pedagogy and worker's history – Andrew McNamara and Toni Ross (UNSW) seek to explore his wider project in this interview, while showing how it leads to his alternative insights into aesthetics. Rancière sets aside the core suppositions linking the medium to aesthetic judgment, which has informed many definitions of modernism. Rancière is emphatic in freeing aesthetic judgment from issues of medium-specificity. He argues that the idea of autonomy associated with medium-specificity – or 'truth to the medium' – was 'a very late one' in modernism, and that post-medium trends were already evident in early modernism. While not stressing a simple continuity between early modernism and contemporary art, Ranciere nonetheless emphasizes the ethical and political ramifications of maintaining an a-disciplinary stance.

Service analysis : A critical assessment of the state of the art

The service-orientation paradigm has not only become prevalent in the software systems domain in recent years, but is also increasingly applied on the business level to restructure organisational capabilities. In this paper, we present the results of an extensive literature review of 30 approaches related to service identification and analysis for both domains. Based on the consolidation of a superset of comparison criteria for service-oriented methodologies found in related literature, we compare and evaluate the different characteristics of service engineering methods with a focus on service analysis. Although a close business and IT alignment is regarded as one of the core beneficial promises of service-orientation, our analysis suggests that there is a lack of unified, comprehensive methodology for service identification and analysis integrating and addressing both domains. Thus, we discuss how our results can inform directions for future research in this area.

Art for architecture's sake?

The Architecture, Disciplinarity and the Arts symposium was organised by the Architecture. Theory, Criticism and History (ATCH) research group at the University of Queensland, run by John Macarthur and Antony Moulis, together with Andrew Leach who joined them last year and organised much of the symposium. The symposium ran for three days in a small room at the Institute of Modern Art (IMA) in Fortitude Valley, Brisbane (generously donated by director Robert Leonard), with about 40 people in attendance. Together with a long question time of an hour after every three speakers, the size of the room and the small number of people made it very different from most architecture or design conferences. The intellectual level of the symposium was high, without the speed dating aspect that one often sees at the Society of Architectural Historians, Australia and New Zealand (SAHANZ) meetings, where endless parallel sessions of short papers create an occasionally disorientating cacophony of words. The symposium was deliberately, unapologetically academic and the intimate nature of the forum made the discussion rich and collaborative, with an active audience. The title of the symposium, 'Architecture, Disciplinarity and the Arts', reflects the connection that already exists between the art history and the architectural history community in Brisbane, with both groups regularly attending each other's functions.

The “Iranian ART Revolution”: infertility, assisted reproductive technology, and third-party donation in the Islamic Republic of Iran

Infertility is a social onus for women in Iran, who are expected to produce children early within marriage. With its estimated 1.5 million infertile couples, Iran is the only Muslim country in which assisted reproductive technologies (ARTs) using donor gametes and embryos have been legitimized by religious authorities and passed into law. Th is has placed Iran, a Shia-dominant country, in a unique position vis-à-vis the Sunni Islamic world, where all forms of gamete donation are strictly prohibited. In this article, we first examine the “Iranian ART revolution” that has allowed donor technologies to be admitted as a form of assisted reproduction. Then we examine the response of Iranian women to their infertility and the profound social pressures they face. We argue that the experience of infertility and its treatment are mediated by women’s socioeconomic position within Iranian society. Many women lack economic access to in vitro fertilization (IVF) technologies and fear the moral consequences of gamete donation. Thus, the benefits of the Iranian ART revolution are mixed: although many Iranian women have been able to overcome their infertility through ARTs, not all women’s lives are improved by these technologies.