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.

Expert science teacher's notion of scientific literacy

This paper will report on the way expert science teachers’ conceive of scientific literacy in their classrooms, the values related to scientific literacy they hold and how this conception and the underpinning values affect their teaching practice. Three perceived expert science teachers who teach both at senior and middle school levels and across the range of sub-disciplines (one senior biology, one senior chemistry and one senior physics) were interviewed about their understanding of scientific literacy and how this influenced their teaching practice. The three teachers were video recorded teaching a junior science class and a senior science class. The data were analysed to identify values that underpin their conceptions of science and science education. The analysis focussed on the matching of the verbalised conceptions and values with their practice of teaching science. This paper will report on these data.

Grounded Media: Expanding the Scope of Ecological Art Practices Within New Media Arts Culture

‘Grounded Media’ is a form of art practice focused around the understanding that our ecological crisis is also a cultural crisis, perpetuated by our sense of separation from the material and immaterial ecologies upon which we depend. This misunderstanding of relationships manifests not only as environmental breakdown, but also in the hemorrhaging of our social fabric. ‘Grounded Media’ is consistent with an approach to media art making that I name ‘ecosophical’ and ‘praxis-led’ – which seeks through a range of strategies, to draw attention to the integrity, diversity and efficacy of the biophysical, social and electronic environments of which we are an integral part. It undertakes this through particular choices of location, interaction design,participative strategies and performative direction. This form of working emerged out of the production of two major projects, Grounded Light [8] and Shifting Intimacies [9] and is evident in a recent prototypical wearable art project called In_Step [6]. The following analysis and reflections will assist in promoting new, sustainable roles for media artists who are similarly interested in attuning their practices.

Arts and creative industries : a historical overview; and an Australian conversation

Australia should seek new and liberating ways to bring together the arts, popular culture and the creative industries, according to Arts and creative industries. The report, funded by the Australia Council for the Arts and prepared by Professor Justin O’Connor of the Creative Industries Faculty at Queensland University of Technology, looks at ways in which the policy relationship between these often polarised sectors of arts and creative industries might be re-thought and approached more productively. The report is in two parts, commencing with An Australian conversation, in which Professor O’Connor, with Stuart Cunningham and Luke Jaaniste, document a series of in depth interviews with 18 leading practitioners across the creative industries. They discuss their perceptions of the similarities, differences and connections between the arts and creative industries. The interviews frequently returned to the fundamental question of what was meant by ‘art’ and ‘creative industries’. The second, larger part of Arts and creative industries, addresses this question through an extensive review of the discussions of art and its relation to society and culture over the last few centuries. A historical overview highlights the importance that art has had in developing our comprehension of the modern world. It also examines the enthusiasm for the creative industries over the last 15 years or so and the impact this has had on creative policy-making. Arts and creative industries suggests there is no dividing line between publicly-funded arts, popular culture and the blossoming businesses of the creative sector – and national policy should reflect this. This study was commissioned by the Australia Council as part of a long-running and productive relationship between the council and the ARC Centre of Excellence on Creative Industries and Innovation at the Queensland University of Technology.

Professional capabilities for twenty-first century creative careers : lessons from outstandingly successful Australian artists and designers

Artists and designers are positioned at the centre of the 21st century creative economy. In order to recognise and make the most of the opportunities afforded by this new era, artists and designers still require the creativity, disciplinary depth of knowledge, and technical skills traditionally possessed by professionals in these fields – skills which are a core strength of higher and further art and design education. However, they may also require a range of other, ‘21st century’ creative capabilities which are harder to define, teach for and assess, and are not the focus of traditional art and design pedagogies. This article draws upon the findings of nine in-depth interviews with award-winning Australian artists and designers about their careers and working practices, along with recent international research about the characteristics of the 21st century creative career, in order to highlight the importance of certain professional capabilities for art and design. It discusses the implications of these findings for art and design educators in universities, and curricular and pedagogic considerations associated with embedding these capabilities into undergraduate courses.

CAUSEE Dataset and documentation

The Comprehensive Australian Study of Entrepreneurial Emergence (CAUSEE) is the largest study of new firm creation ever undertaken in Australia. The project provides an exciting opportunity to fundamentally improve our understanding of independent entrepreneurship in Australia by studying factors that initiate, hinder and facilitate the process of emergence of new economic activities and organisations. The longitudinal project has followed a large random sample of nascent firms (n=625) and young firms (n=559) over a six year period. NFs are on-going start-up efforts while YFs are already established but less than four years old. The study also includes a comparison group of non-founders and over-samples of over 100 high potential start-ups in each category. The CAUSEE dataset file contains hundreds of variables throughout 5 waves of data collection. Extensive documentation on the dataset is available in the related handbook. The CAUSEE project has received significant external funding from the Australian Research Council (DP0666616 and LP0776845); National Australia Bank; BDO Australia, and the Australian Government Department of Industry, Innovation and Science.