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Paul Kefford

Paul Kefford

Area of study
Patient experience
Fellowship level
Year awarded
Host university
Health Services Research Unit, Institute of Applied Health Science
University of Aberdeen
Paul particularly values the illumination offered by lived experience and has actively been involved with PPI engagement and co-production. With a previous career as a civil servant in the Cabinet Office, he has experience of translating research into policy formation.
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Improvement without exception? An investigation of enactments of ‘Treatment as Prevention’ and strategies to enhance responsiveness to diverse priorities for wellbeing in HIV care


Developments in therapeutics have transformed HIV (Human Immunodeficiency Virus) infection from a perceived death sentence to a chronic condition. The policy of ‘Treatment as Prevention’ (TasP) aims to improve healthcare provision though prescribing anti-retroviral therapy (ART) to everyone diagnosed with HIV, both to suppress their viral load and to prevent onward transmission to others (an undetectable viral load is widely considered to be un-transmittable).

This project recognises the health benefits of ART and seeks to bolster efforts to make good use of HIV medication, reduce the transmission of HIV and enable people to live well with HIV. It does this by (i) investigating neglected concerns that enactments of TasP in clinical contexts may have adverse consequences for wellbeing and sometimes unjustly alienate patients and (ii) identifying improvement strategies to tackle these problems.


This three-year project aims broadly to investigate experiences of enactments of TasP to identify and appraise strategies to improve service provision for people living with HIV (PLWHIV). Following a systematic literature review – a meta-ethnographic (or critical interpretive) synthesis of patients’ experiences of HIV service provision and medication-taking alongside healthcare professionals’ experiences of HIV service provision – the qualitative research will examine lived experiences (of PLWHIV) of healthcare and ideas about TasP. An allied strand will investigate the experiences and approaches of healthcare professionals toward PLWHIV who are reticent to take ART medication, the healthcare professionals’ ideas about TasP; and their views on what would constitute and could contribute to improvement to service.

Interpretive analysis of data will be informed by concepts and theories from moral philosophy and social epistemology that support a broad, relationally sensitive view of quality-of-life and that may help identify and articulate concerns about healthcare quality and ethics and strategies for addressing these.

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