Browsing by Author "Cooper, Diane"

Now showing 1 - 11 of 11
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    An approach to developing a prediction model of fertility intent among HIV-positive women and men in Cape Town, South Africa: a case study
    (Springer, 2017) Bai, Dan; Leu, Cheng-Shiun; Mantell, Joanne E.; Exner, Theresa M.; Cooper, Diane; Hoffman, Susie; Kelvin, Elizabeth A.; Myer, Landon; Constant, Debbie; Moodley, Jennifer
    As a ‘case-study’ to demonstrate an approach to establishing a fertility-intent prediction model, we used data collected from recently diagnosed HIV-positive women (N = 69) and men (N = 55) who reported inconsistent condom use and were enrolled in a sexual and reproductive health intervention in public sector HIV care clinics in Cape Town, South Africa. Three theoretically-driven prediction models showed reasonable sensitivity (0.70–1.00), specificity (0.66–0.94), and area under the receiver operating characteristic curve (0.79–0.89) for predicting fertility intent at the 6-month visit. A k-fold cross-validation approach was employed to reduce bias due to over-fitting of data in estimating sensitivity, specificity, and area under the curve. We discuss how the methods presented might be used in future studies to develop a clinical screening tool to identify HIV-positive individuals likely to have future fertility intent and who could therefore benefit from sexual and reproductive health counselling around fertility options.
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    Assessing the influence of gender socialization on early adolescents’ behaviors and perceptions towards sexual and reproductive health and gender-based violence in low socio-economic, urban neighborhoods, Cape Town: a quantitative study
    (University of the Western Cape, 2023) Kinoshita, Rinko; Cooper, Diane
    Early adolescents (EAs), aged between 10 and 14, account for half of 1.2 billion adolescents worldwide. During early adolescence (EA), many EAs experience puberty and social and cognitive shifts. This is a period when gender norms are shaped manifesting in their perceptions and behaviors. Unequal gender norms may negatively affect adolescents’ sexual and reproductive health (ASRH), including early pregnancy, violence, and mental health. There is a paucity of evidence on how EAs construct gender norms, and how unequal gender norms may impact their health and well-being.
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    Contraceptive service uptake and delivery preferences in perinatally and horizontally infected female adolescents living with HIV: Results from a South Africa-based mixed-methods study’
    (Elsevier, 2022) Olagbuji, Biodun; Cooper, Diane; Mathews, Catherine
    To investigate whether contraceptive service uptake (including current contraceptive use), unmet need for contraception, unintended pregnancy, preferences for service provision, and providers among female adolescents living with HIV (ALHIV) vary with HIVacquisition route, that is, perinatal HIV acquisition vs horizontal HIV acquisition. public sector primary health care facilities, Cape Town, South Africa Participants: Sexually experienced female ALHIV aged 14-19 years (n = 303) including both peri/postnatally infected ALHIV (pALHIV) and horizontally infected ALHIV (hALHIV) and health care providers involved in HIV care and treatment services (n = 19) Main Outcome Measures: Current contraceptive use, unintended pregnancy.
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    The Empower Nudge lottery to increase dual protection use: a proof-of-concept randomised pilot trial in South Africa
    (Informa UK Limited, trading as Taylor & Francis Group, 2018) Galárraga, Omar; Harries, Jane; Maughan-Brown, Brendan; Cooper, Diane; Short, Susan E.; Lurie, Mark N.; Harrison, Abigail
    The objective of this study is to measure the preliminary efficacy of a pilot intervention, grounded in behavioural economics, increasing adherence of dual protection (simultaneous use of effective modern contraception and a barrier method, such as a condom) to protect against HIV, other sexually transmitted infections, and unintended pregnancy. Between 2015 and 2016, 100 women aged 18–40 years, seeking post-abortion care in Cape Town, South Africa were recruited to Empower Nudge, a randomised controlled trial to test a lottery incentive intervention designed to increase dual protection. At baseline, the mean age of participants was 27 years; 82% of them were from South Africa; 58% self-identified as Black African; average education completed was 11.7 years. At three months, assignment to the lottery intervention was associated with higher odds of returning for study visits (OR: 6.0; 95%CI: 2.45 to 14.7, p < 0.01), higher condom use (OR: 4.5; 95%CI: 1.43 to 14.1; p < 0.05), and higher use of dual protection (OR: 3.16; 95%CI: 1.01 to 9.9; p < 0.05). Only 60% of the study population returned after three months and only 38% returned after six months. Women who receive post-abortion care represent a neglected population with an urgent need for HIV and pregnancy prevention. Dual protection is a critically important strategy for this population. Lottery-based behavioural economics strategies may offer possible ways to increase dual protection use in this population. Further research with larger samples, longer exposure time, and more sites is needed to establish fully powered efficacy of lottery incentives for dual protection; using objective verification for monitoring.
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    Emtonjeni—A structural intervention to integrate sexual and reproductive health into public sector HIV care in Cape Town, South Africa: results of a phase II study
    (Springer Verlag, 2017) Mantell, Joanne E.; Cooper, Diane; Exner, Theresa M.; Moodley, J.; Hoffman, Susie
    Integration of sexual and reproductive health within HIV care services is a promising strategy for increasing access to family planning and STI services and reducing unwanted pregnancies, perinatal HIV transmission and maternal and infant mortality among people living with HIV and their partners. We conducted a Phase II randomized futility trial of a multi-level intervention to increase adherence to safer sex guidelines among those wishing to avoid pregnancy and adherence to safer conception guidelines among those seeking conception in newly-diagnosed HIV-positive persons in four public-sector HIV clinics in Cape Town. Clinics were pair-matched and the two clinics within each pair were randomized to either a three-session provider-delivered enhanced intervention (EI) (onsite contraceptive services and brief milieu intervention for staff) or standard-of-care (SOC) provider-delivered intervention. The futility analysis showed that we cannot rule out the possibility that the EI intervention has a 10 % point or greater success rate in improving adherence to safer sex/safer conception guidelines than does SOC (p = 0.573), indicating that the intervention holds merit, and a larger-scale confirmatory study showing whether the EI is superior to SOC has merit.
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    Exploring the guidance and attitudes regarding infant feeding options provided by Healthcare workers (HCWs) to HIV positive mothers of infants 0 – 12 months of age in South Africa
    (University of the Western Cape, 2021) Roberts, Erin; Cooper, Diane
    South Africa’s Infant and Young Child Feeding (IYCF) policy guidelines of 2013 and its 2017 amendments recommend that mothers, including those living with HIV, exclusively breastfeed their infants until 24 months of age, followed by their gradual weaning. The 2013 changed policy guidelines occurred to align with global WHO recommendations of six-month exclusive breastfeeding for all HIV positive mothers, and consequently no longer recommended free formula feed as an option for HIV-positive mothers attending public sector services, except in limited circumstances. Despite these policy guidelines, less than a third of South African mothers exclusively breastfeed their infants. The other two thirds of mothers either formula feed or mixed feed their infants. Mixed feeding or exclusive breastfeeding by HIV positive mothers who have either not been on antiretroviral therapy (ART) long enough or are insufficiently adherent to ART to suppress their viral loads, can potentially lead to increased risk of Mother to Child Transmission (MTCT) of the Human Immunodeficiency Virus (HIV). Since healthcare workers (HCWs) play a key role in promoting the IYCF policy guidelines and encouraging its practice among HIV-positive mothers, it is crucial to determine the extent to which HCWs understand and subscribe to this important policy. Using purposeful sampling and in-depth qualitative interview techniques, this qualitative study explored the attitudes of HCWs towards different infant feeding options, especially for HIV positive mothers, against the background of their understanding of the changes in IYCF policy guidelines between 2013 and 2017. The participants in this study included ten HCWs selected from three primary health care facilities in Khayelitsha (Western Cape, South Africa), and two programme coordinators based at the Western Cape’s Department of Health Khayelitsha substructure office. By interviewing this diverse sample of HCW cadre, the study aimed to explore their perceptions related to the factors which facilitate IYCF policy implementation versus those that hinder the implementation of this policy. The findings revealed that HCWs interviewed had good overall familiarity with the IYCF policy guidelines. However, their depth of understanding and acceptability of the policy varied, especially in the context of high HIV MTCT risk. Suboptimal implementation of the policy occurred due to inadequate policy dissemination, diverse views on the limitations of the policy, such as the promotion of only exclusive breastfeeding as an option and an unclear rationale for recent policy changes. Additionally, HCWs high workload and insufficient training on the changed 2017 guidelines were identified as barriers to effectively implementing the new infant feeding policy guidelines. HCW further perceived that personal, socio-cultural and health system factors influenced new mothers’ decisions and/or ability to breastfeed. These findings highlight that improved policy dissemination strategies and training should be used to increase HCWs knowledge regarding infant feeding counselling content, including HIV MTCT risk. Western Cape Department of Health alignment and implementation of relevant National Department of Health HIV policies should occur to decrease MTCT risk while breastfeeding. Peer support groups could provide maternal support for continued postnatal ART adherence and for sustained safer feeding practices. Finally, while exclusive breastfeeding is the optimal feeding choice generally for mothers, future revision of the 2017 IYCF policy should consider allowing HCW to act more flexibly in the maternal guidance they provide on infant feeding options. This could allow greater discretion for HCW in infant feeding counselling of mothers, particularly for those women who are HIV positive. This would promote improved patient-centred counselling that takes into account both maternal socio-cultural context and the right to make individualised decisions regarding infant feeding.
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    Factors impacting on menstrual hygiene and their implications for health promotion
    (Sage, 2018) Lahme, Anne Mutunda; Stern, Ruth; Cooper, Diane
    Background: In the lives of women, puberty is marked by the onset of menarche. From this stage onwards until menopause, reproductive health and menstrual hygiene are important aspects of women’s lives. In Zambia’s Western Province, the natural process of menstruation is a taboo and dealt with secretly. Information and knowledge about menstruation and menstrual hygiene among adolescent girls is inadequate. This paper explores the factors influencing the understanding, experiences and practices of menstrual hygiene among adolescent girls in Mongu District, Western Province of Zambia. Methods: An explorative study design was used by means of six focus group discussions conducted with 51 respondents, aged 13–20 years, from three secondary schools. Their age at menarche was 11–15. For data analysis thematic content analysis was used. Results: The paper shows that the girls suffer from poor menstrual hygiene, originating from lack of knowledge, culture and tradition, and socio-economic and environmental constraints, leading to inconveniences, humiliation and stress. This leads to reduced school attendance and poor academic performance, or even drop outs, and ultimately infringes upon the girls’ human rights. Conclusion: To address these shortcomings, a ‘super setting approach’ is recommended, in which a Health Promoting School could improve the girls’ individual and group needs, and a community setting which would address the broader socio-economic, cultural and environmental conditions. This would enable creating a supportive environment for the girls to manage their periods. To successfully utilize the approach, all stakeholders (parents, teachers, children, governments and communities) should cooperate to generate context-specific solutions for creating safe menstrual care, and better and dignified conditions for adolescent girls. Therefore, this calls for comprehensive, strident advocacy for policy changes at national level, and mediation and involvement at community level. (Global Health Promotion, 2018; 25(1): 54–62)
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    Harnessing Resilience: An exploration into individual and contextual factors that facilitate uptake of sexual and reproductive health services (SRHS) and HIV testing amongst South African youth
    (University of the Western Cape, 2022) Cooper, Diane; Christie, Sarah Spence
    Youth is generally defined as young people between the ages of 14- 24 years, however, in South Africa the age range is extended to 34 years. In 2020, the estimated youth population (14-35 years) in South Africa was 20.1 million, with just over 5 million being between the ages of 15- 19 years. In 2009, the World Health Organization (WHO) described South Africa as experiencing a ‘youth health crisis’, reflective of a syndemic disease burden caused by early childbearing, poor nutrition, high HIV incidence, sexual risk behavior, substance abuse, violence, and injuries.
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    Opportunities for linking research to policy: lessons learned from implementation research in sexual and reproductive health within the ANSER network
    (Springer Nature, 2018) Ogbe, Emilomo; Cooper, Diane
    Background: The uptake of findings from sexual and reproductive health and rights research into policy-making remains a complex and non-linear process. Different models of research utilisation and guidelines to maximise this in policy-making exist, however, challenges still remain for researchers to improve uptake of their research findings and for policy-makers to use research evidence in their work. Methods: A participatory workshop with researchers was organised in November 2017 by the Academic Network for Sexual and Reproductive Health and Rights Policy (ANSER) to address this gap. ANSER is a consortium of experienced researchers, some of whom have policy-making experience, working on sexual and reproductive health and rights issues across 16 countries and 5 continents. The experiential learning cycle was used to guide the workshop discussions based on case studies and to encourage participants to focus on key lessons learned. Workshop findings were thematically analysed using specific stages from Hanney et al.’s (Health Res Policy Syst 1:2, 2003) framework on the place of policy-making in the stages of assessment of research utilisation and outcomes. Results: The workshop identified key strategies for translating research into policy, including joint agenda-setting between researchers and policy-makers, as well as building trust and partnerships with different stakeholders. These were linked to stages within Hanney et al.’s framework as opportunities for engaging with policy-makers to ensure uptake of research findings. Conclusion: The engagement of stakeholders during the research development and implementation phases, especially at strategic moments, has a positive impact on uptake of research findings. The strategies and stages described in this paper can be applied to improve utilisation of research findings into policy development and implementation globally.
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    A scoping review of how exposure to urban violence impacts youth access to sexual, reproductive and trauma health care in LMICs
    (Taylor and Francis Group, 2022) Green, Gill; Swartz, Alison; Cooper, Diane
    Violence in the community can impact access to health care. This scoping review examines the impact of urban violence upon youth (aged 15–24) access to sexual and reproductive health and trauma care in Low and Middle Income Countries (LMICs). We searched key electronic health and other databases for primary peer-reviewed studies from 2010 through June 2020. Thirty five of 6712 studies extracted met criteria for inclusion. They were diverse in terms of study objective and design but clear themes emerged. First, youth experience the environment and interpersonal relationships to be violent which impacts their access to health care. Second, sexual assault care is often inadequate, and stigma and abuse are sometimes reported in treatment settings. Third is the low rate of health seeking among youth living in a violent environment. Fourth is the paucity of literature focusing on interventions to address these issues. The scoping review suggests urban violence is a structural and systemic issue that, particularly in low-income areas in LMICs, contributes to framing the conditions for accessing health care. There is a gap in evidence about interventions that will support youth to access good quality health care in complex scenarios where violence is endemic.
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    The social context of early adolescents in the global early adolescent study
    (Elsevier, 2021) Mmari, Kristin; Cooper, Diane; Moreau, Caroline
    This paper used data from the Global Early Adolescent Study (GEAS) to provide a descriptive analysis of how early adolescents’ social environments vary by sex across diverse cultural settings.The analyses were based on baseline data among 10e14-year old adolescents living in disadvantaged urban areas in seven sites: Kinshasa (DRC), Shanghai (China), Cuenca (Ecuador), Lampung, Semarang and Denpasar (Indonesia), and Flanders (Belgium). Except in Kinshasa where face-to face interviews were used, data were collected using self-administered surveys on mobile tablets. Social environments were measured by examining factors within five main domains, including the household and family, school, peers, neighborhoods, and the media. Site-specific descriptive analyses were performed, using Chi square tests and Student T-tests to identify sex differences in each site.