Browsing by Author "Crowley, Talitha"
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Item Community leaders’ experiences regarding the spread of Hepatitis E in the Havana informal settlement, Khomas region, Namibia(University of the Western Cape, 2024) Nghikevali, Abraham Venelao; Crowley, TalithaBackground: Hepatitis E virus (HEV) is one of the foremost health problems globally, it is estimated that one third of the human population is infected with HEV. Moreover, statistics have shown HEV is more common in developing countries, particularly in informal settlements, where there is poor sanitation and a lack of clean water for human consumption. Research aim: The study aimed to explore and describe community leaders’ experiences regarding the spread of Hepatitis E in the Khomas region of Namibia to make recommendations on the prevention of the spread of HEV in the community. Methods: The study utilised a qualitative, exploratory descriptive design. Individual semi-structured interviews were conducted. Participants were purposively selected if they were community leaders in the Havanna informal settlement. The sample size was 17 participants. Data analysis included the use of thematic analysis with the researcher identifying recurring themes, language, opinions, and beliefs. Trustworthiness was ensured using the criteria of Lincoln and Guba namely: credibility, transferability, dependability and confirmability.Item Contextual factors influencing self-management of adolescents and youth living with HIV: A cross-sectional survey in Lesotho(MDPI, 2023) Nagenda, Mapaseka Chabalala; Crowley, TalithaHIV treatment outcomes of adolescents and youth living with HIV (AYLWH) are lagging. One way to improve outcomes is through supporting AYLWH to acquire self-management skills. Although self-management is associated with improved health outcomes, condition-specific, individual/family, and social/environmental contextual factors influence self-management. We aimed to describe factors influencing the self-management of AYLWH in Lesotho. A cross-sectional survey design was used. AYLWH (n = 183) aged 15–24 were conveniently sampled from two HIV treatment sites in Lesotho. Participants completed self-report questionnaires in English or Sesotho.Item Contextual factors influencing self-management of adolescents and youth living with HIV: A cross-sectional survey in Lesotho(MDPI, 2023) Nagenda, Mapaseka Chabalala; Crowley, TalithaHIV treatment outcomes of adolescents and youth living with HIV (AYLWH) are lagging. One way to improve outcomes is through supporting AYLWH to acquire self-management skills. Although self-management is associated with improved health outcomes, condition-specific, individual/family, and social/environmental contextual factors influence self-management. We aimed to describe factors influencing the self-management of AYLWH in Lesotho. Methods: A cross-sectional survey design was used. AYLWH (n = 183) aged 15–24 were conveniently sampled from two HIV treatment sites in Lesotho. Participants completed self-report questionnaires in English or Sesotho. Participants (89.1% female) had high HIV self-management scores (mean 92.7%, SD 5.3%) that corresponded with treatment outcomes (98.9% adherent and 100% viral load < 1000 copies/mL). This might be attributed to condition-specific factors, including once-daily doses (100%) and longer duration of treatment (81.4% on ART for more than 10 years).Item Effectiveness, acceptability and feasibility of technology-enabled health interventions for adolescents living with HIV in low- and middle-income countries: A systematic review(MDPI, 2023) Crowley, Talitha; Petinger, Charné; Nchendia, Azia IvoAdolescents living with HIV (ALHIV) are challenged to remain adherent and engaged in HIV care. Technology-enabled interventions can be used to optimize healthcare delivery to adolescents. The largest proportion of ALHIV resides in sub-Saharan Africa. This review synthesized the evidence for the effectiveness, acceptability, and feasibility of technology-enabled health interventions for ALHIV in low and middle-income countries (LMIC). Eight electronic databases (Ebscohost, CINAHL, ERIC, MEDLINE, PubMed, SCOPUS, Science Direct, and Sabinet) and Google Scholar were searched to identify studies in LMIC published from 2010 to 2022. Quantitative and qualitative studies reporting on technology-enabled health interventions for predominantly adolescents (10–19 years) were included. The review was performed, and findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols.Item Effectiveness, acceptability, and feasibility of technology-enabled health interventions for adolescents living with HIV in low- and middle income countries: A systematic review protocol(Public Library of Science, 2023) Crowley, Talitha; Petinger, Charne; van Wyk, BrianAdolescents living with chronic conditions such as HIV (ALHIV) are challenged to remain adherent and engaged in HIV care. Technology offers a promising platform to deliver behaviour-change interventions to adolescents. The largest proportion of ALHIV resides in sub-Saharan Africa; yet little is known about the effectiveness, feasibility and acceptability of technology-enabled interventions to deliver and support health care to ALHIV in resource-constraint settings. This study aims to explore the literature and synthesise the evidence for the effectiveness, acceptability, and feasibility of technology-enabled health interventions for ALHIV in low and middle-income countries (LMIC). Eight electronic databases (Ebscohost, CINAHL, ERIC, MEDLINE, PubMed, SCOPUS, Science Direct, and Sabinet) and Google Scholar will be searched to identify technology-enabled health interventions for ALHIV in LMIC published from 2010–2022. Quantitative and qualitative studies reporting on technology-enabled health interventions for predominantly adolescents (10–19 years) will be included.Item Experiences of adolescents living with HIV on transitioning from pediatric to adult HIV care in low and middle-income countries: a qualitative evidence synthesis protocol(Public Library of Science, 2024) Petinger, Charné; Crowley, Talitha; van Wyk, BrianIn South Africa, it is estimated that approximately 320,000 adolescents living with HIV (ALHIV) will transition from pediatric to adult antiretroviral treatment (ART) by 2028. However, the age period of 10–19 years is accompanied by a myriad of barriers that challenge the transition process, and continued adherence to ART. The transition process involves ALHIV taking charge of their own health and disease management which raises challenges for their retention in care. Managing transition becomes particularly challenging in low-resource contexts as their healthcare systems are not adapted to the specific needs it requires. There is a need to garner an understanding of existing transition practices which address the specific needs of adolescents and is optimized to their requirements and available resources within a low- or middle-income country context. This review will include all qualitative and mixed method studies which will facilitate a deeper understanding the experiences of ALHIV on transition experiences. The review will specifically look at studies conducted in low- and middle-income countries. The included studies must be presented in the English language and published between 2010–2023. The search strategy will be finalized with consultation with an information specialist. All three reviewers will be present throughout all stages of the review. One reviewer will work independently on the initial screening of studies and another reviewer will assist in checks. After data is extracted, the data will be thematically analyzed with the use of Atlas.Ti computer software. No ethics approval is required and the review will be published in peer reviewed journals and submitted to conferences.Item Experiences of adolescents living with HIV on transitioning from pediatric to adult HIV care in low- and middle-income countries: a qualitative evidence synthesis(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Petinger, Charné; Crowley, Talitha; van Wyk, Brian(1) Background: Adolescents living with HIV (ALHIVs) experience significant challenges in adhering to treatment and remaining engaged in care as they transition from pediatric to adult HIV care programs. The aim of this qualitative evidence synthesis (QES) was to review qualitative studies that describe how ALHIVs experience transition practices in low- and middle-income countries. (2) Methods: The following databases were searched: PubMed, Wiley Library Online, EbscoHost (PsychARTICLES, MEDLINE, Scopus, CINAHL), the WHO database, Google Scholar, and reference mining of the included studies. The inclusion criteria were as follows: ALHIV 10–19 years old, interventions on the transition period or studies describing transition practices, published between 2012 and 2023, conducted in low- and middle-income countries, English language, and qualitative and mixed-method studies. This review adheres to the PRISMA guidelines. CASP and MMAT were used for methodological quality assessment, and GRADE CERQual was used for the confidence in review findings. (3) Results: Seven articles were included in the final review. The five overarching themes described: (1) transition readiness during the pre-transition phase; (2) structural (health systems) barriers and treatment literacy as challenges during the transition period; and (3) provided accounts of successful post-transition experiences and recommendations for improving the transition process (when these were not experienced as positive), while also describing the individual and collective contexts in which transition took place, as they outlined (4) individual (psychological) barriers and the facilitative role that (5) a supportive environment played in the outcome of the transition process. There was a high level of confidence in transition readiness, while the other themes were assessed as having moderate confidence due to methodological limitations and minor concerns about adequacy or relevance. (4) Conclusions: There is a dearth of qualitative studies on the transition experiences of ALHIVs and on how the transition process impacts adherence, retention in care, and mental well-being. We recommend the development of interventions in the form of a guided transition protocol to improve the transition experiences of ALHIVs.Item Factors promoting exclusive breastfeeding at a public health facility in Windhoek Namibia: A descriptive comparative study(Elsevier, 2023) Nangolo, Ruusa Megameno; Robertson, Anneline; Crowley, TalithaExclusive breastfeeding (EBF) refers to the practice of giving an infant breast milk only up to the age of six months, except for oral rehydration solutions or drops/syrups of vitamins, minerals or medicines. Globally and in Namibia, EBF rates remain well below the 70% World Health Organisation (WHO) target. This study aimed to investigate factors that promote EBF amongst mothers at a public health facility in Windhoek, Namibia. A quantitative comparative descriptive design was used. Women aged 18 and above with infants aged 0 to 6 months attending a public health facility (n = 270) in Windhoek, Namibia, were selected using non-probability consecutive sampling. A structured self-administered questionnaire was used to collect data on socio-demographic, economic, knowledge, psychosocial, biophysical and sociocultural factors. Data was analysed using descriptive statistics and logistic regression..Item Health workers’ responses to covid-19 pandemic’s impact on service delivery to adolescents in hiv treatment in cape town, south africa: a qualitative study(Multidisciplinary Digital Publishing Institute (MDPI), 2024) Mayman, Yolanda; Crowley, Talitha; van Wyk, BrianAdolescents living with HIV (ALHIVs) are considered a priority population in the fight against HIV, requiring dedicated services. The COVID-19 pandemic and subsequent disruptions deprived ALHIVs on antiretroviral therapy (ART) of the care and social support essential for treatment adherence and positive treatment outcomes. This study describes health managers’ and healthcare workers’ responses to the impact of COVID-19 on service delivery to ALHIVs in HIV treatment in the Cape Town Metropole. A descriptive qualitative design was employed, where semi-structured individual interviews (n = 13) were conducted with senior and programme managers as well as healthcare workers between April and October 2023. Inductive thematic analysis was performed using Atlas.ti version 23. Two main themes emerged from these interviews: “HIV service delivery to adolescents during the COVID-19 pandemic” and “Lessons learnt—the way forward”. The de-escalation of health services at primary health facilities and the disruption of HIV services resulted in disengagement from care by ALHIVs, increasing mental health and treatment challenges. This warrants the restoration of psychosocial support services and the re-engagement of ALHIVs. The findings from this study can function as a guide for health systems and healthcare providers to navigate future pandemics to ensure that vulnerable populations such as ALHIVs continue to receive care and treatment.Item Knowledge, attitudes and practices regarding paediatric pain management among undergraduate nursing students at a university in the Western Cape(University of the Western Cape, 2022) Karikurubu, Amrani; Crowley, TalithaDespite the availability of analgesics for pain relief, children experience moderate to severe pain during hospitalisation. A student nurse placed in a paediatric setting is part of the healthcare team who can support children in pain. However, studies have documented a gap in the knowledge, attitudes, and practices (KAP) of nursing students regarding paediatric pain management. The study aimed to describe the KAP of undergraduate nursing students regarding paediatric pain management at a university in the Western Cape. The research objectives were to describe a) the knowledge of undergraduate nursing students regarding paediatric pain management, b) the attitudes of undergraduate nursing students regarding paediatric pain management, and c) the practices of undergraduate nursing students regarding paediatric pain management.Item Mapping the transition of adolescents to adult HIV care: a mixed-methods perspective from the Cape Town Metropole, South Africa(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Petinger, Charné; van Wyk, Brian; Crowley, Talitha(1) Background: Globally, an estimated 1.7 million adolescents (aged 10–19 years) were living with HIV in 2023, with 82% residing in sub-Saharan Africa. For ALHIV, transitioning to adult care involves assuming responsibility for their own health and disease management, posing significant challenges to persistent engagement in care. There is a paucity in health policies guiding this transition in many sub-Saharan African countries. Overburdened and poorly functioning health systems struggle to provide optimal care for ALHIV amidst the rising HIV pandemic in this priority population. (2) Methods: This study employed a mixed-methods design, comprising a descriptive qualitative study with healthcare workers and managers and a cross-sectional survey to examine the practices and pathways in which the transition to adult HIV care occurs in the Cape Town Metropole, South Africa. (3) Results: We delineate three distinct ways in which transition occurs (transfer-only, adolescent-friendly, and supportive transition). A successful transition involves a sufficient level of self-management of their chronic condition and healthcare journey, which is preceded by adequate preparation pre-transition, and the monitoring of engagement post-transition. This ideally requires developing relevant health policies and implementing guidelines signaling political will and providing the impetus and agency of implementation at the service level in South Africa.Item Nurse prescribing and dispensing in South Africa: gaps in the current legislative framework(AOSIS (Pty) Ltd, 2024) Crowley, Talitha; Gray, Andy Lofts; Geyer, NelouiseNurse prescribing and dispensing are central to ensuring universal health access in South Africa. To describe the historical development of the legal enablements of nurse prescribing and dispensing in South Africa and highlight gaps in the current legislative framework We emphasise significant deficiencies in the current legislative landscape that pose challenges to these vital nursing practices and call for urgent revisions of the legislative framework, particularly the revision of Section 56 of the Nursing Act (33 of 2005) and its related regulations, to formalise authorisation of specialist nurse prescribers in public and private practice. This will also entail an application to the South African Health Products Regulatory Authority (SAPHRA) for the scheduling of substances by authorised nurse prescribers in the defined professional nurse and specialist nurse categories by the Minister of Health There is a necessity for prompt legislative revisions to address identified deficienciesItem Nurse prescribing and dispensing in South Africa: gaps in the current legislative framework(AOSIS (Pty) Ltd, 2024) Crowley, Talitha; Gray, Andy Lofts; Geyer, NelouiseNurse prescribing and dispensing are central to ensuring universal health access in South Africa. To describe the historical development of the legal enablements of nurse prescribing and dispensing in South Africa and highlight gaps in the current legislative framework We emphasise significant deficiencies in the current legislative landscape that pose challenges to these vital nursing practices and call for urgent revisions of the legislative framework, particularly the revision of Section 56 of the Nursing Act (33 of 2005) and its related regulations, to formalise authorisation of specialist nurse prescribers in public and private practice. This will also entail an application to the South African Health Products Regulatory Authority (SAPHRA) for the scheduling of substances by authorised nurse prescribers in the defined professional nurse and specialist nurse categories by the Minister of Health There is a necessity for prompt legislative revisions to address identified deficienciesItem Nursing education reform in South Africa: Implications for postgraduate nursing programmes(Elsevier, 2023) Crowley, Talitha; Daniels, FelicityTraining of Specialist Nurses is of critical importance for the continued delivery of quality health services globally and in South Africa. In accordance with international trends, nursing education in South Africa has undergone significant educational reforms in the past few years. The aim of this paper is to critically reflect on current nursing education reform in South Africa and the implications for the postgraduate diploma in nursing programmes. The paper highlights some of the challenges encountered with the development, accreditation and implementation of the new nursing postgraduate diploma programmes. Successful nursing education reform requires collaborative and proactive conversations between all stakeholders before changes are made to existing nursing categories and skills mix, during the development of new programme frameworks, during programme development and after implementation of the reform strategies.Item Patterns of transition of adolescents in an HIV care programme in peri-urban Cape Town, South Africa: a photovoice study(SAGE Publications, 2025) Petinger, Charné; van Wyk, Brian; Crowley, TalithaSuccessful transition from paediatric to adult HIV care programme is a critical developmental milestone in the care trajectory of adolescents living with HIV (ALHIV). The transition process involves a shift from a structured, caregiver-supported healthcare model to one that requires independence and self-management. This process should be guided and supportive to ensure continued engagement in care and optimal adherence when ALHIV are transferred. This study utilised photovoice methods to explore the transition experiences of ALHIV in the Cape Town Metropole. Audio-recorded focus group data were transcribed verbatim and subjected to reflexive thematic analysis. Three distinctive patterns of behaviour from ALHIV were identified as themes. Type 1: socially reliant, dependent adolescent who heavily relies on family and peer support and struggles with adherence. Type 2: socially disconnected, hyper-independent adolescent, who is self-reliant, seeks solitude, and is generally resistant to external support. We configured a third (ideal) type, who is interdependent and able to self-manage their chronic condition, but within a supportive health care environment that provides positive healthcare and transition experiences. The findings underscore the need for supportive transition models promoting self-management skills, while facilitating a symbiotic relation with healthcare staff promoting sustained engagement in care well into adulthood. We recommend that adolescent or youth friendly services for ALHIV be expanded to support and monitor the transition process and outcomes in the adult HIV program.Item Primary care nurses’ preparedness for COVID-19 in the Western Cape province, South Africa(AOSIS, 2021) Crowley, Talitha; Kitshoff, Danine; de Lange-Cloete, FrancesThe novel coronavirus 2019 or COVID-19 pandemic has brought about a global public health crisis. Primary care (PC) nurses render first line care, or refer for more specialised services. To investigate the preparedness of PC nurses for COVID-19 in the Western Cape. The Western Cape province of South Africa. We administered an online survey, with closed and open-ended questions, to 83 Stellenbosch University postgraduate PC nursing students and alumni working in the Western Cape, between 03 July and 01 September 2020.Item Reflections of resilience and vulnerability of adolescents living with HIV during COVID-19: a photovoice study in peri-urban Cape Town, South Africa(SAGE Publications Inc, 2025) Mayman, Yolanda; Wyk, Brian van; Crowley, TalithaBackground: Adolescents living with HIV (ALHIV) in low socio-economic contexts face challenges related to physical development and health, stigma, and economic instability. The onset of the COVID-19 pandemic exacerbated these vulnerabilities, impacting the physical, mental, and social well-being of ALHIV. ALHIV were positioned in a particularly precarious situation, requiring them to navigate the disruptions caused by the pandemic while simultaneously striving to maintain resilience and adherence to their antiretroviral treatment (ART). Objectives: To explore the resilience and vulnerability of ALHIV on ART in a peri-urban community in Cape Town, South Africa during the COVID-19 pandemic. Methodology: A participatory photovoice study was employed with 20 ALHIV aged 14 to 19 years. Participants received basic training on photography techniques and were asked to capture images representing their experiences during the COVID-19 pandemic. These photographs were shared and discussed in both individual interviews and group discussions. All interviews and discussions were audio-recorded, and the resulting transcripts were analysed using content analysis to identify key themes and insights. Results: Four key themes were identified: (1) disrupted routines and emotional strain, (2) support systems and coping mechanisms, (3) HIV treatment adherence facilitators and barriers, and (4) economic vulnerability and household stress. Despite the compounded challenges and significant hardships, ALHIV in this study demonstrated notable resilience, maintaining treatment adherence and a positive outlook despite economic struggles and social disruptions. Conclusions: This study highlights the resilience and vulnerability of ALHIV in resource-limited settings. Findings underscore the need for targeted mental health and social support interventions to address their unique vulnerabilities. Strengthening healthcare access, social support networks, and local community resources can improve the well-being and coping capacity of ALHIV in future crises.Item Tracking viral control in adolescents on antiretroviral therapy in Lusaka, Zambia: a retrospective cohort analysis(AOSIS (pty) Ltd, 2025) Moomba, Kaala; van Wyk, Brian; Crowley, TalithaBackground: In 2023, an estimated 39.9 million people globally were living with HIV, of which 1.55 million were adolescents aged 10–19 years. The 2021 Zambia HIV Impact Assessment revealed lower viral suppression rates in adolescents (15–24 years old) compared to adults on antiretroviral therapy (ART). Lusaka District, Zambia, has the highest number of adolescents on ART, with a 15.1% HIV prevalence in 2018. Objectives: To determine the prevalence and factors associated with viral suppression among adolescents living with HIV (10–19 years) on ART in Lusaka District, Zambia. Method: A retrospective cohort analysis was done of 3409 adolescents on ART at public health facilities in Lusaka from January 2023 to December 2023, and who had viral loads recorded. Socio-demographic, clinical, treatment and behavioural data were extracted from electronic health records and analysed using SPSS version 29. Results: The adolescent cohort in Lusaka achieved 91.8% viral suppression rate (< 1000 copies/ mL), with 79% fully suppressed (< 50 copies/mL). In multivariate analysis, older adolescents (15–19 years) had lower odds of suppression compared to younger adolescents (10–14 years) (adjusted odds ratio [AOR] = 1.79; confidence interval [CI]: 1.32–2.43). Higher odds of viral suppression were linked to first-line dolutegravir regimen (AOR = 5.12; CI: 3.23–8.11) and optimal adherence (AOR = 1.89; CI: 1.03–3.47), while regimen switches reduced the odds of viral suppression (AOR = 0.60; CI: 0.45–0.80). Conclusion: Zambia reached the previous UNAIDS 90-90-90 targets with a viral suppression rate of 91.8%. However, to reach the revised 95% target by 2030, tailored interventions should be implemented to improve adherence and retention in care, particularly for older adolescents