Research Articles (School of Public Health)

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A formative evaluation of the TB Think Tank’s role and influence on TB policy in South Africa
(Public Library of Science, 2026) Schmidt, Bey-Marrie; Mulopo, Chanelle; Mayieka, Lilian M.
Tuberculosis (TB) remains one of the leading causes of death globally, despite being both preventable and treatable. South Africa continues to experience a high burden, with an estimated 56,000 TB-related deaths recorded in 2023. In response to this public health crisis, the TB Think Tank (TB TT) was established in 2014 to strengthen the government’s programmatic response to TB. This formative evaluation examines the activities, processes, and outputs through which the TB TT has influenced TB policy between 2021 and 2024, identifies areas for improvement, and provides actionable recommendations to enhance its impact. To conceptualise the TB TT as a Knowledge Translation Platform, Bennett and Jessani’s (2011) framework was applied, focusing on knowledge generation, dialogue, and capacity building. Data were collected through 14 in-depth interviews with key stakeholders, a survey of 65 TB TT members conducted between June and July 2024, document review, and observational data to provide contextual insight; survey data were analysed using descriptive statistics, while qualitative data were analysed using inductive thematic analysis. Findings indicate that the TB TT has played a significant role in shaping South Africa’s TB response, with 97% of survey respondents affirming its effectiveness in advising the National Department of Health on policy. Key strengths include diverse membership, strong leadership, and alignment with national priorities, which have supported influential outputs such as the TB Strategic Plan 2023–2028. However, several challenges persist, including delays in the approval of recommendations, underrepresentation of key stakeholders such as district and provincial practitioners and other government sectors, limited monitoring mechanisms, and broader systemic constraints such as bureaucratic processes, competing priorities, and data access issues. Overall, the TB TT has made a substantial contribution to South Africa’s public health landscape and remains well positioned to advance the national TB agenda by strengthening evidence-informed decision-making and promoting equitable care.
HIV care through their eyes: navigating HIV services and art adherence among adolescents and their caregivers in Lusaka, Zambia
(John Wiley and Sons Ltd, 2026) Moomba, Kaala; Van Wyk, Brian; Crowley, Talitha
Introduction: Adolescents living with HIV (ALHIV) face unique psychosocial and structural challenges affecting ART adherence and engagement in care. Despite Zambia’s expansion of adolescent-friendly HIV services, adolescents continue to experience poorer adherence and treatment outcomes than adults, including lower viral suppression and retention in care and limited understanding remains around the experiences of ALHIV and their caregivers. This study explored multilevel factors influencing ART adherence in Lusaka district from the perspectives of ALHIV and their caregivers. Methods: We conducted an exploratory qualitative study on psychosocial, behavioral, and structural factors influencing ART adherence and experiences of HIV services among ALHIV in Lusaka, Zambia. Between February and July 2025, 35 in-depth interviews (20 ALHIV who were already aware of their HIV status and engaged in long-term care and 15 caregivers) were conducted across six health facilities (four PHC and two first-level facilities). Interviews were held in English or Nyanja, audio-recorded, transcribed, and analyzed using ATLAS.ti v24. A hybrid inductive-deductive approach, informed by the socioecological model, guided coding. Themes were organized in an analytical matrix showing multilevel influences on adherence, including emotional burden, stigma, support systems, and structural barriers. Trustworthiness was ensured through triangulation, peer debriefing, and iterative codebook development. Results: The themes identified spanned intrapersonal (individual), interpersonal, organizational/institutional, community, and structural/policy-level factors influencing ART adherence, alongside participant-generated cross-cutting recommendations to strengthen adolescent HIV service delivery. Many adolescents struggled with stigma, emotional distress, and challenges of consistent medication adherence, while others adapted through acceptance, spirituality, and counseling. Supportive relationships with family, peers, and healthcare workers fostered adherence, but stigma, school challenges, inconsistent caregiving, and limited privacy remained significant barriers. Socioeconomic issues, such as transport costs, hindered treatment continuity. Helpful strategies included routine-building, reminders, and increased health literacy. Participants recommended improving adolescent-friendly services by integrating mental health support, strengthening provider communication, expanding peer networks, and reactivating support groups to better support ART adherence among ALHIV. Conclusion: Addressing psychological, social, service delivery, and structural barriers such as coordination between schools and the health system is vital to improving ART adherence among ALHIV in Zambia. A multilevel approach is needed to support sustainable treatment outcomes.
Community care policy at the intersection of HIV and unemployment crises in South Africa: paradoxes and paradigms
(Oxford University Press, 2026) van Ryneveld, Manya; Schneider, Helen
The community care sector is a major component of social protection systems in South Africa. However, despite considerable investment and policy attention on social protection in South Africa, the community care sector continues to face enormous challenges and pressures. On the one hand, government invests a significant amount in social spending and aims to honour its constitutional responsibilities towards improving the health and social welfare of the country. On the other hand, community-based care workers are socially and economically marginalised, and community care services remain fragmented and often inaccessible to those who need them most. This paper explores how elements of South African policy on the community care sector emerged historically out of policy responses to parallel social crises of HIV/AIDS and unemployment in the period 2000–10. We draw on the theories of John Kingdon (agenda setting) and Nancy Fraser (needs interpretation) as the lenses to analyse data from policy documents, published literature, and key informant interviews. We show the convergence and consolidation of policies across sectors in the study period into a community care sector characterised by competing and unresolved tensions: between constitutional promises of social and economic rights and enduring conceptualisations of social reproductive labour as feminised, devalued, and ‘invisibilised’ within the private, domestic sphere. This results in a community care sector that has limited effectiveness as an arm of the social protection system, and which continues to be plagued by the structural inequalities that characterise South African society.
Losing their way: a cohort analysis of retention in care among adolescents on antiretroviral therapy in lusaka district, Zambia
(SAGE Publications Inc., 2025) Moomba, Kaala; Okonji, Emeka F; Crowley, Talitha; Van Wyk, Brian
Background: Retention in antiretroviral therapy (ART) is crucial for adherence, viral suppression, and preventing drug resistance. Adolescents (10-19 years) face retention challenges, affecting progress toward 95% viral suppression. Data on retention for this specific age bracket remains limited in Zambia. Methods: A retrospective cohort analysis of 3978 adolescents on ART in Lusaka examined socio-demographic, clinical, treatment, and behavioral data. Kaplan–Meier estimates analyzed retention, and Cox regression identified associated factors using SPSS v29. Results: Seventy percent remained in care, while 30% had interruptions, transfers, or death. Females (57.1%) had a higher non-retention risk (aHR: 1.21 [1.08-1.36]). Retention was lower in older adolescents (15-19 years, aHR: 0.11 [0.10-0.13]). Retention increased with early ART initiation with those starting ART at 15 to 19 years showed lowest retention (aHR: 578.50 [421.00-794.91]). Not changing ART regimens decreased retention (aHR: 0.88 [0.77-0.99]). Conclusions: Targeted interventions should prioritize females, older adolescents, early ART initiation, and regimen changes.
School health initiatives in low-income and middle-income countries: a scoping review protocol
(BMJ Publishing Group, 2026) Hibusu, Ladislas; Mianda, Solange; Akintola, Olagoke
Background: Schools are key settings for implementing school health initiatives to prevent health problems facing learners. Initiatives exist to help learners build health literacy, adopt positive behaviours and improve their health and academic outcomes. Yet, school health outcomes have not been achieved in many settings, particularly in low-income and middle-income countries. This failure is attributed to mismatches between the initiatives and the problems being addressed, or the ill implementation of school health initiatives. Mapping these initiatives to school health problems and other school health characteristics is essential to fully understand and achieve the desired school health outcomes.Methods and analysisThis study will map literature on school health initiatives with other characteristics from 2013 to 2025. We will search articles in PubMed, Scopus, Web of Science and Google Scholar databases. Two reviewers will independently screen records and chart data; disagreements will be resolved by consensus and, when needed, adjudicated by a third reviewer. Analysis will include a qualitative review of key concepts in school health and a quantitative analysis of all included studies based on the main text categories and themes from the qualitative phase.Ethics and disseminationEthics approval is not required because this study is a scoping review of published literature and does not involve human participants. The results will be published as an article in a peer-reviewed journal and presented to stakeholders involved in implementing school health initiatives.
Exploration of pregnant and breastfeeding women’s acceptability of rapid point-of-care urine testing within antenatal and postnatal care, and Its perceived impact on PrEP adherence when paired with PrEP biofeedback adherence counselling in Cape Town, South Africa
(Springer, 2026) Knight, Lucia; Court, Lara; Mvududu, Rufaro
Pregnant and breastfeeding women (PBFW) on oral pre-exposure prophylaxis (PrEP) face barriers to adherence and persistence which may be improved by point-of-care adherence monitoring using urine tenofovir testing. We explored the acceptability of urine tenofovir testing for PrEP adherence monitoring among PBFW on oral PrEP, and how this, together with PrEP biofeedback adherence counselling, may have shaped PBFW’s PrEP adherence and persistence. Between September 2022 and May 2024, we conducted a study among PBFW without HIV on oral PrEP in Cape Town, South Africa. Participants were randomized to intervention (urine tenofovir testing at each study visit with biofeedback adherence counselling) or standard-of-care arms (urine collected but not analyzed with participant, with standard PrEP adherence counselling). Participants, with consistent and inconsistent PrEP use, were purposively sampled from both study arms between October and December 2023 for qualitative interviews. Analysis was guided by the Theoretical Framework of Acceptability and Consolidated Framework for Implementation Research 2.0 using codebook thematic analysis. Among n = 39 women, who were pregnant (n = 16) or postpartum (n = 13); mean age was 29 years (SD = 7), and median time on PrEP was 11.9 weeks (IQR = 4.0,12.1). Acceptability of urine tenofovir testing was high, as it was perceived as familiar, appropriate and easy to use. Most felt that the limited perceived burden and opportunity costs were outweighed by the benefits, which included receiving feedback on their PrEP-taking behavior and if PrEP was present for HIV protection. Urine tenofovir testing with biofeedback counselling was seen as motivational to daily PrEP use. It positively reinforced PrEP-taking behaviors among those consistently using PrEP and allowed others the opportunity to reconsider their risk for HIV acquisition. Urine tenofovir testing facilitated more accurate self-reporting of PrEP adherence, although some reported restarting taking PrEP prior to visits. Participants’ PrEP-taking was supported by non-judgmental and encouraging biofeedback counselling which included co-development of strategies to overcome pregnancy and postpartum related barriers to PrEP persistence. Confusion of urine tenofovir testing with other antenatal urine tests and perceptions of blood-based testing being more effective hindered application to motivating PrEP use. Addressing perceived efficacy and coherence related to urine tenofovir testing within counselling is key. Urine tenofovir testing with biofeedback counselling was perceived as acceptable and motivational to PrEP adherence among PBFW. Integration is further recommended, given that other urine tests are routinely utilized in antenatal care.
‘The not talking is actually what kills you’– young South African women’s communication barriers about sexual health
(Routledge, 2026) Hartley, Felicity; Trappler, Jill; Gill, Katherine Margaret; Bekker, Linda-Gail Gail; MacKenny, Virginia; Knight, Lucia C.; Passmore, Jo Ann Shelley
Conversations about sex and sexual health are often stigmatised and shaped by socio-cultural influences. For young women, lack of adequate communication can influence access to information, knowledge and behaviour and therefore increase vulnerability to negative outcomes such as sexually transmitted infections (STIs) and unintended pregnancy. This qualitative study investigated the barriers young women face when seeking dialogue about sex, their sexual health and relationships. Seven isiXhosa-speaking young women (aged 21–25) participated in a six-session art-based engagement, creating large-format paintings reflecting their sexual health experiences. Data collection included in-depth interviews and a focus group discussion, which were transcribed, translated and thematically analysed. Findings revealed that communication about sex and sexual health was hindered by the attitudes of family, partners, communities and health care providers. The need to please and retain partners also restricted young women’s ability to express their sexual health needs and desires. Young women felt that with age and maturity they gained confidence, agency and capacity to navigate difficult conversations. Empowering tools and strategies to improve communication could enhance young women’s agency, enabling them to overcome barriers for communication and actively seek sexual health information and services.
Using natural language processing in the LACE index scoring tool to predict unplanned trauma and surgical readmissions in South Africa
(John Wiley and Sons Inc, 2025) Tokac Umit; Chipps Jennifer; Brysiewicz Petra; Bruce John; Clarke Damian
Background: Unplanned and potentially avoidable readmission within 30 days post discharge is a major financial burden. Aim: To use text‐based electronic patient records to calculate the Charlson Comorbidity Index (CCI) score using a natural language processing technique to establish the feasibility and usefulness of the text‐based electronic patient records in identifying patients at risk for unplanned readmission. Methods: A retrospective review of electronic patient records for general and trauma surgery in a hospital in South Africa (2012–2022) was conducted using the LACE score. Validated sentiment analysis analyzed free text components of electronic patient records to compute the CCI score and to establish the feasibility and usefulness of the LACE score in identifying patients at risk for unplanned readmission. Results: Trauma surgery patients had a mean LACE score of 5.91 (SD = 2.41), with 8.44% scoring 10 or higher and a specificity and sensitivity of 91.63% and 13.81%, respectively. The general surgery patients had a mean LACE score of 7.75 (SD = 3.04), with 10.63% scoring 10 or higher and a specificity of 71.47% and a sensitivity of 44.80%, respectively. Logistic regression analysis revealed that LACE scores significantly predicted unplanned readmissions in both trauma (β = 0.11, p < 0.001; OR = 1.112, 95% CI [1.082, 1.143]) and general surgery (β = 0.15, p < 0.001; OR = 1.162, 95% CI [1.130, 1.162]) patients. Conclusion: The LACE score demonstrated the predictive value for readmission in trauma and general surgery patients. The LACE score was relatively effective in identifying patients who were less likely to be readmitted but showed limitations in identifying patients at higher risk of readmission. However, the successful use of natural language processing for data extraction of comorbidities shows promise on addressing the challenges around text‐based medical records.
Preconception mental health (Healthy Life Trajectories Initiative): Identifying factors associated with probable anxiety and depression among young women living in urban-poor South Africa
(Public Library of Science, 2026) Norris, Shane A; Hart, Claire; Nyati, Lukhanyo H; Taljaard, Wihan; Hung, Rayjean J; Retnakaran, Ravi; Lye, Stephen; Draper, Catherine E; Craig, Ashleigh
Mental health disorders affect millions worldwide, with socially vulnerable youth in urban environments disproportionately affected. South Africa (SA) remains one of the most inequitable countries, and specific pathways linking poverty to mental health remains unclear. This cross-sectional study analyzed baseline data from the Bukhali trial in Soweto, SA part of the global Healthy Life Trajectories Initiative (HeLTI). Young women (n = 7735) completed surveys with physical assessments covering sociodemographic, household-level and behavioral-level factors, and mental health. Among the women, 12.6% reported anxiety, 15.8% reported depression, and 9.7% experienced both. Hazardous alcohol use (20.0%) and poor sleep (55.5%) were commonly reportedly behavioral factors among these women. Being in a committed relationship reduced the odds of reporting anxiety and depression (OR ≥0.66), while childhood adversity, hazardous alcohol use, and poor sleep increased the odds (OR ≥1.29). Moderate to severe anxiety greatly increased the risk of depression (OR 32.20). In the comorbid model, while being in a committed relationship remained protective (OR 0.67), childhood adversity and poor sleep quality was associated with substantial risk (OR ≥1.31) of this co-morbidity. In a gem constructed a priori, significant direct associations were found for poverty (measured by household socioeconomic status) on alcohol use (p = 0.015), childhood adversity on mental health (p < 0.001), and committed relationship on anxiety (p < 0.001). Mediation analysis revealed that poverty affected anxiety partially through poor sleep (54.2%), and fully via depression (86.9%), and affected depression fully via sleep (43.7%). Childhood adversity associated with depression partially via anxiety (79.4%), sleep (31.3%), and alcohol use (14.2%), and anxiety through depression (88.6%) and sleep (42.2%). In conclusion, childhood adversity, poverty and behavioral factors co-occur, and are collectively associated with elevated symptoms of anxiety and depression among young women in urban-poor settings. While tackling structural inequalities is critical, strengthening mental health support networks in these settings could aid women.
Experiences and outcomes of peer navigation and support interventions for adolescents on HIV treatment in Sub-Saharan Africa: protocol for a qualitative evidence synthesis
(BMJ Publishing Group, 2025) Van Wyk, Brian Eduard; Mabuza, Bernard Nhlanhla; Petinger, Charné
Introduction Adolescents living with HIV (ALHIV) on antiretroviral therapy (ART) globally report lower rates of viral suppression because of challenges to remain adherent and engage in HIV treatment. Psychosocial support is critical to meet the unique needs of ALHIV. Peer navigation has been found to be effective in supporting adults in ART adherence, but the evidence for adolescents is scant. Given the large proportion of adolescents on ART in sub-Saharan Africa, peers hold promise to deliver psychosocial support. The aim of this qualitative evidence synthesis is to review qualitative and mixed-methods studies describing experiences of peer navigation and support interventions for ALHIV on ART in sub-Saharan Africa. Methods and analysis The population–concept–context configuration will be applied to identify suitable studies on ALHIV and on ART (population) and experiences of peer navigation and support (concept) and conducted in sub-Saharan African countries (context). The review will only include studies published in the English language. The following databases will be searched: PubMed, Wiley Library Online, EbscoHost (PsycArticles), MEDLINE, Scopus, CINAHL, WHO database and Google Scholar, for eligible qualitative studies published from January 2015 (to ensure relevance) to November 2025. Two-stage screening will be done by two reviewers independently. Extracted data will be thematically analysed with Atlas.Ti (v25) software. A narrative synthesis will be conducted to describe the reported outcomes, experiences and challenges with receiving and delivery of peer navigation and support interventions in sub-Saharan Africa. The review will adhere to Preferred Reporting Items for Systematic reviews and Meta-Analyses and Enhancing Transparency in Reporting the Synthesis of Qualitative Research reporting guidelines. Ethics and dissemination Ethics approval is not required for this qualitative evidence synthesis. The findings will be submitted to a peer-reviewed journal and disseminated to via conference proceedings. PROSPERO registration number CRD42024541951.
Health services' responses to transitioning adolescents to adult HIV care in South Africa
(AOSIS (Pty) Ltd, 2025) Petinger, Charné; Crowley, Talitha; Van Wyk, Brian Eduard
BACKGROUND: Adolescents living with human immunodeficiency virus (HIV) aged 10-19 years account for 1.7 million globally, with 82% residing in sub-Saharan Africa. Older adolescents (15-19 years) assume greater responsibility for their own care, often leading to reduced adherence, lower retention, and poorer health outcomes. Understanding the role of healthcare workers (HCWs), key stakeholders in the HIV care continuum, is essential to strengthening transition practices and health system responses. AIM: To describe HCWs' perspectives on transition practices for adolescents living with HIV in the Cape Town Metropole, South Africa. SETTING: Six public primary health facilities in the Cape Town Metropole, South Africa. METHODS: A descriptive qualitative design was used. Data were collected through in-depth, semi-structured interviews with 16 HCWs and analysed thematically. RESULTS: Healthcare workers identified challenges to optimal transition (theme 1), including delayed disclosure, low adolescent readiness, and inconsistent transition processes. Health service responses (theme 2), such as youth clubs and provider-adolescent relationships, were supportive but unevenly applied. Gaps and recommendations (theme 3) included improving youth club management and ensuring system-wide support to enhance engagement and continuity of care. CONCLUSION: Successful transition to adult HIV care requires structural and psychosocial support mechanisms. Healthcare workers play a critical role and should be supported to consistently implement adolescent-friendly services during and post-transition. CONTRIBUTION: This study offers system-level insights to inform policy, HCW training, and integrated models of care tailored to adolescents living with HIV in primary health settings in South Africa.
Scaling COPC in South Africa: insights and priorities from the 2024 national workshop
(AOSIS (Pty) Ltd, 2025) Govender, Karessa; Schneider, Helen; Gilson, Lucy; Mash, Robert J.; Whyle, Eleanor Beth; Motshweneng, Oupa Steven; Nkosi, Nonhlanhla; Goliath, Charlyn; Mahomed, Hassan; Kariem, Saadiq
There has been increasing interest in Community-Oriented Primary Care (COPC) in South Africa in recent years. Community-Oriented Primary Care was first introduced in KwaZulu-Natal (KZN) in the 1940s.1 It has re-emerged and has been implemented in varied ways and settings across the country, including in KZN, Gauteng and Western Cape. Community-Oriented Primary Care is of relevance to ongoing health reforms that seek to reorganise the South African health system and provide health care services in an equitable manner.
Factors that influence caregivers’ and adolescents’ views and practices regarding human papillomavirus (HPV) vaccination for adolescents: a qualitative evidence synthesis
(John Wiley and Sons Ltd, 2025) Cooper, Sara; Schmidt, Bey-Marrié; Jama, Ngcwalisa A; Ryan, Jill; Leon, Natalie; Mavundza, Edison J; Burnett, Rosemary J; Tanywe, Asahngwa Constantine; Wiysonge, Charles S
Human papillomavirus (HPV) vaccination in adolescents provides a powerful tool for preventing cervical cancer in women and other HPV-associated diseases in people of all genders. HPV vaccines have been progressively introduced in many countries. However, worldwide, many adolescents do not receive HPV vaccination, for various reasons. The HPV vaccine might be costly or unavailable, healthcare systems might lack capacity for its delivery, or adolescent health might not be prioritised. Some caregivers and adolescents may not accept available HPV vaccines and vaccination services. We currently lack a comprehensive understanding of the factors that influence HPV vaccination views and practices, and why some caregivers and adolescents may be less accepting of the vaccine. Qualitative research can contribute to this understanding and help inform policy and practice, including the development of more relevant, acceptable and effective interventions to promote public acceptance and uptake of HPV vaccination in adolescents. This qualitative evidence synthesis supplements a Cochrane review of the effectiveness of interventions to improve uptake of adolescent vaccination, including HPV vaccination. Objectives: The objectives of the review are to identify, appraise, and synthesise qualitative studies that explore caregivers’ or adolescents’ views, experiences, practices, intentions, decision-making, acceptance, hesitancy, or nonacceptance of HPV vaccination; to gain an understanding of the factors that influence caregiver and adolescent views and practices regarding HPV vaccination for adolescents; and to explore how the findings of this review can enhance our understanding of the related Cochrane intervention review. Search methods: We searched MEDLINE, Embase, CINAHL, PsycInfo, and Scopus for eligible studies (February 2023). We updated this search in October 2024, but these results have not yet been fully incorporated. Selection criteria: We included studies that utilised qualitative methods for data collection and analysis; focused on caregivers’ or adolescents’ views, practices, acceptance, hesitancy, or refusal of HPV vaccination for adolescents aged 9 to 19 years of age; and were from any setting globally where HPV vaccination is provided. Data collection and analysis: We used a prespecified sampling frame to capture a sample of eligible studies that were from a range of geographical and income-level settings, were conceptually rich in relation to the review's phenomenon of interest, and included HPV vaccination for diverse genders. We extracted contextual and methodological data from each sampled study. We used a thematic synthesis approach to analyse the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We integrated the findings of this review with those from the related Cochrane review of intervention effectiveness (by Abdullahi and colleagues), by mapping whether the trial interventions reflected or targeted the factors identified by this review as influencing caregivers’ or adolescents’ views and practices regarding HPV vaccination. Main results: We included 206 studies in the review and sampled 71 of these for our synthesis. Of these, 35 studies were conducted in high-income countries, 26 studies in middle-income countries, 8 studies in low-income countries, and 2 studies in multiple-income settings. Studies came from all six World Health Organization (WHO) regions and included urban and rural settings. We downgraded our confidence in several findings, mainly due to concerns about how the studies were conducted (methodological limitations), concerns about perspectives lacking from some types of participants or in some settings (relevance), or because of variability in the data or insufficient evidence to support all aspects of a review finding (coherence). Many complex factors were found to influence caregivers’ and adolescents’ HPV vaccination views and practices, which we categorised into eight overarching themes: 1) A lack of biomedical knowledge; 2) Perceptions of a range of interrelated risks and benefits (or lack thereof) associated with HPV vaccination; 3) Routine responses to vaccination generally or more specific views or experiences of other vaccines and vaccination programmes; 4) Complex nuclear familial decision-making dynamics; 5) Extended familial and social relations and networks, particularly extended family members, peers, traditional or religious leaders, and the media; 6) Interrelated socio-cultural beliefs and practices regarding adolescence, sexuality, gender, parenting and health; 7) Trust or distrust in the institutions, systems or experts associated with vaccination, most particularly teachers and the school, the pharmaceutical industry, government, science and biomedicine, and healthcare professionals; and 8) Access to, and experiences of, HPV vaccination programmes and delivery services, such as the convenience (or lack thereof) of HPV vaccination services, the cost of the vaccine, language barriers, the feminisation of HPV vaccination programmes and procedural aspects of school-based vaccination delivery. We did not identify any major differences in the occurrence of these overarching themes between subgroups. However, for various subthemes certain differences emerged in relation to place, gender and socio-economic status, and between caregivers and adolescents. The interventions tested in the related Cochrane review of intervention effectiveness most commonly targeted caregivers' and adolescents’ lack of biomedical knowledge and their perceptions of the risks and benefits of HPV vaccination, with the other influencing factors identified by our review being underrepresented. Authors' conclusions: Our review reveals that caregivers’ and adolescents’ HPV vaccination views and practices are not only influenced by issues related to individual knowledge and perceptions of the vaccine, but also an array of more complex, contextual factors and meanings: social, political, economic, structural, and moral. Successful development of interventions to promote the acceptance and uptake of HPV vaccination for adolescents requires an understanding of the context-specific factors that influence HPV vaccination views and practices in the target setting. Through this, more tailored and in turn more relevant, acceptable, and effective responses could be developed. The eight overarching themes that emerged from our review could serve as a basis for gaining this understanding.
Routine electronic mother-infant data (REMInD): a proof-of-concept data to care study to support retention in maternal HIV treatment and infant HIV testing in Cape Town, South Africa
(Springer, 2025) Phillips, Tamsin K; Gomba, Yolanda; Mogoba, Pheposadi; Phelanyane, Florence; Anderson, Kim; Chi, Benjamin H; Clouse, Kate; Davies, Mary-Ann; Euvrard, Jonathan; Knight, Lucia; Myer, Landon; Abrams, Elaine J
Data to Care (D2C) strategies– using routine data to identify and re-engage people living with HIV who are not in care– have shown promise in high-income settings but remain underexplored in lower-resource and vertical HIV transmission prevention (VTP) contexts. In this prospective, single-arm, proof-of-concept study, we used facility-linked public sector electronic medical records (Provincial Health Data Centre [PHDC] data) to identify, validate and trace postpartum VTP gaps among 336 mothers living with HIV and their infants in Cape Town, South Africa (March 2021–April 2022). Of 302 observed gaps, 123 (41%) were false, while 179 (59%) were probable gaps affecting 133 mother-infant pairs. Overall, 16% of mothers did not link to HIV care within 12 weeks postpartum and 13% had ART dispensing gaps, while 10% and 17% of infants had no HIV test around 10 weeks and six months, respectively. Only 100 (56%) probable gaps were confirmed through telephonic tracing, with 47 mothers subsequently re-linked to care. Mobility, stigma, and employment challenges contributed to disengagement. While our D2C approach streamlined tracing efforts, re-engagement remained difficult. Strategies integrating D2C approaches with interventions addressing social determinants are needed.
Optimizing adolescent HIV care: a review of EMR system quality for clinical monitoring in Zambia
(Frontiers Media SA, 2026) Moomba, Kaala; Van Wyk, Brian Eduard
Adolescents living with HIV (ALHIV) in Zambia experience poorer treatment outcomes than adults, with lower viral suppression and higher loss to follow-up rates. Electronic medical record (EMR) systems such as SmartCare aim to strengthen patient monitoring, but their utility is contingent on high data quality. Accurate monitoring of ALHIV treatment outcomes is critical for improving patient care and supporting progress toward UNAIDS 95–95-95 targets. We conducted a retrospective cross-sectional review of EMR data for ALHIV on antiretroviral therapy in selected Lusaka facilities (January–December 2023). Data were extracted from SmartCare and assessed using the WHO Routine Data Quality Assessment framework across three dimensions: completeness, correctness, and consistency. Records from 3,978 ALHIV were analysed. Socio-demographic variables (gender, date of birth, age at ART initiation) and treatment data (ARV regimen) performed strongly, with ≥98% completeness, correctness, and consistency. In contrast, clinical variables showed substantial gaps. Completeness for baseline (n = 1,707) and current (n = 2,149) CD4 counts was 43% and 54%, respectively, though correctness and consistency exceeded 99%. Pregnancy and breastfeeding data among female adolescents (n = 2,177) were particularly poor, with completeness of 4% and 12%. By comparison, history of tuberculosis (100%) and current viral load results (91%) were reliably captured. Whereas SmartCare demonstrated strong reliability for demographic and treatment indicators, notable weaknesses in the completeness of key clinical variables, such as CD4 count and pregnancy/breastfeeding status were observed. These gaps may reflect variability in data entry workflows and system-level factors, including EMR upgrades, highlighting areas for targeted improvement. We recommend targeted training, system redesign to enforce mandatory entry of critical fields, and routine data quality monitoring to ensure EMR systems provide accurate and actionable data. Addressing these gaps would facilitate optimising HIV care and support progress toward achieving the UNAIDS 95–95-95 goals for ALHIV in Zambia.
Unravelling dual violence against women in Ethiopia: experiences of obstetric violence and postpartum intimate partner violence
(Elsevier B.V., 2026) Makandi, Millicent; Benová, Lenka; Gebremedhin, Samson; Mohammed, Zemzem; Votruba, Nicole; Tabana, Hanani; Dadi, Abel Fekadu; Asefa, Anteneh
ObjectiveTo examine the prevalence of dual violence—experience of obstetric violence (OV) and postpartum intimate partner violence (IPV)—and factors associated with it among women in Addis Ababa, Ethiopia.MethodsAs part of a broader longitudinal study, we surveyed 354 postpartum women six to sixteen weeks after childbirth. OV was assessed across seven domains (e.g., verbal abuse, non-consented care, lack of privacy), and IPV across three (physical, sexual, emotional). Dual violence was defined as experiencing at least one form of both OV and IPV. We used logistic regression to identify factors associated with dual violence.ResultsExperience of OV was reported by 87.0% (95% CI: 82.9%-90.2%) of the participants, while 31.2% (95% CI: 26.1–36.0%) reported experiencing postpartum IPV. The prevalence of dual violence was 29.4% (95% CI: 24.9%–34.2%). Most prevalent OV forms were: lack of privacy, confidentiality, or access to information (65.5%) and non-consented care (61.6%), whereas emotional violence was the most experienced form of postpartum IPV (29.4%). Dual violence was significantly associated with unemployment (AOR: 2.31, 95% CI: 1.20–4.54), lack of postnatal check (AOR: 2.23; 95% CI: 1.06–4.72), and experience of IPV during pregnancy (AOR: 6.91, 95% CI: 3.92–12.55). Conversely, women who gave birth in private facilities had lower odds of experiencing dual violence (AOR: 0.41, 95% CI: 0.15–0.99).ConclusionThe high prevalence of dual violence identified by our study underscores the need for integrated interventions to strengthen OV and IPV prevention and response actions.
The healthy hard worker: a critical analysis of young adult South Africans’ discursive constructions of health
(SAGE Publications Ltd, 2025) De Jong, Michelle; Plüg, Simóne; Collins, Anthony
This qualitative study explores how a small group of young adult South Africans discursively construct health during in-depth semi-structured interviews, and the ways in which these discourses are used to construct subjectivity. Data was collected from 20 mostly white, university educated participants and were analysed using Foucauldian discourse analysis. One of the discourses identified, ‘health and work’, is discussed with a specific focus on the construction of subject positions and the possible implications these have. We explore the personal implications of how the use of ‘health and work’ discourses construct participants as in alignment with moral norms. However, we also argue that these discourses individualise the responsibility for (ill)health and deploy the association between good health and virtue to perpetuate capitalist notions of the work ethic and neoliberal ideologies which are implicated in the perpetuation of health inequities.
Transition of adolescents from paediatric to adult HIV care in South Africa: a policy review
(AOSIS (pty) Ltd, 2025) Petinger, Charné; Crowley, Talitha; van Wyk, Brian
The successful roll-out and improved delivery of antiretroviral therapy (ART) services has led to paediatric HIV patients surviving to reach adolescence. Adolescents living with HIV (ALHIV) are challenged when transitioning to adult HIV care programmes where they must negotiate new care pathways, changes in healthcare providers and self-manage their chronic condition, in addition to dealing with the psychological and physiological developmental changes of adolescence. The transition process needs to be well guided, to ensure that ALHIV on ART maintain optimal adherence and remain engaged in care. Viral suppression and retention in care are significantly lower for older adolescents (15–19 years) compared to children and younger adolescents under 15 years – coinciding with the post-transition period. Comprehensive and structured transition protocols may have a significant impact on positive health outcomes. In sub-Saharan Africa, there is a dearth of policies and implementation guidelines for ALHIV who are transitioning to adult HIV care. The current review reports on policies and guidelines for transitioning ALHIV to adult HIV care in South Africa. Eight policies were identified, which were developed at global (n = 2), national (n = 2) and provincial levels (n = 1), and guided implementation (n = 3). Current national and provincial policies provide guidance on when to transition a patient clinically to facilitate the switch to adult ART regimens. Although global policies and implementation guidelines emphasise specific and comprehensive care for ALHIV on ART, these are not carried over to national and provincial policies in South Africa. Further development of policies is required to guide comprehensive, adolescent-friendly transition processes for ALHIV on ART in South Africa.
Drivers of food choice in three urban communities in South Africa
(Taylor and Francis Ltd., 2026) Sayed, Nazeeia; Swart, Elizabeth Catherina
Background: With South Africa's high burden of disease, increasing attention has been given to improving food environments to facilitate healthier food access. An understanding of the main drivers of food choice and barriers in consuming healthier foods can assist in the formulation of nudge strategies to improve the quality of diets consumed. Objectives: To explore the drivers of food choice among adults in three urban communities in South Africa. Design: Qualitative descriptive phenomenological study using focus-group discussions. Setting: Three urban sites in the Eastern Cape, KwaZulu Natal, and Western Cape provinces in South Africa. Subjects: Adults (male and female, 21 to 59 years of age). Outcome measures: Self-administered sociodemographic questionnaire and focus-group discussions. Findings: Nine focus groups with 68 participants were completed. Financial considerations, household/family factors, and shop/food retail factors were the key drivers of food choice identified. Health considerations were present, but not prevalent. Enablers of healthy food consumption included: cost, recognised health/nutrition benefits, and good taste. Barriers were unavailability, unknown preparation, beliefs, and disliked taste. Conclusions: This study found that financial considerations, household/family factors, and the retail food environment were key influences on food choice in three urban South African communities. The research contributes to qualitative evidence on consumer perspectives in urban contexts. Recommendations include exploring retail interventions and pricing strategies to improve access to healthy foods. The study limitations include limited transferability beyond the study sites, but findings remain valuable for guiding future research and public health nutrition policy.
“If there is no data, how do we improve?” exploring health workers’ perspective on stillbirth recording in the ashanti region of ghana
(BioMed Central Ltd, 2026) Mensah-Abrampah, Nana Afriyie; Okwaraji, Yemisrach Behailu; Oteng, Kenneth Fosu; Asiedu, Ernest Konadu; Larsen-Reindorf, Rita; Blencowe, Hannah K.; Jackson, Debra J.
Background: Health workers play a critical role in documenting the estimated 2 million stillbirths that occur annually. From the moment a stillbirth occurs, a health worker is responsible for recording the birth outcome. The reliability of stillbirth data for informing global and national-level strategies on stillbirths depends on the information recorded by the health worker at the point of care. This study aimed to gain insights into the health worker practices and challenges related to stillbirth recording and reporting. Methods: The qualitative study explored three objectives using an a priori framework: 1) experiences, perceptions, and attitudes; 2) barriers; and 3) support mechanisms available to health workers for stillbirth recording and reporting. Semi-structured interviews were conducted with 28 health workers, including midwives, medical officers, physician assistants, and health information officers. The study was conducted across four secondary and four primary care facilities in the Ashanti Region of Ghana. All health facilities are government owned. Thematic analysis was performed. Results: Under experiences, perceptions, and attitudes, inconsistent definitions were used to describe stillbirths. Health workers described stillbirths using various gestational age thresholds, including 24-,28-,36-, and 38-weeks. Some health workers did not reference gestational age when describing stillbirths. Pre-service education shaped knowledge on stillbirths and its recording, with limited opportunities for in-service training. The motivation to record stillbirths was influenced by both intrinsic, driven by the moral imperative to do what is right, and extrinsic factors, influenced by district-level standards. Misclassifications and omissions of stillbirths occurred due to a higher workload, a large volume of forms requiring completion, limited knowledge and experience, and a deliberate effort to minimize facility mortality rates, especially in cases of macerated stillbirths. For barriers to stillbirth recording, midwives reported that blame was evident at three levels: blame from the broader health system, blame within the organizational facility-level, and individual-level blame. The failure to implement audit recommendations was identified as a bottleneck perpetuating negative attitudes toward collecting stillbirth data. The engagement of clinical staff in audit reviews and training was identified as support available to health workers. Conclusion: We need to understand the health worker experiences, perceptions, and attitudes that underpin stillbirth data to reduce the stillbirth burden. The study suggests several recommendations, including socializing the national stillbirth definition, and reviewing audit protocols. © The Author(s) 2026.

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