Research Articles (School of Public Health)

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To what extent are digital health interventions targeting HIV care cascade among mobile populations feasible, acceptable, and effective? A mixed methods systematic review protocol
(BioMed Central Ltd, 2025) Knight, Lucia; Mathenjwa, Thulile; Malila, Bessie
Introduction: Human mobility is associated with an increased risk of HIV acquisition and disengagement from HIV care, leading to poorer health outcomes among highly mobile individuals compared to less mobile individuals. Mobile individuals, broadly defined as those who temporally, seasonally, or permanently move from one place to another for voluntary or involuntary reasons, face many challenges in accessing HIV care services. These challenges include logistical difficulties, interruptions in HIV care continuity, and limited access to services across different locations, which together hinder timely testing, treatment initiation, and viral suppression. Digital health interventions offer flexible approaches that can adjust to the mobile individual’s location to improve HIV care engagement and health outcomes for this underserved and hard-to-reach population. However, evidence on the feasibility, acceptability, and efficacy of digital health interventions across the HIV care cascade among mobile populations has not yet been appraised. Objectives: We seek to synthesize empirical evidence on the feasibility, acceptability, and efficacy of digital health interventions targeting the HIV care cascade among mobile populations. Methods: We will conduct a mixed methods systematic review of peer reviewed studies published between 1 January 2010 and 31 July 2024 that evaluated digital health interventions targeting the HIV care cascade among mobile populations. We will search PubMed, Web of Science, and EBSCOhost (Academic Search Premier, Africa-Wide information, CINAHL, Health Source: Nursing/Academic Edition, APA PsycInfo, APA PsycArticles) electronic databases. Bibliographies of retrieved studies will also be reviewed for relevant citations. Only studies published in English language and involved a digital health intervention, report an outcome related to the HIV care cascade, and involve mobile populations either partially or completely will be included. Two reviewers will independently screen titles and abstracts against the inclusion criteria, followed by full text screening for eligible articles. In case of disagreements, consensus will be sought from a third reviewer. Data synthesis will follow the Joanne Briggs Institute’s convergent segregated approach. If sufficient quantitative studies with comparable outcome measures are available, a meta-analysis will be performed. Discussion: This review will address a critical evidence gap by consolidating data on digital health interventions’ feasibility, acceptability, and efficacy across the HIV care cascade among mobile populations. The results will inform the development of tailored digital health interventions to enhance HIV care delivery and health outcomes for this hard-to-reach population, supporting global HIV prevention and treatment goals. Systematic review registration: This protocol is registered on PROSPERO (CRD42024528122).
Secondary prevention medications in 17 countries grouped by income level (pure): a prospective cohort study
(Elsevier Inc., 2025) Puoane, Thandi; Joseph, Philip; Avezum, Álvaro
Background: It is unclear whether global use of medications for secondary cardiovascular (CVD) prevention is improving over time. Objectives: This study across 17 high-, middle- and low-income countries described variations in secondary CVD prevention medication use over a median follow-up of 12 years. Methods: In the multinational PURE (Prospective Urban Rural Epidemiology) cohort study, we conducted a repeated cross-sectional analysis to examine temporal variations in the use of secondary prevention medications in participants with CVD. In participants with coronary artery disease, we focused on antiplatelet agents, statins, renin-angiotensin system (RAS) inhibitors, and β-blockers. In participants with stroke, we focused on antiplatelet agents, statins, RAS inhibitors, and other blood pressure–lowering drugs. Medications were collected at baseline and on 4 subsequent follow-up visits. Results: The analysis included 7,409 participants with a diagnosis of CVD at the baseline visit, 8,792 at the second visit, 9,236 at the third visit, 11,082 at the fourth visit, and 11,677 at the last visit. The median age at baseline was 58.0 years, and 52.9% of the participants were female. The median follow-up was 12 years, with the median year of the baseline visit in 2007 and the fifth visit in 2019. Over this period, use of 1 or more classes of medications for secondary CVD prevention was 41.3% (95% CI: 40.2%-42.4%) at baseline, peaked at 43.1% (95% CI: 42.0%-44.1%), and then decreased to 31.3% (95% CI: 30.4%-32.1%) by the last study visit. In high-income countries, this use decreased from 88.8% (95% CI: 86.6%-91.0%) to 77.3% (95% CI: 74.9%-79.6%). In upper-middle-income countries, this use increased from 55.0% (95% CI: 52.8%-57.3%) to 61.1% (95% CI: 59.1%-63.1%). In lower-middle-income countries, use of at least 1 class of medications was 29.5% (95% CI: 28.1%-30.9%) at baseline, peaked at 31.7% (95% CI: 30.4%-33.1%), and then decreased to 13.4% (95% CI: 12.5%-14.2%) by the last visit. In low-income countries, use of at least 1 class of medications was 20.8% (95% CI: 18.1%-23.5%) at baseline, peaked at 47.3% (95% CI: 44.8%-49.9%), and then decreased to 27.5% (95% CI: 25.2%-29.9%) by the last study visit. Conclusions: Globally and in most country income-level groups, the use of medications for secondary CVD prevention has been low, with little improvement over time.
A qualitative process evaluation of community-based participatory research and human-centered design in the ‘let’s talk about vaccines’ approach in Mozambique and Malawi
(BioMed Central Ltd, 2025) Shuro, Linda; De Man, Jeroen; Knight, Lucia; Tabana, Hanani; Schneider, Helen
Background: Ensuring full coverage of childhood vaccination programmes is a persistent challenge in low- and middle-income countries. Urgent action is required to ensure catch up of missed immunisations in children, while simultaneously building trust and demand within communities to sustainably address existing immunization gaps. This paper summarizes the findings of a process evaluation of the ‘Let’s talk about vaccines’ approach by VillageReach in Mozambique and Malawi. The approach used community-based participatory research to identify the barriers to childhood vaccination faced by caregivers and healthcare workers, with human-centered design to codesign potential interventions to improve under two immunization access and uptake. Methods: To evaluate the implementation of the ‘Let’s talk about vaccines’ approach we conducted a qualitative process evaluation guided by the Reach Effectiveness Adoption Implementation Maintenance framework and Consolidated Framework for Implementation Research (CFIR). We completed a total of 76 qualitative interviews and 85 self-administered surveys among caregivers, healthcare workers, health officials and other stakeholders involved in the approach. We transcribed the interviews verbatim and analysed them using thematic analysis and constructs of the RE-AIM and CFIR frameworks. We analysed the survey results in Excel. Results: Key elements of the approach contributing to high fidelity to community-based participatory research principles in both countries, included diverse collaborative study and project teams, involvement of eight caregiver researchers, novel and traditional participatory methods, and extensive mobilization efforts. Success factors for human-centered design in the ideation and prototyping phase included fostering equal participation and empathy, value placed on each participant’s input, mitigating inherent power differences, interactive feedback processes, and extensive iterative processes leading to tangible solutions. Challenges included adjusting to new methods and contextual realities. Factors influencing the potential adoption of the approach included locally developed solutions, participant involvement, collaboration, a major advantage over alternative approaches, ease of use of the co-created interventions, alignment with government objectives, and adaptability for system-wide integration into immunization programming. The potential sustainability of the approach was supported by the involvement of health ministries, health professionals, community representatives, and capacity building of local structures. However, resource and incentive constraints posed as a potential challenge to maintaining long-term motivation and action. Conclusion: The evaluation findings from the ‘Let’s talk about vaccines’ approach highlighted key elements for applying community-based participatory research and human-centered design to collaboratively identify immunization barriers and create tangible solutions to overcome them. By integrating these approaches into routine immunization programs, it can potentially improve vaccination efforts for children under two in low and middle-income countries, leading to lasting change. Supporting policies that prioritize community involvement in research, program design and implementation and sustainable funding enhances immunization strategies, ensuring that they are tailored to local needs.
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.
Irrational medicine use and its associated factors in conflict-affected areas in Mali: a cross-sectional study
(Taylor and Francis Ltd., 2025) Ravinetto, Raffaella; Ahmed, Mohamed Ali Ag; Seydou, Alassane
Background: Rational use of essential medicines is a critical step towards prevention and treatment of many illnesses. However, it represents a significant challenge worldwide, and particularly for under-resourced health systems in conflict-affected areas. Objective: To assess barriers to rational use of essential medicines at primary healthcare level in conflict-affected areas of Mali. Methods: We conducted a cross-sectional study in twenty randomly selected community health centres (CHCs) in four health districts, by applying the World Health Organisation and International Network on Rational Use of Drugs core forms for the rational use of medicines. Seven hundred eighty-nine (789) prescriptions were retrospectively selected and analysed; four hundred forty-three (443) patients were interviewed: and health facility-related indicators were collected prospectively from the 20 CHCs. Results: The average number of medicines per prescription was 3.89 ± 1.83; out of these, 94.0% were prescribed by generic name, and 91.0% belonged to Mali’s National List of Essential Medicines. Overall, 68% of the assessed prescriptions included antibiotics; 58% included injectables; and 75.79% were characterized by polypharmacy, i.e. more than two medicines per prescription.
The anti-politics of food in South Africa: transformation, accountability and the nutrition policy subsystem
(Cambridge University Press, 2025) Moyo, Busiso Helard; Kroll, Florian; Thow, Anne Marie
Objective: To examine power and governance arrangements in food and nutrition policy formulation and agenda-setting in South Africa Design: Analysis of the policy implementation environment and in-depth interviews were conducted focussing on: existing policy content and priorities across food system sectors; institutional structures for cross-sectoral and external stakeholder engagement; exercise of power in relation to food system policies; and opportunities to strengthen action on nutrition. Setting: South Africa Participants: Interviews were conducted with 48 key stakeholders involved in the food and nutrition policy sphere: government sectors relevant to food systems (n=21), the private sector (n=4), academia (n=10), NGOs (n=11) and farmers (n=2). Results: This study found that there are power dynamics involved in shaping the planning agenda that is inadvertently generating a food system that undermines the right to food. The concept of nutrition governance remains poorly defined and applied in different ways and usually based on a relatively narrow interpretation - therefore limiting policy coherence and coordination. South Africa has strong legal institutions and practices, and social policies that support public provisioning of food, but a non-interventionist approach to the food system. Conclusions: The right to food and nutrition, as outlined in the South African Constitution, has not yet been effectively utilized to establish a robust normative and legal basis for tackling the dual challenges of food insecurity and malnutrition. Currently, the governance of the food system is grappling with substantial obstacles, balancing the influence of powerful stakeholders who uphold the status quo against its responsibilities for food justice.
Structural barriers and facilitators to accessing HIV services for marginalized working populations: insights from farm workers in South Africa
(Oxford University Press, 2025) Lembani, Martina; Mlangeni, Nosimilo; Adetokunboh, Olatunji
Farm workers are vulnerable working populations who face significant inequalities in accessing health services, including those for human immunodeficiency virus (HIV) prevention, treatment and care. This descriptive phenomenological study aimed to explore farm workers’ experiences when accessing HIV services and was conducted in Limpopo province, South Africa. Eighteen in-depth interviews were conducted in four health facilities from two districts, and two focus group discussions were conducted in one of the farms within the province. Purposive sampling and systematic random sampling were used to select study participants. A deductive thematic approach was used to analyse data, informed by the social–ecological model of health. The results reveal that farm workers perceive multiple interdependent factors that inhibit or enable their access to HIV healthcare services. Key barriers to HIV healthcare were transport affordability, health worker attitudes, stigma and discrimination, models of HIV healthcare delivery, geographic location of health facilities and difficult working conditions. Key facilitators to HIV healthcare included the availability of mobile health services, the presence of community health workers and a supportive work environment. The findings suggest disparities in farm workers’ access to HIV services, with work being the main determinant of access. We, therefore, recommend a review of HIV policies and programmes for the agricultural sector and models of HIV healthcare delivery that address the unique needs of farm workers.
Beliefs of pentecostal pastors on the use of antiretroviral treatment among pentecostal christians living with HIV in a suburb of Cape Town-South Africa: a community health systems lens
(Oxford University Press, 2025) Azia, Ivo Nchendia; Nyembezi, Anam; Carelse, Shernaaz
The global public health community accepts antiretroviral therapy (ART) for controlling and managing human immunodeficiency virus (HIV). However, within some communities, claims of faith or miraculous healing of HIV and acquired immunodeficiency syndrome (AIDS) by Pentecostal pastors continue to spark controversies. This paper reports on an exploratory qualitative study to explore the beliefs held by Pentecostal pastors regarding the use of ART among Pentecostal Christians who are living with HIV. Twenty (20) purposively selected Pentecostal pastors from two informal settlements in Cape Town, South Africa, participated in the study. Open-ended, semi-structured, in-depth individual interviews were conducted on their religious beliefs concerning ART adherence. Interviews were conducted in English, audiotaped and transcribed verbatim before being imported into the Atlas.ti 2023 software program for thematic data analysis. Since our study was guided by the relational community health system model a hybrid deductive–inductive thematic analysis was used. Two contrasting themes about the influence of the religious beliefs of Pentecostal pastors were identified. The first theme and its associated subthemes highlight the lack of basic HIV and ART knowledge among pastors. Consequently, these pastors tend to nudge their Christians to rely more on faith and spiritual healing at the expense of adherence to ART. The second theme and its related sub-themes suggest that some pastors possess some basic HIV knowledge and understand the role of ART and how it works. This group of pastors advise their congregants to use ART and other healthcare services in tandem with spiritual rituals, faith and prayers. Our findings highlight the need for functional community-based structures, such as community health committees and health facility management committees, in settings where complex interaction within the belief systems, practices and norms of some stakeholders can influence people’s health-seeking behaviours such as adherence to chronic medications like ART.
Human resource management in a district health system in the public health sector
(AOSIS, 2025) Mathews, Verona
Orientation: There is a misalignment between the strategic goals of the public health sector, which include strengthening health systems to produce desired health outcomes, and the human resource management of the human resources for health. Research purpose: This study aimed to describe the extent and identify the factors influencing the human resource management in achieving the strategic objectives of the public health sector. Motivation for the study: Managers in the public health sector can develop interventions and effective procedures to improve alignment in the human resource management of the human resources for health to improve health outcomes. Research approach/design and method: A qualitative descriptive study design with an interpretivist approach was utlised to conduct the study. A document review and sixteen face-to-face interviews were conducted, eight human resource (HR) practitioners and eight line managers purposively selected from an urban and rural district. Main findings: The public health sector provides a unique context that requires different considerations for human resource management. Human resource managers and line managers do not only have different backgrounds and orientations but they also function in different contexts (administrative vs. clinical) in the public health sector. The factors influencing effective human resource management are as follows: the lack of capacity to implement key HR strategies in the public health sector, competing priorities and the absence of clear roles in performing human resource practices. Practical/managerial implications: There is a need to foster a partnership approach between the HR manager and line manager to provide effective human resources management as it is complex and fractured, particularly during change and decentralisation. Contribution/value-add: This article addresses the research gap on human resource management in the public health sector shifting focus from individual practices to a systems thinking approach in strengthening human resource management. It also makes a theoretical contribution by adding context to human resource management as a key requirement for implementation decision making.
#BecomingYou: discourses of authenticity, work, and success in South African consumer culture
(SAGE, 2024) De Jong, Michelle; Plüg, Simóne; Collins, Anthony
Authenticity is now being used to describe things as diverse as politicians, wallets and holiday packages, and claims to authenticity have become increasingly marketable. Media sources from magazines to social media blogs are all inundated with a persisting, recurring message: that tapping into the “real you” will be the liberating force allowing you to live a happy and successful life. This paper draws on a social constructionist theoretical framework and discourse analytic method to critically analyse three interconnected discourses of personal authenticity (as success, change and work) explored in 10 marketing campaigns prominent in South African media. The constructions found in these media are important not just as reflections of current subject positions available in a particular context, but also in the (re)construction of these particular identities and the (re)production of particular social systems. More specifically, in this case, by closely tying authenticity to notions of success, work and change, these discourses produce “good neoliberal subjects”- ambitious, self-regulated, proactive and productive citizens committed to personal progress and contributing to a “functioning” society. In other words, through these discourses, individuals’ personal aspirations (e.g. self-improvement or happiness) become inextricably linked with capitalist modes of being (work and consumption).
Factors shaping Covid-19 vaccine acceptability among young people in South Africa and Nigeria: an exploratory qualitative study
(Public Library of Science, 2025) Casale, Marisa; Somefun, Oluwaseyi; Sumankuuro, Joshua
Covid-19 vaccine hesitancy among young people can be seen as an acute – but not isolated – phenomenon within an alarming longer-term trend of broader vaccine distrust in Africa. Yet there are still considerable knowledge gaps in relation to the scope and drivers of low vaccine acceptability among young people. Moreover, better frameworks and tools are needed to conceptualise and better understand acceptability in this population group. We applied the recently published Accelerate Framework for Young People’s Acceptability to guide qualitative research with young people living in South Africa and Nigeria. We aimed to investigate their overall acceptability of the Covid-19 vaccine, and explore factors shaping this acceptability and willingness to be vaccinated. In collaboration with seven community-based organisation partners, we conducted 12 in-person focus groups and 36 remote interviews with 163 individuals aged 15-24. Through a collaborative, iterative process we conducted thematic analysis, incorporating aspects of both deductive and inductive approaches. Our findings show how vaccine acceptability is shaped by a multiplicity of inter-related factors. They also provide a more in-depth perspective of some of these phenomena, their relative importance and their connections in this group of young people. Limited vaccine understanding, conflicting information and distrust, the influence of others, and fear of side effects were key inter-related drivers of low vaccine acceptability. Factors promoting Covid-19 vaccine acceptability were instead: positive perceptions of vaccine safety and efficacy, protection from disease, protection of others, and a desire to return to normal activity. We discuss implications of these findings for policy and practice, both to increase acceptability of Covid-19 vaccination among young people, and more broadly promote vaccination as a critical component of public health programs. Lastly, we reflect on this first application of theAccelerate Framework, and implications for its use in future studies.
Towards a better tomorrow: addressing intersectional gender power relations to eradicate inequities in maternal health
(Elsevier Ltd, 2024) George, Asha S; Bohren, Meghan A.; Iyer, Aditi
Background : Improving access to and use of quality maternity care services as a means to reduce maternal morbidity and mortality are critical goals for maternal health. However, inequalities in access, use, and health outcomes remain persistent and profound. Exploring and responding to inequalities in coverage and use of services are important, but do not reflect the broader human rights and factors that influence women and birthing peoples’ ability to obtain dignified, quality maternity care. A more comprehensive and holistic approach to maternal health ensures terms to reflect all populations with the reproductive capacity for pregnancy and birth (e.g., including cisgender women, and people who are transgender, non-binary, gender-fluid, intersex, and gender nonconforming). Where we use “women” only, it is to reflect the term used in existing data sources, as these data sources typically come from maternal health studies conducted with cisgender women
The Durban university of technology faculty of health sciences decentralized clinical training project: protocol for an Implementation study in KwaZulu-Natal, South Africa
(JMIR Publications Inc., 2024) Nxumalo, Celenkosini Thembelenkosini; Pillay, Pavitra; Mchunu, Gugu Gladness
Background: The Durban university of technology (DUT) faculty of health sciences (FHS) in KwaZulu-Natal, South Africa, is embarking on a project to implement a decentralized clinical training program (DCTP). The DUT FHS DCTP project is being conducted in response to the growing demands of students requiring clinical service placements as part of work-integrated learning. The project is also geared toward responding to existing gaps in current practices related to the implementation of a DCTP, which has mainly been through traditional universities providing training to medical, optometry, occupational therapy, and physiotherapy students. In South Africa, a DCTP is yet to be implemented within the context of a university of technology; it is yet to be implemented within health science faculties that offer undergraduate health science programs in mainstream biomedicine and alternative and complementary disciplines. Objective: We aim to design, pilot, and establish an effective DCTP at the DUT FHS in KwaZulu-Natal, South Africa. Methods: Participatory action research comprising various designs-namely, appreciative inquiry, qualitative case study design, phenomenography, and descriptive qualitative study design-will be used to conduct the study. Data will be collected using individual interviews, focus group discussions, nominal group technique, consensus methodology, and narrative inquiry. Study participants will include various internal and external stakeholders of the DUT, namely, academic staff; students; key informants from universities currently using successfully established DCTPs; academic support staff; staff working in human resources, finance, procurement, and accounting; and experts in other disciplines such as engineering and information systems.
Whole-of-community and intersectoral interventions that address alcohol-related harms: a scoping review
(Taylor & Francis, 2024) Ulla Walmisley; Michelle De Jong; Asha George
Alcohol harms threaten global population health, with youth particularly vulnerable. Low–and middle-income countries (LMIC) are increasingly targeted by the alcohol industry. Intersectoral and whole-of-community actions are recommended to combat alcohol harms, but there is insufficient global evidence synthesis and research examining interventions in LMIC. This paper maps existing literature on whole-of–community and intersectoral alcohol harms reduction interventions in high-income countries (HIC) and LMIC. Systematic searching and screening produced 61 articles from an initial set of 1325: HIC (n = 53), LMIC (n = 8). Data were extracted on geographic location, intersectoral action, reported outcomes, barriers, and enablers. HIC interventions most often targeted adolescents and combined community action with other components. LMIC interventions did not target adolescents or use policy, schools, alcohol outlets, or enforcement components. Programme enablers were a clear intervention focus with high political support and local level leadership, locally appropriate plans, high community motivation, community action and specific strategies for parents. Challenges were sustainability, complexity of interventions, managing participant expectations and difficulty engaging multiple sectors
Form and functioning: contextualising the start of the global financing facility policy processes in Burkina Faso
(Taylor and Francis Ltd., 2024) Kiendrébéogo, Joël Arthu; George, Asha; Sory, Orokia
Burkina Faso joined the Global Financing Facility for Women, Children and Adolescents (GFF) in 2017 to address persistent gaps in funding for reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N). Few empirical papers deal with how global funding mechanisms, and specifically GFF, support resource mobilisation for health nationally. This study describes the policy processes of developing the GFF planning documents (the Investment Case and Project Appraisal Document) in Burkina Faso. We conducted an exploratory qualitative policy analysis. Data collection included document review (N = 74) and in-depth semi-structured interviews (N = 23). Data were analysed based on the components of the health policy triangle. There was strong national political support to RMNCAH-N interventions, and the process of drawing up the investment case (IC) and the project appraisal document was inclusive and multi-sectoral. Despite high-level policy commitments, subsequent implementation of the World Bank project, including the GFF contribution, was perceived by respondents as challenging, even after the project restructuring process occurred. These challenges were due to ongoing policy fragmentation for RMNCAH-N, navigation of differing procedures and perspectives between stakeholders in the setting up of the work, overcoming misunderstandings about the nature of the GFF, and weak institutional anchoring of the IC. Insecurity and political instability also contributed to observed delays and difficulties in implementing the commitments agreed upon. To tackle these issues, transformational and distributive leaderships should be promoted and made effective
Experiences of support by unsuppressed adolescents living with HIV and their caregivers in Windhoek, Namibia: a qualitative study
(Frontiers Media SA, 2024) Munyayi, Farai kevin; van Wyk, Brian
Adolescents living with HIV (ALHIV) lag behind younger children and adults in the achievement of HIV care and treatment targets for HIV epidemic control. Treatment outcomes for adolescents may be influenced by their experiences with the support provided in HIV programs. We report on the experiences of virally unsuppressed adolescents and their caregivers with the current support in primary healthcare settings in Namibia. A qualitative descriptive and exploratory study was conducted in 13 public primary healthcare facilities in Windhoek, Namibia. A total of 25 in-depth interviews were conducted with unsuppressed adolescents (n = 14) and their caregivers (n = 11) between August and September 2023. The audio-recorded interviews were transcribed verbatim, and uploaded into ATLAS.ti software, and subjected to thematic content analysis. Three main support domains for the unsuppressed adolescents emerged from our analysis, namely: psychosocial, clinical and care, and socioeconomic support. The psychosocial support was delivered through peer support (teen clubs and treatment supporters) and enhanced adherence counselling mostly. The clinical and care support included implementing adolescent-friendly HIV services, differentiated service delivery approaches, and caregivers and healthcare worker care support for improved ART adherence, clinic attendance and continuous engagement in care. Socioeconomic support was provided for nutritional support, transport to access clinics, and school supplies, as well as income-generating projects. Psychosocial, clinical and care, and socioeconomic support are key elements in addressing the needs of adolescents challenged with achieving viral suppression. Health systems may benefit from whole-of-society and whole-of-government approaches to meet the needs of ALHIV that are beyond the scope of health service delivery such as nutritional, education and socioeconomic influences on both the health and well-being of ALHIV.
Form and functioning: contextualising the start of the global financing facility policy processes in Burkina Faso
(Taylor and Francis Ltd., 2024) Kiendrébéogo, Joël Arthur; George, Asha; Sory, Orokia
Burkina Faso joined the Global Financing Facility for Women, Children and Adolescents (GFF) in 2017 to address persistent gaps in funding for reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N). Few empirical papers deal with how global funding mechanisms, and specifically GFF, support resource mobilisation for health nationally. This study describes the policy processes of developing the GFF planning documents (the Investment Case and Project Appraisal Document) in Burkina Faso. We conducted an exploratory qualitative policy analysis. Data collection included document review (N = 74) and in-depth semi-structured interviews (N = 23). Data were analysed based on the components of the health policy triangle. There was strong national political support to RMNCAH-N interventions, and the process of drawing up the investment case (IC) and the project appraisal document was inclusive and multi-sectoral. Despite high-level policy commitments, subsequent implementation of the World Bank project, including the GFF contribution, was perceived by respondents as challenging, even after the project restructuring process occurred. These challenges were due to ongoing policy fragmentation for RMNCAH-N, navigation of differing procedures and perspectives between stakeholders in the setting up of the work, overcoming misunderstandings about the nature of the GFF, and weak institutional anchoring of the IC. Insecurity and political instability also contributed to observed delays and difficulties in implementing the commitments agreed upon. To tackle these issues, transformational and distributive leaderships should be promoted and made effective
Dietary intake of low-income adults in South Africa: Ultra-processed food consumption a cause for concern
(Cambridge University Press, 2024) Frank, Tamryn; Swart, Elizabeth Catherina; Ng, Shu Wen
Objective: Given the rapidly changing food environment and proliferation of ultra-processed foods (UPF) in South Africa (SA), this study aimed to critically evaluate dietary quality and adequacy of low-income adults using the nova classification system and WHO and world cancer research fund dietary guidelines. Design: Secondary household data and 1-d 24-h recalls were analysed from two cross-sectional studies conducted in 2017-2018. Foods consumed were classified according to the nova classification system. Compliance with WHO dietary guidelines and UPF consumption trends were evaluated. Setting: Three low-income areas (Langa, Khayalitsha and Mount Frere) in SA were included. Participants: In total, 2521 participants (18-50 years) were included in the study. Results: Participants had a mean energy intake of 7762 kJ/d. Most participants were within the acceptable WHO guideline range for saturated fat (80·4 %), total fat (68·1 %), Na (72·7 %) and free sugar (57·3 %). UPF comprised 39·4 % of diets among the average adult participant. Only 7·0 % of all participants met the WHO guideline for fruit and vegetables and 18·8 % met the guideline for fibre. Those within the highest quartile of share of energy from UPF consumed statistically higher amounts of dietary components to limit and were the highest energy consumers overall. Conclusions: Low-income adults living in SA are consuming insufficient protective dietary components, while UPF consumption is prevalent. Higher UPF consumers consume larger amounts of nutrients linked to increased chronic disease risk. Policy measures are urgently needed in SA to protect against the proliferation of harmful UPF and to promote and enable consumption of whole and less UPF.
A planetary health perspective on the translation of climate change research into public health policy and practice: A scoping review protocol
(Public Library of Science, 2024) Mulopo, Chanelle; Abimbola, Samuel; Onkoba, Nyamongo; Schmidt, Bey-Marrie
Background climate change (CC) emanating from anthropocentric human activities is a great threat to the quality of human life and well-being worldwide. The translation of CC research evidence can play a critical role in promoting the formulation of climate-sensitive policies to equip public health systems for CC-associated disaster preparedness, response, and management. This scoping review seeks to explore knowledge translation approaches for promoting, the uptake, and use of CC research evidence in public health policy and practice. Methods This scoping review will be conducted according to the guidelines of Arksey and O’Malley. A search strategy will be developed for published articles in PubMed, CINAHL, and Scopus databases and for grey literature in the world health organization, planetary health alliance, and the University of the Western Cape repositories. Discussion the proposed scoping review will gather existing evidence on the relationship between knowledge translation, CC research, and public health decision-making. This will provide insights into research and practice gaps, and recommendations will be made to ensure effective knowledge translation for CC related decision-making.
Shaping the future of global access to safe, effective, appropriate and quality health products
(BMJ Publishing Group, 2024) Ravinetto, Raffaella; Bradley, Hazel; Coetzee, Renier
Treaties and covenants confirming the right to health would suggest that everybody is entitled to access essential diagnostic, preventive and therapeutic products.1 However, before the COVID-19 pandemic, an estimated twobillion people lacked access to essential medicines and vaccines, and most primary care facilities in low-income and middleincome countries (LMICs) lacked essential diagnostic services.2 The pandemic has widedeepened pre-existing gaps. The inequitable access to COVID-19 vaccines uncovered multiple structural problems in the organisation, financing and governance of the medical research and development (R&D) and supply ecosystem,3 encompassing unclear demand, weak distribution systems, poor donation practices and corruption, historic inequalities in access to knowledge, training and technological capabilities, lack of technology sharing and transfer, limited local production, and the absence of public health perspective in intellectual property governance. Globally, the response to the pandemic tested our world’s solidarity and brought to light continued (colonial) power dynamics that fuelled inequities, misinformation and mistrust. It also blatantly ignored lessons from the past, including the importance of gender equity

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