Research Articles (School of Public Health)

Permanent URI for this collectionhttps://hdl.handle.net/10566/11

Browse

Now showing 1 - 20 of 986

Exploring the effects of mental health on bonding and caregiving among pregnant and postpartum persons with likely depression and/or PTSD in South Africa: a qualitative analysis
(BioMed Central Ltd, 2026) Knight, Lucia; Gulbicki, Lauren R.; Fertig, Madison R.
Perinatal mental health disorders place a particularly high public health burden on South Africa (SA) via adverse health outcomes for the birthing parent and for their infants, and contribute to emotional and behavioral problems later in childhood. There is little research exploring the anticipated impacts mental health symptoms have on one’s ability to emotionally connect or care for their infant after delivery. HIV-negative pregnant persons were recruited from an antenatal clinic in Cape Town as a part of a larger study investigating mental health barriers to pre-exposure prophylaxis (PrEP) uptake during pregnancy. Participants qualified for an in-depth interview based on elevated symptoms of depression and/or PTSD. The interviews explored the likely impact of their mental health symptoms on their baby’s wellbeing, their ability to bond with their baby, and their ability to meet their baby’s needs. After transcription and translation of interviews, a codebook was developed using inductive and deductive methods. Coded data were analyzed using thematic analysis. Twenty-three participants completed 30 interviews (seven were interviewed twice—once during pregnancy and once post-delivery); on average, they were 25.1 years old and had 2.1 previous pregnancies. Three themes emerged from interviews: (1) a strong perceived connection between maternal mental health and baby’s wellbeing; (2) perceived strains on bonding with the baby; and (3) the impact of mental health on the likelihood of completing parenting tasks. These results provide insight on how women expect their mental health symptoms to impact their ability to care for their baby, and also how a sense of resilience can contribute to overcoming anticipated mental health challenges. This study will inform future mental health programming to prepare pregnant persons with mental health symptoms for a successful postpartum period with respect to bonding and caring for their infant.
Dietary practices and nutritional status of older persons: a cross-sectional study of Northern Uganda
(BioMed Central Ltd, 2026) Ocaya, Dennis; Kyeyune, Jemimah Kiboss; Ndagire, Regina
Background: Malnutrition remains a problem in older populations globally. Most older persons do not meet the required dietary intake with the majority consuming mainly carbohydrate-based foods and vegetables. The current study therefore aimed at assessing the dietary practices, nutritional status and associated factors among older persons in Gulu district. Methods: This was a cross-sectional study among older persons aged 60 years and above in Gulu District. The study used a multi-stage sampling procedure. Nutritional status was measured using the Mini Nutrition Assessment – Short Form (MNA-SF). Analysis was done in STATA 16 using modified Poisson regression considering a 5% level of significance. Results: The study enrolled 141 participants with a median age (IQR) of 71(64,79) years. Majority of the respondents, 96(68.1%) were female and 72(51.1%) reported to be widows or widowers. The prevalence of malnutrition was 53.9%. Millet was eaten by 62(45.9%) participants 1-4 times a week while maize and its products were eaten by 56(40.6%) 1-2 times monthly. We found that increasing age (aPR=1.02, p-value=0.021), having primary education (aPR=1.51, p-value=0.046), and staying <5km away from the health facility (aPR=1.60, p-value=0.003) were significantly associated with having malnutrition. Conclusion: Majority of the participants were malnourished. Age, education, and distance from healthcare facility were the factors that influenced nutritional status.
Born too soon: every story counts: lessons in ethical, inclusive storytelling from born too soon
(BioMed Central, 2025) Kinney Mary; Reid Amy; Juma Mercy; Gruending Anna
Storytelling is an effective communication strategy for articulating health needs and service demands, enhancing public understanding of complex and stigmatized health issues, and informing policy reform and innovative public health practices. Specific to pregnancy and childbirth, storytelling has influenced perceptions, reduced fear, empowered women, complemented educational interventions, contributed to legal and policy change and has enhanced understanding of complex issues and cultural norms through personal experiences . The issue of preterm birth remains a global challenge, and personal narratives of preterm birth experience are a critical form of advocacy—amplifying families’ literacy and their voices, highlighting systemic gaps, and reinforcing the call to uphold the rights of babies, mothers, families, and health workers.
Born too soon: priorities to improve the prevention and care of preterm birth
(BioMed Central, 2025) Kinney Mary; Langlois Etienne; Reid Amy; Lawn Joy
For over 50 years there has been a commitment to multilateralism and funding for science and health. Recent shifts around the world jeopardise the ability of all countries to address existing and new health crises, and specifically threaten hard-won progress in reproductive, maternal, newborn, and child health, including for preterm babies who are particularly vulnerable. Preterm birth remains a silent emergency of a global scale. Every 2 seconds, a baby is born too soon [1]. Every 40 seconds, one of those babies dies. An estimated 13.4 million babies were born preterm (before 37 weeks of pregnancy) in 2020 - equivalent to nearly one in ten babies being born preterm worldwide [2].
Determinants of viral suppression among young people living with HIV and on antiretroviral therapy in Eswatini: A cross-sectional study
(Taylor& Francis Group, 2025) Simelane, Thabile P.; Okonji, Emeka F.; van Wyk, Brian E.
Background: HIV treatment, adherence, and retention in care are fundamental in achieving viral load suppression (VLS) and fighting the HIV pandemic. The Government of Eswatini has decentralised antiretroviral treatment (ART) services and introduced differentiated HIV service delivery models to improve treatment outcomes for all people living with HIV, including young people. It is imperative to investigate the success of these initiatives in improving VLS in young people living with HIV (YPLHIV) in Eswatini. Objective: To determine the factors associated with VLS amongst YPLHIV (15 to 24 years) who are on ART in Eswatini. Methodology: A retrospective cohort analysis of 4 334 YPLHIV on ART in Eswatini between January 2018 and December 2021 was conducted. The Statistical Package for Social Scientists version 25 was used to determine the factors associated with viral suppression through bivariate and logistic regression analysis. Results: The prevalence of viral suppression (< 1 000 copies/mL) was 92.9%. After adjusting for all covariates, the likelihood of viral suppression remained significantly higher among YPLHIV who were female (AOR = 2.06; CI 1.04-4.11), had enrolled on the fast-track ART care model (AOR = 2.14; CI 1.09-4.20), and were receiving 4 to 5 months’ (AOR = 5.88; CI 3.14-11.02) and 6+ months’ (AOR = 3.55; CI 1.67-7.53) of medication. Conclusion: The national HIV treatment program in Eswatini exceeded the UNAIDS target of 90% virologic suppression for YPLHIV who are enrolled for ART for more than six months. However, to meet the revised 95% target, tailored interventions are required to strengthen long-term adherence and retention in care for YPLHIV on ART.
The right to science in sexual and reproductive health and the legal status of the human embryo
(Taylor and Francis Ltd., 2025) Dyer, Silke; George, Asha S.; Edelman, Alison B.
Through the examination of scientific evidence related to human embryo development, the aim of this commentary is to support the right to science in sexual and reproductive health, to outline why science supports a legal approach to embryos as the biological material of human life but not as human persons, and to recognise that international human rights law adopts this approach in the protection of sexual and reproductive health and rights.
Reconfiguration of informal social protection systems of older adults in Sub-Saharan Africa amid the COVID-19 pandemic: a narrative review
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Oware, Phoene Mesa; Zembe, Yanga; Zembe-Mkabile, Wanga
he COVID-19 pandemic and associated lockdowns in sub-Saharan Africa led to significant social, economic, and health shocks, raising the need for social protection. While the adaptation of formal systems of social protection in response to these shocks has been investigated, gaps remain in understanding how informal social protection (ISP) systems were reconfigured. Taking the ISP systems of older adults as an entry point, and through the lens of ubuntu, an African moral philosophy that underpins ISP systems, this paper synthesises evidence on the ISP systems of older adults prior to and during the COVID-19 pandemic (2019–2024). It highlights shifts that were experienced within these systems amid the COVID-19 pandemic. Evidence reveals pre-existing barriers for older adults to engage in ISP networks prior to the pandemic. The pandemic context enabled older adults to re-integrate and participate in reciprocal exchanges within kinship and community networks. However, the unique pandemic circumstances revealed the additional vulnerabilities of ISP systems, highlighting the need to strengthen state-led interventions to reduce reliance on ISP systems. Opportunities and social policy considerations to reimagine care for older adults in a post-COVID-19 world are discussed.
Multilevel factors influencing linkage to HIV care in a high HIV prevalence district in South Africa: a mixed methods approach
(Springer, 2026) Mathole, Thubelihle; Nicol, Edward; Basera, Wisdom
Timely linkage to HIV care is essential for achieving South Africa’s treatment goals, yet significant gaps persist in the early stages of the HIV care continuum. This study examined multilevel factors influencing linkage to care in a high HIV-prevalence rural district. A prospective convergent mixed-methods cohort study was conducted over 21 months among 1,194 adults newly diagnosed with HIV across 18 facilities in KwaZulu-Natal. Quantitative analyses (Pearson’s chi-square, Mann-Whitney tests, and logistic regression) were used to identify factors associated with linkage to care within three months of diagnosis. Qualitative data from in-depth interviews with 38 purposively selected participants were analysed thematically and triangulated with quantitative findings to provide contextual insights. Overall, 83% of participants linked to care within three months. Linkage was significantly higher among those diagnosed at hospitals (OR = 4.90; 95% CI: 1.87–12.82; p = 0.003), while diagnosis at mobile clinics showed borderline significance. Among women, later sexual debut (≥ 17 years) was associated with increased likelihood of timely linkage. In contrast, condom use at last sex (OR = 0.50; 95% CI: 0.32–0.79; p = 0.03) and substance use (OR = 0.67; 95% CI: 0.47–0.96; p = 0.05) were associated with lower linkage. Qualitative findings highlighted supportive family environments and positive provider interactions as key facilitators of linkage, while stigma, fear of disclosure, confidentiality concerns, preference for traditional or spiritual healing, and health system challenges, including lost clinic files and poor counselling, emerged as significant barriers. These findings underscore the need for patient-centred, stigma-free, and responsive health systems to improve timely linkage to HIV care in high-burden settings.
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.

Browse

Recent Submissions