Research Articles (Family Medicine)

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Assisted suicide : ethical considerations and the South African debate
(South African Medical Association, 2024-06) Van Eeden, Albu; Nemutandani, Simon; Meiring, Michelle; Mabuza, Langalibalele Honey; Steinberg, Hannes (W.J.); Hardcastle, Timothy; Bac, Martin; Larsen, Jonathan V.; Michael, Keith; Louw, Murray
No abstract available.
An investigation of factors associated with antenatal care attendance in Gauteng in 2015
(South African Medical Association, 2024-06) Mostert, J.; Webb, Elizabeth M.; Girdler-Brown, B.V. (Brendan); Ngcobo, Sanele
BACKGROUND : Many studies have shown that South African women tend to initiate antenatal care late in their pregnancies. This presents challenges in the provision of quality healthcare to both mother and child. There are several studies on the social and cultural reasons for late booking. However, understanding the factors in a woman's choice to initiate antenatal care is important in informing healthcare strategies and policies. METHODS : This study was an analytical cross-sectional study of household and general health factors associated with attendance of antenatal care by pregnant women in Tshwane in 2015. It was a secondary data analysis from complete data sampling households registered on AitaHealth™. Univariate and multivariate logistic regression was used to assess which factors are associated with antenatal care attendance. RESULTS : The age of the head of the household was a significant factor in the attendance of antenatal care. The odds of attending antenatal care were 3.3, 2.1 and 1.8 times higher in households where the head of the household was 30 - 39 years of age, 20 - 29 or 40-49 years of age, respectively, than when between 10-19 years of age. Factors that increased the odds of attending antenatal care were living in households that had electricity and piped water, and running a business from home. Residing in a permanent dwelling and being food secure increased the odds of antenatal care attendance. CONCLUSION : The identified health and household factors should inform policies and programmes geared towards improving services around antenatal care provision.
High burden of abnormal cervical smears in South African primary health care : health programmes implications
(Oxford University Press, 2025-02) Omole, Olufemi B.; Francis, Joel M.; Musonda, John M.; Sodo, Pumla P.; Reji, Elizabeth; Phukuta, Nyundu S.J.; Mabuza, Honey L.M.; Musonda, Joyce Sikwese; Akii, Jimmy; Ndimande, John V.; Ayo-Yusuf, Olalekan Abdulwahab
Cervical cancer is the second most common malignancy among South African women and the load of abnormal cervical smears has clinical, programmatic and policy implications. This cross-sectional study of women who presented for cervical cancer screening aimed to determine the prevalence of abnormal cervical smears and associated factors in primary health care (PHC) facilities in Gauteng—the most densely populated province in South Africa. A questionnaire collected data on socio-demography, tobacco use, sexual behaviours, HIV status, past treatment for sexually transmitted infections (STI) and cervical cancer screening in the past 10 years. Cytology reports were extracted from the laboratory reports. Of 749 participants, most were black (89.7%), aged 30–49 years (62.2%), single (57.5%) and attained high school education (76.8%). About 43.9% were HIV positive with almost all (97.2%) on antiretroviral therapy. Cytology results were available for 612 (81.9%) participants. Of these, 25.8% (159) were abnormal: 13.2% low-grade squamous intraepithelial lesion; 5.7% atypical squamous cells of undetermined significance and 4.9% high-grade squamous intraepithelial lesion. In bivariate and multivariable analysis, abnormal cervical cytology was not associated with any sociodemographic characteristics, HIV status, tobacco use status, sexual behaviours or past treatment for STI. In conclusion, the prevalence of abnormal cervical smears is high across all demographic groups and irrespective of HIV status and highlights the need to increase screening uptake, including advocacy for self-sampling. It also calls for capacity building to allow for the devolution of some downstream clinical care from specialist to district hospitals and large PHC facilities.
Experiences of women who inject Nyaope residing in the City of Tshwane Municipality, Gauteng
(AOSIS, 2025-05) Lefoka, Moganki H.; Netangaheni, Robert T.
BACKGROUND : Substance use disorder (SUD) is a serious public health concern in South Africa and throughout the world. Substance use disorder manifests itself as repeated use of a substance causes health problems and social dysfunction, such as health issues, impairment and failure to meet obligations. People who inject drugs (PWIDs) are a particularly vulnerable population with high rates of illness and early deaths. The experiences of women who inject Nyaope (WWIN) are not well understood because they are not often the subject of studies. Therefore, it is important to understand the experience of WWIN in order to understand their needs. AIM : This study explored the experiences of WWIN who reside in the City of Tshwane Municipality, Gauteng. SETTING : The study was conducted in the Community-Oriented Substance Use Programme. METHODS : A qualitative research method using exploratory and descriptive designs was employed. Twenty-four women, ages from 19 years - 35 years, with a history of injecting Nyaope were interviewed using a semi-structured interview guide. Data were analysed thematically. RESULTS : Women who inject Nyaope engage in high-risk behaviours such as sex work, transactional sex, inconsistent condom use and sharing of needles. They further experience stigma in different social settings, like family, community, health settings and with the police, and they also self-stigmatise. They experience a variety of unmet needs. CONCLUSION : Women who inject Nyaope engage in high-risk behaviour and experience stigma across social settings, including self-stigma, and because of their lifestyle, they have a variety of unmet needs. CONTRIBUTION : There is a scarcity of literature on WWIN in a South African context. The findings add to the existing literature on WWIN.
Fertility awareness, perceived factors and approaches to improve contraceptive uptake among sexually active adolescent girls in Phalombe, Malawi
(BioMed Central, 2024-11-12) Hajison, Precious L.; Mpachika‑Mfipa, Felistas; Pitso, Lerato; Tshotetsi, Lumbani; Chimatiro, Chancy Skenard
BACKGROUND : Healthcare practitioners and policymakers in Sub-Saharan Africa face a significant health challenge due to the insufficient fertility awareness and other perceived health outcomes in contraceptive use among adolescent girls. This has resulted in a rise in unplanned pregnancies and other adverse fertility-related health consequences for adolescent girls in Malawi. Consequently, this research examines fertility awareness, perceived factors, and strategies in contraceptive adoption among adolescent girls in Malawi’s Phalombe district. METHODS : The study utilized a mixed-methods approach, with the quantitative component employing structured questionnaires administered in person to collect data from school-going adolescent girls in three traditional authorities in Phalombe district, Malawi. The research employed multivariate logistic regression analysis, and its findings were corroborated with qualitative data obtained through focus group discussions involving adolescent girls in the same environment. RESULTS : The majority of adolescent females were unaware that their fertile period occurs in the middle of their menstrual cycle, indicating a lack of knowledge regarding their reproductive health. The study examined data from 102 sexually active adolescent females in the quantitative component and 72 adolescent girls in the qualitative component. For the quantitative strand, participants' ages ranged from 13 to 19 years, with a mean age of 16.5 and a standard deviation of 1.5. In the qualitative portion, the study conducted interviews with adolescent females aged between 10 and 19 years, with a median age of 15 years. Services that were not tailored to youth needs served as barriers to contraceptive use. Factors that facilitated contraceptive use included a preference for receiving contraceptives from peers, which was associated with a higher probability of usage (AOR: 4.80, 95% CI 1.31–17.32). Moreover, adolescent females who were identified as Catholic (AOR: 14.01, 95% CI 2.50–78.47) or belonged to other Christian denominations (AOR: 5.85, 95% CI 1.20–28.25) exhibited a greater likelihood of using contraceptives compared to their Muslim counterparts. The focus group discussions suggested making contraceptives available in educational institutions, analogous to the distribution of iron supplements. CONCLUSION : Adolescent girls in the Phalombe district seemingly have low awareness and knowledge of their fertility, which may lead to unintended pregnancies. Adolescent girls are unable to access modern contraceptives, and there is a need for youth-friendly structures when delivering contraceptive services. Additionally, participants indicated that community midwives and health surveillance assistants should provide contraceptives within the communities to reduce distance. PLAIN LANGUAGE SUMMARY : This study assessed fertility awareness and perceived factors and approaches to improve contraceptive uptake among sexually active adolescents in Phalombe, Malawi. This mixed-methods study was conducted among adolescent girls in three traditional authorities in the Phalombe District. Most adolescent girls demonstrated limited knowledge of female fertility. Inadequate comprehension of female reproductive physiology is associated with decreased contraceptive utilization and increased risks of unplanned pregnancies, and other adverse reproductive health outcomes. Furthermore, girls with Catholic and other Christian faiths are more likely to use contraceptives than Muslim girls. Most adolescent girls suggested that contraceptives should be delivered via peers, community midwives, and health surveillance assistants to improve the use of contraceptives among adolescents.
ART coverage and viral suppression among female sex workers living with HIV in eThekwini, South Africa : baseline findings from the Siyaphambili study
(Public Library of Science, 2024-05-22) Comins, Carly A.; Baral, Stefan; Mcingana, Mfezi; Shipp, Lily; Phetlhu, Deliwe Rene; Young, Katherine; Guddera, Vijayanand; Hausler, Harry; Schwartz, Sheree
In South Africa >60% of female sex workers (FSW) are living with HIV, the majority of whom are not virally suppressed. Identifying multi-level determinants of viral suppression is central to developing implementation strategies to promote retention in HIV care and viral suppression among FSW with unmet treatment needs. Adult cisgender FSW living with HIV for ≥6 months, conducting sex work as their primary source of income, and residing in Durban (South Africa) were enrolled into the Siyaphambili Study, a sequential multiple assignment randomized trial. Baseline viral load and CD4 were assessed, and an interviewer-administered survey was conducted, capturing socio-demographic, reproductive and sexual history and behaviors, vulnerabilities, substance use, mental health, and stigma. We assessed baseline determinants of viral suppression (<50 copies/mL) using bivariate and multivariable robust poisson regression, considering associations across the individual, network, environmental and macrostructural levels. From June 2018 –March 2020, 1,644 women were screened, with 1,391 eligible FSW living with HIV enrolled. The analyses were conducted among the 1,373 participants with baseline data. Overall, 65% (889/1,373) of participants were reported to be on antiretroviral therapy and 38% (520/1,373) were virally suppressed. In the multivariable model, FSW who experienced a lack of housing in the prior six months were less likely to be virally suppressed (aPR: 0.72, 95%CI 0.56–0.91), while older FSW (aPR: 1.46 95%CI: 1.16–1.83 for 30–39 years old vs. 18–29 years old; aPR: 2.15 95%CI: 1.64–2.80 for 40+ years vs. 18–29 years old) and FSW reporting hormonal or long-acting contraception use were more likely to be virally suppressed (aPR: 1.19 95% CI: 1.00–1.43). We found vulnerability to be high among FSW living with HIV in South Africa and identified individual and structural determinants associated with viral suppression. Taken together these results suggest optimizing HIV treatment outcomes necessitates supporting younger sex workers and addressing housing instability.
Assessing clinical associate students’ views on learning opportunities and involvement during primary health care placements : a mixed methods study in Tshwane
(BioMed Central, 2025-03) Ngcobo, Sanele; Louw, Murray; Bayeni, Luvuyo; Madela-Mntla, Edith
BACKGROUND : The training model for Clinical Associates (Clin-As), initially centered on district hospitals, has increasingly involved primary healthcare (PHC) facilities over the past few years. This study explore and compare the perceptions and experiences of Clin-A students regarding learning opportunities and involvement during hospital and clinic rotations. METHODOLOGY : This cross-sectional mixed-methods study involved two primary data collection techniques: the administration of the validated medical education instructional questionnaire (MedIQ) questionnaire and the facilitation of focus group discussions. RESULTS : A total of 74 Clin-A students participated in the quantitative study, including 20 s-year students from 2022, 35 s-year students from 2023, and 19 third-year students from 2023. The only statistically significant difference was noted in follow-up care, where student involvement was significantly higher in clinics (M = 3.39) compared to hospitals (M = 2.96), with a t-value of 2.933 (p = 0.002). For learning opportunities, the highest mean difference was observed in ‘participation in patient education’, where clinics (M = 4.38) had a higher mean than hospitals (M = 3.96), but without statistically significance (t = 1.715, p = 0.089). Students perceived better learning diversity and proficiency development in clinics (M: 3.91, SD: 1.31; M: 4.18, SD: 1.203) compared to hospitals (M: 4.00, SD: 1.489; M: 3.97, SD: 1.385). Clinics generally outscored hospitals, especially in involvement in patient education, chronic illness, and procedures. Ten students attended two focus group discussion: one with 2023 third-years (n = 5) and one with 2023 s-years (n = 5). Students valued clinics for skill development and patient journey exposure but faced challenges such as feeling like employees, disrupted learning from frequent rotations, patient overcrowding, and poor communication between the program and healthcare staff. CONCLUSION : This study underscores the importance of primary healthcare settings in Clin-A training, demonstrating that clinics provide learning opportunities and involvement in patient care comparable to hospitals. To address challenges such as high workload areas where students feel like employees, insufficient teaching, lack of staff awareness, limited learning in low-volume clinics, and disrupted rotations requires, structured rotations, enhanced preceptor training, and improved communication between programs and clinical sites are essential.
Characteristics of women on opioid substitution therapy in primary healthcare in Tshwane (South Africa) : a retrospective observational study
(Royal College of General Practitioners, 2025-04) Goeieman, Daniela S.; Mash, Robert; Gloeck, Natasha R.; Scheibe, Andrew
BACKGROUND : Women who use drugs face specific challenges compared with men such as higher rates of HIV infection, unsafe injecting practices, and intimate partner violence (IPV). However, this population’s access to drug dependence treatment and gender-sensitive interventions remains limited, leading to unmet needs and increased vulnerability. AIM : To investigate the characteristics of and associations with retention in care among women on opioid substitution therapy (OST) in a community-based primary care setting. DESIGN & SETTING : A descriptive observational study within the Community Orientated Substance Use Programme in Tshwane, South Africa. METHOD : Data from 199 women (aged >18 years) on OST was extracted from an electronic database and paper-based files. Data were analysed descriptively, and inferential analysis looked for association of variables with retention on OST for ≥6 months. RESULTS : The majority of participants were unemployed, with 44.3% aged 20–29 years. During the initiation and course of OST, 39.2% of women had an intimate partner of which 37.2% reported IPV, and 19.2% were pregnant. Retention on OST was significantly associated with increasing age at initiation (P = 0.047), knowledge of HIV status (P = 0.029), an increase in the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) score (P = 0.023), and methadone dose (P<0.001). Factors such as race, employment status, health-system level, pregnancy, intimate partner using substances, IPV, route of administering opioids, and having tuberculosis and/or hepatitis C exposure did not show a significant relationship with retention on OST (P>0.05). CONCUSION : This study reveals specific vulnerabilities in women receiving OST, emphasising the need for the integration of interventions to address reproductive health, violence mitigation, infectious disease, and polydrug use into care.
PrEP discontinuation, cycling, and risk : understanding the dynamic nature of PrEP use among female sex workers in South Africa
(Public Library of Science, 2024-09-26) Shipp, Lillian M.; Ryan, Sofia; Comins, Carly A.; Mcingana, Mfezi; Mulumba, Ntambue; Guddera, Vijayanand; Phetlhu, Deliwe Rene; Hausler, Harry; Baral, Stefan D.; Schwartz, Sheree R.
PrEP cycling among women is thought to be safe when there are distinct “seasons of risk.” However, cyclical PrEP use over short periods may be associated with increased risk of HIV acquisition. We aimed to characterize key social ecological factors contributing toward PrEP cycling among female sex workers (FSW) in the context of high HIV risk. Semi-structured, in-depth interviews were conducted with 36 FSW at risk for HIV acquisition and 12 key informant (KI) service providers in eThekwini (Durban), South Africa from January-October 2020. FSW identified key factors driving temporary discontinuation of PrEP including relocation, lack of information on or difficulty coping with side effects, and delays in accessing PrEP. In many cases, FSW were motivated to restart PrEP once barriers were overcome. In contrast, KIs emphasized the importance of individual adherence to PrEP and reliance on personal risk assessments when counselling FSW on cycling decisions. FSW and KI perspectives highlight a disconnect between providers’ recommendations on the potential for cyclical use of PrEP during periods of minimal risk and actual drivers among FSW causing temporary PrEP discontinuation. Further interventions supporting safe PrEP cycling are needed to ensure decisions around cycling are deliberate and guided by changes in HIV risk rather than external factors.
Exploring prioritization of wellbeing and health impacts for mining communities during the mining life cycle within the sub-Saharan Africa context : a systematic review
(BioMed Central, 2025-03) Pieters, Josephine N.; Ndaba, Nomsa S.; Ngcobo, Sanele; u24090299@tuks.co.za
INTRODUCTION : Sub-Saharan African countries possess rich mineral resources that offer socio-economic development opportunities for mining communities. However, the prioritization of health and wellbeing impacts during the mining life cycle remains unclear. This review examines the focus on health and wellbeing in mining communities within the sub-Saharan African context. METHODS : An online literature search was conducted across four databases (Scopus, PubMed, ProQuest, Web of Science) using the PICOS framework for eligibility criteria. The Rayyan tool was used for screening and data extraction. RESULTS : 45 studies were included (20 qualitative, 25 quantitative, including mixed methods). Most studies were from South Africa. Health impacts identified included: (a) HIV/AIDS, (b) Tuberculosis (TB), (c) Hypertension, and (d) Health Impact Assessment (HIA). The study also explored the mining life cycle stages—Exploration, Development, Production, and Closure—focusing on health and wellbeing prioritization. CONCLUSIONS : While mining offers socio-economic benefits, health and wellbeing impacts are not prioritized, especially in the exploration stage. Tools like HIAs provide valuable insights, but mining communities continue to face health challenges, both positive and negative. PROSPERO : CRD42023474494.
Pilot of methadone for recently incarcerated people with human immunodeficiency virus and opioid use in South Africa
(Mary Ann Liebert, 2025) Bhoora, Urvisha; An, Yangxi; Owczarzak, Jill; Ndini, Pretty; Moyo, Derrick; Shelly, Shaun; Marcus, Tessa S.; Steiner, Laura; Corcoran, Peter C.; Pollock, Sarah; Lefoka, Moganki H.; Mabuto, Tonderai; Hugo, J.F.M. (Jannie); Hoffmann, Christopher J.
In South Africa, there is no provision of medication for opioid use disorder (MOUD) for people who are incarcerated or were recently incarcerated. This study aimed to describe MOUD uptake and barriers among people living with human immunodeficiency virus and using illicit opioids reentering the community from incarceration. A mixed-method exploratory study was conducted between September 2021 and September 2022 in South Africa, during which we offered low-barrier MOUD and harm reduction services. We followed 23 participants postrelease and observed a low uptake of MOUD after release (8 of 23, 35%). Reported barriers to MOUD included perceived ineffectiveness, a preference for residential withdrawal management, and delays in initiating MOUD. Innovation is needed in strategies to deliver MOUD and harm reduction in South Africa.
Insights into the value of the market for cocaine, heroin and methamphetamine in South Africa
(LSE Press, 2024) Scheibe, Andrew; Shelly, Shaun; Stowe, M.J.
The illicit drug trade generates billions of dollars and sustains transnational criminal organisations. Drug markets can destabilise governance and undermine development. Data indicate increasing drug use in South Africa. However, information on the size and value of the drug market is limited. This is the first study to estimate the market value of cocaine, heroin and methamphetamine in South Africa. People who use drugs were meaningfully involved in all aspects of implementation. We used focus group discussions, ethnographic mapping, brief interviews, and the Delphi method to estimate the number of users, volumes consumed, and price for each drug in South Africa in 2020. Nationally, we estimated there to be: 400,000 people who use heroin (probability range (PR) 215,000–425,000) consuming 146.00 tonnes (PR 78.48–155.13) with a value of US$1,898.00 million (PR US$1,020.18–US$2,016.63); 350,000 people who use cocaine (PR 250,000–475,000) consuming 18.77 tonnes (PR 13.41–25.47) with a market value of US$1,219.86 million (PR 871.33–1,655.52) and 290,000 people who use methamphetamine (PR 225,000–365,000) consuming 60.19 tonnes (PR 6.58–10.68) and a market value of US$782.51 million (PR 607.12–984.88). The combined value was calculated at US$3.5 billion. Findings can be used to stimulate engagement to reform drug policy and approaches to mitigate the impact of the illicit drug trade. Additional studies that include people who use drugs in research design and implementation are needed to improve our understanding of drug markets.
The oral health status and anthropometric measurements of children at early childhood development centers in an informal settlement in Pretoria, South Africa
(Jaypee Brothers Medical Publishers, 2024) Bhayat, Ahmed; Madiba, Thomas Khomotjo; Beeforth, Marion; Nkambule, Ntombizodwa Rosemary; ahmed.bhayat@up.ac.za
OBJECTIVES : Early childhood caries (ECC) continue to increase, especially among low socioeconomic communities. This study was conducted in an informal settlement comprising mostly foreigners who have settled in the area. Given the limited dental and medical services available to these communities, this study aimed to determine the dental and medical disease profile of these inhabitants. The objective was to determine the oral health status and the body mass index (BMI) of children attending crèches in an informal settlement. MATERIALS AND METHODS : Oral health data, including dental caries (DC), soft tissue lesions, fluorosis, erosion, and trauma, were recorded using the World Health Organization (WHO) recommended methods. The examiners were calibrated, and all examinations took place at the crèches under natural sunlight. The BMI was calculated by a team of dieticians who were blinded to the oral health status. The height and weight were measured by calibrated examiners under standardized conditions. RESULTS : There were a total of 169 participants; the mean age was 4.02 years (±1.13; 1–7) and there was an equal distribution of males and females (49.7% females and 49.3% males). The prevalence of DC was 39.1%, with 19% having 4 or more carious teeth. The mean decayed, missing, and filled teeth (dmft) and plaque scores [Simplified Oral Hygiene Index (OHI-S)] were 1.58 (±2.70) and 0.65 (±0.43), respectively, and the mean dmft score increased with increasing age. The mean d component contributed 99% of the total mean dmft score (1.56). The mean BMI was 15.44, and this decreased significantly (p = 0.009) while the OHI increased significantly (p < 0.001) as the number of carious teeth increased. CONCLUSION : The prevalence of caries was relatively high, and those with caries had multiple decayed teeth. The d component contributed almost 100% to the mean score, indicating a lack of access to dental care. The mean BMI score was inversely proportional to the number of carious teeth, which could imply that those with caries had difficulty eating.
An audit of completeness of Road to Health Booklet at a community health centre in South Africa
(AOSIS, 2024-12) Machimana, Pfunzo; Nyalunga, Suzan L.N.; Madela-Mntla, Edith; Nzaumvila, Doudou
BACKGROUND: For continuity and quality of care, accurate record-keeping is crucial. Complete care is facilitated by completing a child’s Road to Health Booklet (RTHB) as well as prompt interpretation and appropriate action. This could result in a decrease in child morbidity and mortality. AIM: The study was aimed at assessing the completeness of the RTHB of children younger than 5 years. SETTING: Temba Community Health Centre (CHC), Tshwane District, South Africa. METHODS: A cross-sectional study was conducted using a data collection sheet adopted from previous studies. RESULTS: Children less than 1-year-old accounted for 70.2% of the 255 RTHBs. The mean ± s.d. age was 11.5 ±10.76 months. The study finding showed no section was 100% fully completed. Of the 255 records studied, 38 (14.9%) human immunodeficiency virus (HIV)-exposed babies were recorded at birth, 39.5% were negative at 6 weeks and 60.5% were not recorded. Ninety-one (35.7%) children were unexposed. The HIV status of 126 (49.4%) children was not recorded. Sixty-six per cent (66%) of recorded maternal syphilis was negative. Immunisations, weight-for-age, neonatal information, and details of the family and child were fully completed in 80% of the booklets. Developmental screening was 17.2% completed, and oral health was 1.6% partially completed. The overall completeness was 40.3%. CONCLUSION: The completeness of RTHBs was found to be suboptimal. CONTRIBUTION: The present study’s findings should serve as a reminder that healthcare practitioners must complete RTHBs in their totality in order to improve continuity and care quality, as the results indicated that RTHB completion was below ideal.
Feasibility of implementing viral hepatitis services into a correctional service facility in Cape Town, South Africa
(Elsevier, 2025-03) Scheibe, Andrew; Steingo, Joel; Grace, Gaynor; Savva, Helen; Sonderup, Mark; Hausler, Harry; Spearman, C. Wendy
BACKGROUND : Hepatitis B virus (HBV) and hepatitis C virus (HCV) are estimated to be of the most prevalent infectious diseases in correctional settings worldwide. However, viral hepatitis services have not been routinely integrated into South African correctional facilities. We aimed to assess prevalence of HBV infection and HCV infection among people accessing HIV services and assess the feasibility of viral hepatitis service integration in a South African correctional centre. METHODS : Voluntarily participating people in a correctional services facility were offered free hepatitis B surface antigen (HBsAg) and anti-HCV point-of-care testing in addition to routine HIV testing and treatment services on a first-come, first-served basis during June 2021–March 2022. Off-site laboratory testing (HBV and HCV molecular testing and non-invasive liver fibrosis staging) and screening for hepatocellular carcinoma informed further management. A general practitioner at the facility managed participants, with virtual support from hepatologists. Data on age and history of injecting was collected and point-of-care and laboratory results were recorded. Data were analysed using descriptive statistics. RESULTS : The median age of the 765 people who participated was 32.5 years (IQR 27.5 – 38.2), with 2.2% (17/765) reporting having ever injected a drug. The sample prevalence was 3.9% (30/765) for HBV infection, 0.5% (3/665) for HCV infection, and 1.2% (9/765) for HIV-HBV coinfection. Thirty people had reactive HBsAg point-of-care tests. Among those with reactive HBsAg point-of-care tests 90.0% (27/30) received work-up, among whom 48.1% (13/27) were monitored, 44.4% (12/27) were placed on treatment and two people were released before a management plan could be finalised. Of those treated 33.3% (4/12) started tenofovir/emtricitabine and 66.7% (8/12) antiretroviral therapy. Of the eligible participants, 27.3% (201/735) received at least one hepatitis B vaccine dose and 26.9% (54/201) received three doses. All three participants who had confirmed HCV infection were started on direct-acting antivirals. Of the two completing treatment one achieved sustained virological response at 12 weeks (SVR12), one person was released before SVR12 was done. One person was lost to follow-up. No clinical adverse events were reported. CONCLUSION : There was a notable viral hepatitis burden among people in this correctional centre and integration of viral hepatitis services into the existing HIV services was acceptable and feasible. Further efforts to sustain and expand access to viral hepatitis services in South African correctional centres could catalyse national viral hepatitis elimination efforts.
Giving adolescent girls and young women a foothold : economic strengthening as a key protection strategy against HIV infection in South Africa
(Taylor and Francis, 2024-12-19) Hartnack, Andrew; Mcloughlin, Jenny; Pretorius, Anje; Hausler, Harry
This paper focused on the prevention of HIV transmission for adolescent girls and young women (AGYW), through a layered approach which included economic strengthening as a core strategy, especially for the most vulnerable. Based on multi-year data in KwaZulu-Natal, South Africa, we assessed the outcomes of an economic strengthening model developed by TB HIV Care (THC) in the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) HIV prevention programme. The methods used are primarily qualitative. In 2021, 2022, and 2024 DREAMS implementation staff (n = 72) and economic strengthening beneficiaries (n = 73) from four districts were interviewed on the dynamics of the model and its emerging outcomes. The qualitative data were supplemented by monitoring data. The study results showed that, while longer-term outcomes for the beneficiaries were unclear, the short and medium-term benefits of economic strengthening activities for vulnerable AGYW were highly promising. Not only did beneficiaries gain valuable technical and life skills through training, but they showed increased confidence and hope for the future, and a new sense of empowerment. They also experienced social asset building and an increase in their social, economic, and emotional efficacy. Importantly, beneficiaries also showed signs of behaviour change, away from risky behaviours towards protective ones. The paper concludes that layered economic strengthening initiatives targeted towards those most at risk AGYW, is an important pillar of efforts to reduce HIV infection; however, challenges around taking such initiatives to scale and tracking long-term outcomes remain
HIV incidence and factors associated with HIV risk among people who inject drugs engaged with harm-reduction programmes in four provinces in South Africa : a retrospective cohort study
(Elsevier, 2024-12) Artenie, Adelina; Perry, Rachel; Mahaso, Memory; Jankie, Thenjiwe; McNaughton, Anna L.; Stone, Jack; Vickerman, Peter; Scheibe, Andrew
BACKGROUND : HIV incidence among people who inject drugs in South Africa has never been estimated. We aimed to estimate HIV incidence and associations with risk and protective factors among people who inject drugs engaged with harm-reduction services. METHODS : For this retrospective cohort study we used programmatic data collected from April 1, 2019, to March 30, 2022, by the Networking HIV and AIDS Community of South Africa, which offers harm-reduction services and HIV testing to people who inject drugs. During this 3-year period, services were delivered through drop-in centres and outreach in four South African provinces: Gauteng, KwaZulu-Natal, Western Cape, and Eastern Cape. Our cohort comprised people who inject drugs who did not self-report being HIV positive, were HIV negative at first testing, and had at least one follow-up test. Data were collected by outreach teams. We estimated HIV incidence, assuming seroconversions occurred at the midpoint between the last negative test and first positive test. We assessed associations between HIV seroconversion risk and several factors with Cox regression models, including sociodemographic characteristics, primary drugs used, uptake of interventions (ie, number of harm-reduction packs and opioid agonist treatment [OAT]), and HIV testing interval. FINDINGS : Of 31 182 people who inject drugs accessing harm-reduction services, 20 955 (including 3409 self-reporting being HIV positive) were not tested for HIV. Of 10 227 people who tested at least once, 8152 were HIV negative at first test and of these, 2402 had at least two tests and formed the study cohort. Overall, 283 (11·8%) people who inject drugs acquired HIV over 2306·1 person-years. HIV incidence was higher in Gauteng (16·7 per 100 person-years; 95% CI 14·5–19·1) and KwaZulu-Natal (14·9 per 100 person-years; 11·3–19·3), than in the Eastern Cape (5·0 per 100 person-years; 2·3–9·6) and Western Cape (3·2 per 100 person-years; 1·9–4·9). In multivariable Cox models, HIV acquisition risk varied by race, primary drugs used, and interval between HIV tests. Additionally, people who injected drugs and received OAT in the past year had lower HIV risk (adjusted hazard ratio 0·48; 95% CI 0·22–1·03) than people who did not receive OAT, although the 95% CI was wide and crossed the null. INTERPRETATION : Our study highlights a pressing need for scale-up of HIV prevention strategies, particularly opioid agonist treatment, for people who inject drugs in South Africa. Dedicated investments are needed to develop monitoring systems for HIV incidence, risk behaviours, and uptake of interventions to ensure effective and equitable programmes.
E-cigarettes and harm reduction : a view from sub-Saharan Africa
(BMJ Publishing Group, 2024-07) Egbe, Catherine; Khan, Arshima; Scheibe, Andrew; Ayo-Yusuf, Olalekan Abdulwahab
No abstract available.
Community members’ perceptions of community health workers in Melusi, Tshwane, South Africa
(AOSIS, 2024-09) Madzivhandila, Rebaone K.; Ngcobo, Sanele; sanele.ngcobo@up.ac.za
BACKGROUND: Community health workers (CHWs) play an important role in health promotion through health campaigns and home visits, and provide linkage to care and support patient management. In the informal settlements, CHWs identify health challenges and help residents to access healthcare facilities. AIM: This study aimed to explore the perception held by the community members regarding CHWs’ contribution to health promotion in Melusi informal settlements within the Tshwane district. SETTING: The study was conducted in Melusi informal settlement situated in Pretoria west in South Africa. METHODS: Descriptive exploratory qualitative research methods were used, with open and closed-ended questions during individual interview sessions. Participants were purposefully selected in collaborating with the community leaders and using CHWs’ data to identify individuals with direct interaction with CHWs. RESULTS: Participants praised CHWs’ communication skills, engagement strategies, and ability to provide valuable health services. Community members expected CHWs to provide healthcare services, educational support, advocacy for health issues and guidance on well-being. Barriers such as community resistance, a lack of privacy and difficulties in reaching households were noticed. However, CHWs were commended for their impact on well-being, offering health services, emergency support, food assistance and improved healthcare accessibility. CONCLUSION: The study indicates that community members have positive perceptions of CHWs. This highlights the significant role of CHWs in promoting health and well-being within the community. CONTRIBUTION: This study provides insights into community perceptions of CHWs in informal settlements, emphasising their impact on community well-being. It provides a basis for their effectiveness and support in delivering health services in the informal settlement.
Contextual factors influencing implementation of HIV treatment support strategies for female sex workers living with HIV in South Africa : a qualitative analysis using the Consolidated Framework for Implementation Research
(Lippincott Williams and Wilkins, 2024-11) Comins, Carly A.; Mcingana, Mfezi; Genberg, Becky; Mulumba, Ntambue; Mishra, Sharmistha; Phetlhu, Deliwe R.; Shipp, Lillian; Steingo, Joel; Hausler, Harry; Baral, Stefan D.; Schwartz, Sheree R.
BACKGROUND : Female sex workers (FSWs) face a confluence of multilevel barriers to HIV care. In South Africa, 63% of FSWs are living with HIV and <40% are virally suppressed. The objective of this analysis was to identify implementation determinants of 2 HIV treatment support strategies. METHODS : The Siyaphambili trial tested a decentralized treatment provision and an individualized case management strategy aimed to support FSWs living with unsuppressed HIV viral loads. We identified a nested sample of trial participants using maximum variation sampling (n = 36) as well as a purposively selected sample of implementors (n = 12). We used semistructured interview guides, developed using the Consolidated Framework for Implementation Research (CFIR) and deductively coded the transcripts using CFIR, systematically assessing the strength and valence of implementation. We compared construct ratings to determine whether any constructs distinguished implementation across strategies. RESULTS : Across 3 CFIR domains (innovation characteristics, inner setting, and outer setting), 12 constructs emerged as facilitating, hindering, or having mixed effects on strategy implementation. The relative advantage, design, adaptability, and complexity constructs of the innovation characteristics and the work infrastructure construct of the inner setting were strongly influential (±2 or +2). While the majority of construct valence and strength rating (9–12) were not distinguishing across strategies, we observed 3 weakly distinguishing CFIR constructs (relative advantage, complexity, and available resources). CONCLUSIONS : Given the potential benefits of differentiated service delivery strategies, identifying the relative importance of implementation determinants facilitates transparency and evaluation, supporting future strategy design and implementation. Optimizing implementation will support addressing inequities in HIV care and treatment services.

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