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In the context of a couples cohort established to evaluate an optimised couples-focused behavioural intervention in rural South Africa, we examined: (1) Is couples' relationship quality (RQ) associated with couples HIV testing and counselling (CHTC) uptake? (2) Does CHTC uptake or the intervention components uptake improve subsequent RQ? Enrolled couples, (n = 218), previously naïve to couples HIV testing, were invited to two group sessions and offered four couples counselling sessions (CS1-CS4), as part of the intervention and administered a questionnaire individually at baseline, four weeks, and four months, which included item-scales to measure RQ: satisfaction, intimacy, dyadic trust, conflict, and mutual constructive communication. Logistic models indicated that no baseline RQ measures were significantly associated with CHTC uptake. Linear regression models showed that CHTC uptake before four weeks assessment significantly improved couples' satisfaction and trust at four weeks, and intimacy at four months. Attending at least one CS was associated with increased satisfaction, intimacy, and decreased conflict within couples at four weeks; the improvement in intimacy was sustained at four months. Consistent with the theoretical interdependence model, our findings suggest that CHTC and CS seemed to strengthen aspects of relationship quality, possibly leading to further collaboration in managing lifestyle changes and treatment adherence. [ABSTRACT FROM AUTHOR]

Continuous monitoring of glucose (CGM) via subcutaneous patch is an accurate self-monitoring tool of blood glucose, but also introduces a range of additional benefits such as real-time feedback. While its value among pregnant women with gestational diabetes mellitus (GDM) is established in high-income countries, little is known about the feasibility and acceptability among pregnant women without GDM in low-resource settings in low- and middle-income countries. This study aims to assess the feasibility and acceptability of CGM with pregnant mothers in South Africa and to explore the value of a collected data set for GDM prevention. Ten women between 12 and 18 weeks pregnant were recruited from the antenatal clinic at Chris Hani Baragwanath Academic Hospital into a prospective mixed-methods pilot study. Demographic and anthropometric data, HbA1c and a lipid panel were collected. Women then wore two consecutive Freestyle Libre 2 patches for a total of 28 days. In-depth interviews were undertaken with all 10 women on study exit to explore themes of acceptability and the use of technology during pregnancy. Thematic analysis was performed on the qualitative data while exploratory data-analysis techniques were applied to the CGM data. Pregnant women (n = 10) had a mean (SD) age of 29.81 years (4.39), with most being unemployed (8), unmarried (8) and without a tertiary degree (7). Analysis suggests that fear of use was greater than the actual discomfort experienced during use of the CGM patch. The main barrier to use was the patch falling off and women being uncomfortable to reapply it. This was borne out by all 10 women wearing the first patch for at least 12 of the 14 days, but only 4 managing the same with patch two – primarily applied by themselves at home. Women expressed support for the use of technology during pregnancy, especially as it related to feeling that their pregnancy was being monitored and that they were being supported. In this pilot study, women overwhelmingly found the wearing of a CGM patch during pregnancy to be acceptable. Feasibility was reasonable with most data being successfully retrieved from the devices over a two-week period. Longer use was found to have additional challenges. The use of CGM patches appear to be a possible candidate for inclusion in GDM prevention or behavioural interventions during pregnancy in South Africa. [ABSTRACT FROM AUTHOR]

Despite significant gains in HIV testing, treatment and prevention in sub-Saharan Africa, male engagement and retention in HIV care remains a challenge. We conducted in-depth interviews with 25 men with HIV (MWH) living in rural South Africa to explore how men's reproductive goals could inform approaches to engage men and their female partners in HIV care and prevention. Themes were organised into opportunities and barriers for HIV care, treatment and prevention that men articulated as important to their reproductive goals at the individual, couple and community levels. At the individual level, men are motivated to remain healthy so they can raise a healthy child. At the couple level, the importance of maintaining a healthy partner to raise children may promote serostatus-disclosure, testing and encourage men to support partners to access HIV prevention. At the community level, men described the need to be seen as fathers who provide for their families as important motivators to engage in care. Men also articulated barriers including low knowledge about antiretroviral-based HIV prevention, lack of trust within partnerships and community stigma. Addressing reproductive goals of MWH may be an untapped path for promoting male engagement in HIV care and prevention for their partners. [ABSTRACT FROM AUTHOR]

This scoping review synthesises evidence on mHealth in South Africa specifically related to the use and application of mobile technology, the population groups targeted, and the health outcomes measured. Three scholarly databases were searched, data was extracted using standard scoping review methods. Of 287 peer-reviewed articles, 36 articles meeting inclusion criteria were analysed. Mobile applications and short-messaging services were the primary technologies employed by mHealth interventions which increasingly incorporates bi-directional communication. Published research has increased since 2016 with the majority of studies carried out in three provinces, the Western Cape, KwaZulu-Natal, and Gauteng. This paper provides an overview of mHealth in South Africa with recommendations for mHealth integration into private and public healthcare. [ABSTRACT FROM AUTHOR]

The Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) Partnership is an initiative to reduce new HIV infections in Adolescent Girls and Young Women (AGYW) in 15 sub-Saharan countries. It is implemented through the delivery of a comprehensive package of evidence-based approaches and interventions in health, but also with an emphasis on addressing key drivers of high HIV prevalence in AGYW including poverty, gender inequality, sexual violence, lack of education, and social isolation and exclusion, which limit access to information, support, services, and livelihood opportunities. This study aimed to investigate the DREAMS initiative in Lesotho by comparing AGYW and their caregivers who had received two or more of the intervention services to match peers who had not yet participated in the program. A random sample of 150 AGYW were selected from implementing partner intervention lists, 126 (84%) of whom were enrolled. While HIV status was unknown, Dreamers across all age groups reported lower levels of sexual risk (OR 1.28; CI 1.01–1.63) and higher levels of self-efficacy (OR 0.85; CI 0.78–0.93). Dreamers were also more likely to have access to savings (Chi-Square 9.1, df 3, p < 0.05) as well as a plan for how to spend the money they earn (Chi-Square 11.0, df 4, p < 0.05). The parenting program was less successful with no meaningful difference being observed between the two groups of caregivers. These findings suggest that such AGYW in Lesotho who have participated in the initiative have shown improvements in their psychosocial and financial wellbeing as compared to their peers. [ABSTRACT FROM AUTHOR]

Background: The pre-pubertal socioeconomic environment may be an important determinant of age at menarche, adult height, body proportions and adiposity: traits closely linked to adolescent and adult health. Aims: This study explored differences in age at menarche, adult height, relative leg-length and waist circumference between rural and urban black South African young adult women, who are at different stages of the nutrition and epidemiologic transitions. Subjects and methods: We compared 18-23 year-old black South African women, 482 urban-dwelling from Soweto and 509 from the rural Mpumalanga province. Age at menarche, obstetric history and household socio-demographic and economic information were recorded using interview-administered questionnaires. Height, sitting-height, hip and waist circumference were measured using standardised techniques. Results: Urban and rural black South African women differed in their age at menarche (at ages 12.7 and 14.5 years, respectively). In urban women, a one-year increase in age at menarche was associated with a 0.65 cm and 0.16% increase in height and relative leg-length ratio, respectively. In both settings, earlier age at menarche and shorter relative leg-length were independently associated with an increase in waist circumference. Conclusions: In black South African women, the earlier onset of puberty, and consequently an earlier growth cessation process, may lead to central fat mass accumulation in adulthood. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a global health problem of epidemic proportions, affecting a third of women across the globe and as many as 60% in heavily affected regions of Africa. There is strong evidence that risk of IPV is heightened in HIV-infected women, and emerging evidence linking experiencing IPV and/or HIV to a higher likelihood of experiencing mental health problems. This triple burden makes women in Africa, living in the epicentre of HIV, all the more vulnerable. In this synthesis, this study reviewed literature pertaining to the overlap of IPV, HIV, and mental health problems. It presents a series of geographical maps illustrating the heavy burden of IPV and HIV globally, and how these coincide with a growing prevalence of mental health problems in Africa. Furthermore, it presents evidence on: the association between IPV and HIV, shared risk factors, and health consequences. This synthesis sheds light on the fact that ∼30% of women are affected by these three burdens concurrently, and the need for intervention is essential. Promising large scale interventions which have taken place in Africa are described, and evidence is presented in support of integrated versus targeted screening. [ABSTRACT FROM PUBLISHER]

While evidence for home based counselling and testing (HBCT) as an effective HIV testing strategy is growing, men are often under-represented in this approach. Following up on a sample of households previously offered HBCT, the study contacted men who had not tested. Ninety men were randomly divided between voice, text or instant message arms, contacted and encouraged to test. Additionally, focus groups were conducted with 10 men and 10 women to better understand the barriers that prevent men from participating in HBCT. Men who answered or replied to the unsolicited contact varied from a low of 23% with instant message to 60% with voice message. Overall, four men self-reported testing for HIV. The two major themes that emerged from the qualitative data were ambivalence towards seeking medical help and psycho-social barriers to HIV testing. These barriers were a discomfort with testing in a public forum, fear of positive results and fears of indirect disclosure due to HBCT. Although feasible and acceptable, this approach requires more work to understand how it could be made more effective and efficient at getting men tested. [ABSTRACT FROM PUBLISHER]