25 results on '"van Heerden, Alastair"'
Search Results
2. Adapting and testing measures of organizational context in primary care clinics in KwaZulu-Natal, South Africa
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Leslie, Hannah H, Lippman, Sheri A, van Heerden, Alastair, Manaka, Mbali Nokulunga, Joseph, Phillip, Weiner, Bryan J, and Steward, Wayne T
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Health Services and Systems ,Health Sciences ,Behavioral and Social Science ,Health Services ,Sexually Transmitted Infections ,Cancer ,Clinical Research ,Infectious Diseases ,HIV/AIDS ,Good Health and Well Being ,South Africa ,Humans ,Primary Health Care ,Cross-Sectional Studies ,HIV Infections ,Implementation Science ,Leadership ,Ambulatory Care Facilities ,Reproducibility of Results ,Female ,Male ,Organizational Culture ,Interviews as Topic ,Organizational context ,Primary care ,Stress ,Cohesion ,Critical consciousness ,Instrument development ,Reliability ,Validity ,Library and Information Studies ,Nursing ,Public Health and Health Services ,Health Policy & Services ,Health services and systems ,Public health - Abstract
BackgroundImplementation science frameworks situate intervention implementation and sustainment within the context of the implementing organization and system. Aspects of organizational context such as leadership have been defined and measured largely within US health care settings characterized by decentralization and individual autonomy. The relevance of these constructs in other settings may be limited by differences like collectivist orientation, resource constraints, and hierarchical power structures. We aimed to adapt measures of organizational context in South African primary care clinics.MethodsWe convened a panel of South African experts in social science and HIV care delivery and presented implementation domains informed by existing frameworks and prior work in South Africa. Based on panel input, we selected contextual domains and adapted candidate items. We conducted cognitive interviews with 25 providers in KwaZulu-Natal Province to refine measures. We then conducted a cross-sectional survey of 16 clinics with 5-20 providers per clinic (N = 186). We assessed reliability using Cronbach's alpha and calculated interrater agreement (awg) and intraclass correlation coefficient (ICC) at the clinic level. Within clinics with moderate agreement, we calculated correlation of clinic-level measures with each other and with hypothesized predictors - staff continuity and infrastructure - and a clinical outcome, patient retention on antiretroviral therapy.ResultsPanelists emphasized contextual factors; we therefore focused on elements of clinic leadership, stress, cohesion, and collective problem solving (critical consciousness). Cognitive interviews confirmed salience of the domains and improved item clarity. After excluding items related to leaders' coordination abilities due to missingness and low agreement, all other scales demonstrated individual-level reliability and at least moderate interrater agreement in most facilities. ICC was low for most leadership measures and moderate for others. Measures tended to correlate within facility, and higher stress was significantly correlated with lower staff continuity. Organizational context was generally more positively rated in facilities that showed consistent agreement.ConclusionsAs theorized, organizational context is important in understanding program implementation within the South African health system. Most adapted measures show good reliability at individual and clinic levels. Additional revision of existing frameworks to suit this context and further testing in high and low performing clinics is warranted.
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- 2024
3. A Sequential Multiple Assignment Randomized Trial of scalable interventions for ART delivery in South Africa: the SMART ART study
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van Heerden, Alastair, Szpiro, Adam, Ntinga, Xolani, Celum, Connie, van Rooyen, Heidi, Essack, Zaynab, and Barnabas, Ruanne
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- 2023
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4. Understanding the factors that impact effective uptake and maintenance of HIV care programs in South African primary health care clinics
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van Heerden, Alastair, Ntinga, Xolani, Lippman, Sheri A, Leslie, Hannah H, and Steward, Wayne T
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Health Services and Systems ,Public Health ,Health Sciences ,Infectious Diseases ,Prevention ,Health Services ,Clinical Research ,HIV/AIDS ,Sexually Transmitted Infections ,Behavioral and Social Science ,Health and social care services research ,8.1 Organisation and delivery of services ,Infection ,Good Health and Well Being ,HIV ,Primary health care providers ,Health care facilities ,South Africa ,Public Health and Health Services ,Epidemiology ,Midwifery ,Public health - Abstract
BackgroundThere is an increasingly urgent gap in knowledge regarding the translation of effective HIV prevention and care programming into scaled clinical policy and practice. Challenges limiting the translation of efficacious programming into national policy include the paucity of proven efficacious programs that are reasonable for clinics to implement and the difficulty in moving a successful program from research trial to scaled programming. This study aims to bridge the divide between science and practice by exploring health care providers' views on what is needed to implement new HIV programs within existing HIV care.MethodsWe conducted 20 in-depth interviews with clinic managers and clinic program implementing staff and five key informant interviews with district health managers overseeing programming in the uMgungundlovu District of KwaZulu-Natal Province, South Africa. Qualitative data were analyzed using a template approach. A priori themes were used to construct templates of relevance, including current care context for HIV and past predictors of successful implementation. Data were coded and analyzed by these templates.ResultsHeath care providers identified three main factors that impact the integration of HIV programming into general clinical care: perceived benefits, resource availability, and clear communication. The perceived benefits of HIV programs hinged on the social validation of the program by early adopters. Wide program availability and improved convenience for providers and patients increased perceived benefit. Limited staffing capacity and a shortage of space were noted as resource constraints. Programs that specifically tackled these constraints through clinic decongestion were reported as being the most successful. Clear communication with all entities involved in clinic-based programs, some of which include external partners, was noted as central to maximizing program function and provider uptake.ConclusionsAmid the COVID-19 pandemic, new programs are continuously being developed for implementation at the primary health care level. A better understanding of the factors that facilitate and prevent programmatic success will improve public health outcomes. Implementation is likely to be most successful when programs capitalize on endorsements from early adopters, tackle resource constraints, and foster greater communication among partners responsible for implementation.
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- 2022
5. People living with HIV’s perspectives of acceptability of fee for home delivery of ART: a qualitative study
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Ntinga, Xolani, Musiello, Franco, Pita, Thembelihle, Mabaso, Nomagugu, Celum, Connie, Szpiro, Adam, van Rooyen, Heidi, Barnabas, Ruanne, and van Heerden, Alastair
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- 2024
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6. Use of social media big data as a novel HIV surveillance tool in South Africa
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van Heerden, Alastair and Young, Sean
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Communication and Media Studies ,Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Language ,Communication and Culture ,Clinical Research ,HIV/AIDS ,Infection ,Good Health and Well Being ,Epidemiological Monitoring ,Feasibility Studies ,HIV Infections ,Humans ,Social Media ,South Africa ,General Science & Technology - Abstract
Sub-Saharan Africa has been heavily impacted by the HIV/AIDS epidemic. Social data (e.g., social media, internet search, wearable device, etc) show great promise assisting in public health and HIV surveillance. However, research on this topic has primarily focused in higher resource settings, such as the United States. It is especially important to study the prevalence and potential use of these data sources and tools in low- and middle-income countries (LMIC), such as Sub-Saharan Africa, which have been heavily impacted by the HIV epidemic, to determine the feasibility of using these technologies as surveillance and intervention tools. Accordingly, we 1) described the prevalence and characteristics of various social technologies within South Africa, 2) using Twitter, Instagram, and YouTube as a case study, analyzed the prevalence and patterns of social media use related to HIV risk in South Africa, and 3) mapped and statistically tested differences in HIV-related social media posts within regions of South Africa. Geocoded data were collected over a three-week period in 2018 (654,373 tweets, 90,410 Instagram posts and 14,133 YouTube videos with 1,121 comments). Of all tweets, 4,524 (0.7%) were found to related to HIV and AIDS. The percentage was similar for Instagram 95 (0.7%) but significantly lower for YouTube 18 (0.1%). We found regional differences in prevalence and use of social media related to HIV. We discuss the implication of data from these technologies in surveillance and interventions within South Africa and other LMICs.
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- 2020
7. Protocol: evaluation of an optimised couples-focused intervention to increase testing for HIV in rural KwaZulu-Natal, South Africa, the Igugu Lethu (‘Our treasure’) cohort study
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McGrath, Nuala, Ngcobo, Nathi, Feng, Zhixin, Joseph, Phillip, Dladla, Pumla, Ngubane, Thulani, Hosegood, Victoria, Morton, Katherine, Van Rooyen, Heidi, and Van Heerden, Alastair
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- 2022
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8. Using mHealth to Deliver a Home-Based Testing and Counseling Program to Improve Linkage to Care and ART Adherence in Rural South Africa
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Comulada, W Scott, Wynn, Adriane, van Rooyen, Heidi, Barnabas, Ruanne V, Eashwari, Rajeev, and van Heerden, Alastair
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Health Services and Systems ,Health Sciences ,Pediatric ,HIV/AIDS ,Prevention ,Networking and Information Technology R&D (NITRD) ,Clinical Research ,Behavioral and Social Science ,Health Services ,Infectious Diseases ,7.1 Individual care needs ,Management of diseases and conditions ,Infection ,Adolescent ,Adult ,Aged ,Anti-Retroviral Agents ,Cell Phone ,Female ,HIV Infections ,Health Care Surveys ,Health Services Accessibility ,House Calls ,Humans ,Male ,Middle Aged ,Patient Compliance ,Rural Population ,South Africa ,Telemedicine ,Young Adult ,HIV ,ART adherence ,mHealth ,Home visiting ,Linkage to care ,Public Health and Health Services ,Substance Abuse ,Public health ,Clinical and health psychology - Abstract
Community-based HIV testing and counseling (HTC) programs have become an important part of the healthcare system in South Africa and other low- and middle-income countries with a high HIV prevalence and strained primary healthcare system. Current HTC programs excel at identifying people living with HIV (PLH) but leave gaps in linkage to care and antiretroviral therapy (ART) as most HTC programs do not have the capacity to ensure that linkage has occurred. This article presents the protocol for an mHealth study, that is, pilot testing a mobile platform in KwaZulu-Natal (KZN), South Africa, to improve linkage to care and ART adherence after home-based HTC. Testing data are shared with designated clinics. PLH are identified using fingerprint scans, mobile numbers, or South African IDs. If PLH do not present at a designated clinic after testing HIV positive, study field staff are sent SMS alerts to prompt follow-up visits. Similarly, if PLH do not refill ART prescriptions after their initial 1-month dose runs out, SMS alerts that are sent to field staff. This paper presents the mHealth study protocol and baseline sample characteristics (N = 101 PLH). Analyses will summarize rates of linkage to care and ART prescription refills. Cost-effectiveness analyses will examine the costs and benefits of linkage and ART adherence using our mHealth system. Linkage to care rates will be compared between our study and a historical control, that is, provided by a prior HTC program that was conducted in KZN without our mHealth system (n = 615).
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- 2019
9. Two-way associations between relationship quality and uptake of couples health screening including HIV testing and counselling together: quantitative analysis of a couples cohort in rural South Africa.
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Abdelkhalek, Fatma, Joseph, Phillip, DeRose, Laurie, Olamijuwon, Emmanuel, Dladla, Pumla, Ngubane, Thulani, Hosegood, Victoria, van Rooyen, Heidi, van Heerden, Alastair, and McGrath, Nuala
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PATIENT compliance ,RISK-taking behavior ,BEHAVIOR modification ,INTERPROFESSIONAL relations ,RESEARCH funding ,COUPLES therapy ,QUESTIONNAIRES ,SEXUAL excitement ,HIV infections ,UNSAFE sex ,QUANTITATIVE research ,LONGITUDINAL method ,RURAL population ,TRUST ,COMMUNICATION ,MATHEMATICAL models ,HEALTH behavior ,MEDICAL screening ,THEORY ,INTIMACY (Psychology) ,REGRESSION analysis - Abstract
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]
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- 2024
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10. Criterion Validity of Self-Reports of Alcohol, Cannabis, and Methamphetamine Use Among Young Men in Cape Town, South Africa
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Arfer, Kodi B, Tomlinson, Mark, Mayekiso, Andile, Bantjes, Jason, van Heerden, Alastair, and Rotheram-Borus, Mary Jane
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Biological Psychology ,Psychology ,Alcoholism ,Alcohol Use and Health ,Behavioral and Social Science ,Brain Disorders ,Substance Misuse ,Methamphetamine ,Good Health and Well Being ,Criterion validity ,Self-report ,Alcohol ,Cannabis ,South Africa ,alcohol ,cannabis ,criterion validity ,methamphetamine ,self-report ,Public Health and Health Services ,Substance Abuse ,Public health ,Clinical and health psychology - Abstract
Valid measurement of substance use is necessary to evaluate preventive and treatment interventions. Self-report is fast and inexpensive, but its accuracy can be hampered by social desirability bias and imperfect recall. We examined the agreement between self-report of recent use and rapid diagnostic tests for three substances (alcohol, cannabis, and methamphetamine) among 904 young men living in Cape Town, South Africa. Rapid diagnostic tests detected the respective substances in 32%, 52%, and 22% of men. Among those who tested positive, 61% (95% CI [56%, 66%]), 70% ([67%, 74%]), and 48% ([42%, 54%]) admitted use. Men were moderately more willing to admit use of cannabis than alcohol (log OR 0.42) or admit use of alcohol than methamphetamine (log OR 0.53). Our findings show that self-report has reasonable criterion validity in this population, but criterion validity can vary substantially depending on the substance.
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- 2018
11. Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa
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van Heerden, Alastair, Harris, Danielle M, van Rooyen, Heidi, Barnabas, Ruanne V, Ramanathan, Nithya, Ngcobo, Nkosinathi, Mpiyakhe, Zukiswa, and Comulada, W Scott
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Health Services and Systems ,Public Health ,Health Sciences ,Human Society ,Social Work ,Behavioral and Social Science ,HIV/AIDS ,Prevention ,Clinical Research ,Health Services ,Pediatric ,Networking and Information Technology R&D (NITRD) ,Management of diseases and conditions ,7.1 Individual care needs ,Health and social care services research ,8.1 Organisation and delivery of services ,Infection ,Good Health and Well Being ,Adult ,Community Health Workers ,Counseling ,Diagnostic Tests ,Routine ,Female ,Focus Groups ,Government Employees ,HIV Infections ,Health Services Accessibility ,Humans ,Male ,Middle Aged ,Perception ,Qualitative Research ,South Africa ,Telemedicine ,mHealth ,Biometric authentication ,HIV ,Home-based counseling and testing ,Medical and Health Sciences ,Economics ,Studies in Human Society ,Health sciences ,Human society - Abstract
mHealth has been proposed to address inefficiencies in the current South African healthcare system, including home-based HIV testing and counseling (HTC) programs. Yet wide-scale adoption of mHealth has not occurred. Even as infrastructure barriers decrease, a need to better understand perceived adoption barriers by stakeholders remains. We conducted focus group discussions (FGD) in South Africa in 2016 with 10 home-based HTC field staff, 12 community health workers (CHWs) and 10 persons living with HIV (PLH). Key informant (KI) interviews were conducted with five health officials. Perceptions about current home-based HTC practices, future mHealth systems and the use of biometrics for patient identification were discussed, recorded and transcribed for qualitative analysis. Themes were based on a conceptual model for perceived mHealth service quality. Stakeholders brought up a lack of communication in sharing patient health information between clinics, between clinics and CHWs, and between clinics and patients as major barriers to care that mHealth can address. CHWs need better patient information from clinics in terms of physical location and health status to plan visitation routes and address patient needs. CHWs perceive that communication barriers create distrust towards them by clinic staff. PLH want automated appointment and medication reminders. KI see mHealth as a way to improve health information transfer to government officials to better allocate healthcare resources. Stakeholders are also optimistic about the ability for biometrics to improve patient identification but disagreed as to which biometrics would be acceptable, especially in older patients. All stakeholders provided useful information towards the development of mHealth systems. Hospitals are adopting patient-centered approaches that solicit feedback from patients and incorporate them into decision-making processes. A similar approach is needed in the development of mHealth systems. Further, such systems are critical to the successful extension of the health system from health facilities into people's homes.
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- 2017
12. Development and empirical test of the research-informed South African Relationship Functioning Assessment (SARFA).
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Belus, Jennifer M., Hines, Abigail C., Magidson, Jessica F., Iwamoto, Derek K., Rose, Alexandra L., Li, Alison, Barnabas, Ruanne V., and van Heerden, Alastair
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PSYCHOMETRICS ,EXPLORATORY factor analysis ,FUNCTIONAL assessment ,SEXUAL excitement ,TEST validity ,INTIMATE partner violence - Abstract
Intimate partners play an important role in chronic diseases. Despite the chronic disease burden in sub- Saharan Africa, very few culturally relevant quantitative measures of intimate relationship functioning are available. We conducted an empirical investigation evaluating the psychometric properties of the South African Relationship Functioning Assessment (SARFA) assessing healthy relationship functioning in N = 150 community members (50% women; M age = 27.2 years) living in the Vulindlela area of KwaZulu-Natal, South Africa. Item development was based on prior qualitative research from two South African communities. All assessments were conducted in isiZulu, participants' primary language. An exploratory factor analysis was conducted on the initial 39-item measure. The best-fitting model consisted of one factor with 22 items. The SARFA's internal consistency was a = .94. Convergent validity was observed via significant positive associations (all rs = .38, p < .001) between the SARFA's total score and measures of trust, emotional intimacy, constructive communication, sexual satisfaction, and relationship control (women only). Divergent validity was observed for women only. Encouraging initial psychometric properties of a culturally relevant measure of relationship functioning in KwaZulu-Natal may have relevance to other communities and potential to be used in research involving couples and health in chronic disease-burdened communities. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Childhood Economic Well-Being in South Africa: Construction of a Theoretically-Grounded Empirically-Derived Multidimensional Measure
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Turbeville, Ashley, Aber, J. Lawrence, Weinberg, Sharon L., Richter, Linda, and van Heerden, Alastair
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- 2019
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14. Pregnant Women Living with HIV (WLH) Supported at Clinics by Peer WLH: A Cluster Randomized Controlled Trial
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Richter, Linda, Rotheram-Borus, Mary Jane, Van Heerden, Alastair, Stein, Alan, Tomlinson, Mark, Harwood, Jessica M, Rochat, Tamsen, Van Rooyen, Heidi, Comulada, W Scott, and Tang, Zihling
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Public Health ,Health Sciences ,Clinical Research ,Prevention ,Behavioral and Social Science ,Clinical Trials and Supportive Activities ,Pediatric AIDS ,Mental Health ,Infectious Diseases ,HIV/AIDS ,Pediatric Research Initiative ,Pediatric ,Infection ,Reproductive health and childbirth ,Good Health and Well Being ,Adult ,Anti-HIV Agents ,Depression ,Female ,HIV Infections ,Health Behavior ,Health Knowledge ,Attitudes ,Practice ,Humans ,Infant ,Infant ,Newborn ,Infectious Disease Transmission ,Vertical ,Male ,Maternal Health Services ,Mentors ,Patient Compliance ,Peer Group ,Postnatal Care ,Pregnancy ,Pregnancy Complications ,Infectious ,Prenatal Care ,Program Evaluation ,Risk Reduction Behavior ,Social Support ,South Africa ,Treatment Outcome ,HIV ,Maternal health ,Child health ,PMTCT ,Public Health and Health Services ,Social Work ,Public health - Abstract
Throughout Africa, Peer Mentors who are women living with HIV (WLH) are supporting pregnant WLH at antenatal and primary healthcare clinics (McColl in BMJ 344:e1590, 2012). We evaluate a program using this intervention strategy at 1.5 months post-birth. In a cluster randomized controlled trial in KwaZulu-Natal, South Africa, eight clinics were randomized for their WLH to receive either: standard care (SC), based on national guidelines to prevent mother-to-child transmission (4 clinics; n = 656 WLH); or an enhanced intervention (EI; 4 clinics; n = 544 WLH). The EI consisted of four antenatal and four postnatal small group sessions led by Peer Mentors, in addition to SC. WLH were recruited during pregnancy and 70 % were reassessed at 1.5 months post-birth. EI's effect was ascertained on 16 measures of maternal and infant well-being using random effects regressions to control for clinic clustering. A binomial test for correlated outcomes evaluated EI's overall effectiveness. Among EI WLH reassessed, 87 % attended at least one intervention session (mean 4.1, SD 2.0). Significant overall benefits were found in EI compared to SC using the binomial test. However, it is important to note that EI WLH were significantly less likely to adhere to ARV during pregnancy compared to SC. Secondarily, compared to SC, EI WLH were more likely to ask partners to test for HIV, better protected their infants from HIV transmission, and were less likely to have depressed mood and stunted infants. Adherence to clinic intervention groups was low, yet, there were benefits for maternal and infant health at 1.5 months post-birth.
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- 2014
15. A cluster randomized controlled trial evaluating the efficacy of peer mentors to support South African women living with HIV and their infants.
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Rotheram-Borus, Mary Jane, Richter, Linda M, van Heerden, Alastair, van Rooyen, Heidi, Tomlinson, Mark, Harwood, Jessica M, Comulada, W Scott, and Stein, Alan
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Humans ,Pregnancy Complications ,Infectious ,HIV Infections ,Anti-HIV Agents ,Treatment Outcome ,Postnatal Care ,Prenatal Care ,Cluster Analysis ,Health Knowledge ,Attitudes ,Practice ,Peer Group ,Pregnancy ,Time Factors ,Mentors ,Adult ,Infant ,Infant ,Newborn ,Maternal Health Services ,South Africa ,Female ,Infectious Disease Transmission ,Vertical ,Young Adult ,Surveys and Questionnaires ,Pregnancy Complications ,Infectious ,Health Knowledge ,Attitudes ,Practice ,Newborn ,Infectious Disease Transmission ,Vertical ,General Science & Technology - Abstract
ObjectiveWe evaluate the effect of clinic-based support by HIV-positive Peer Mentors, in addition to standard clinic care, on maternal and infant well-being among Women Living with HIV (WLH) from pregnancy through the infant's first year of life.MethodsIn a cluster randomized controlled trial in KwaZulu-Natal, South Africa, eight clinics were randomized for pregnant WLH to receive either: a Standard Care condition (SC; 4 clinics; n = 656 WLH); or an Enhanced Intervention (EI; 4 clinics; n = 544 WLH). WLH in the EI were invited to attend four antenatal and four postnatal meetings led by HIV-positive Peer Mentors, in addition to SC. WLH were recruited during pregnancy, and at least two post-birth assessment interviews were completed by 57% of WLH at 1.5, 6 or 12 months. EI's effect was ascertained on 19 measures of maternal and infant well-being using random effects regressions to control for clinic clustering. A binomial test for correlated outcomes evaluated EI's overall efficacy.FindingsWLH attended an average of 4.1 sessions (SD = 2.0); 13% did not attend any sessions. Significant overall benefits were found in EI compared to SC using the binomial test. Secondarily, over time, WLH in the EI reported significantly fewer depressive symptoms and fewer underweight infants than WLH in the SC condition. EI WLH were significantly more likely to use one feeding method for six months and exclusively breastfeed their infants for at least 6 months.ConclusionsWLH benefit by support from HIV-positive Peer Mentors, even though EI participation was partial, with incomplete follow-up rates from 6-12 months.Trial registrationClinicalTrials.gov NCT00972699.
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- 2014
16. Effects of a community intervention on HIV prevention behaviors among men who experienced childhood sexual or physical abuse in four African settings: findings from NIMH Project Accept (HPTN 043).
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Daniels, Joseph, Komárek, Arnošt, Makusha, Tawanda, Van Heerden, Alastair, Gray, Glenda, Chingono, Alfred, Mbwambo, Jessie KK, Coates, Thomas, and Richter, Linda
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Humans ,HIV Infections ,Prevalence ,Cross-Sectional Studies ,Random Allocation ,Directive Counseling ,Child Abuse ,Sexual ,National Institute of Mental Health (U.S.) ,Community Networks ,Adolescent ,Adult ,Child ,Tanzania ,South Africa ,Zimbabwe ,United States ,Male ,Young Adult ,Child Abuse ,Sexual ,National Institute of Mental Health ,General Science & Technology - Abstract
BackgroundThere is increased focus on HIV prevention with African men who report experiencing childhood sexual (CSA) or physical abuse (CPA).ObjectiveTo better understand the effects of a community-based intervention (Project Accept HPTN 043) on HIV prevention behaviors among men who report CSA or CPA experiences.MethodsProject Accept compared a community-based voluntary mobile counseling and testing (CBVCT) intervention with standard VCT. The intervention employed individual HIV risk reduction planning with motivational interviewing in 34 African communities (16 communities at 2 sites in South Africa, 10 in Tanzania, and 8 in Zimbabwe). Communities were randomized unblinded in matched pairs to CBVCT or SVCT, delivered over 36 months. The post-intervention assessment was conducted using a single, cross-sectional random survey of 18-32 year-old community members (total N = 43,292). We analyzed the effect of the intervention on men with reported CSA or CPA across the African sites. Men were identified with a survey question asking about having experienced CSA or CPA across the lifespan. The effect of intervention on considered outcomes of the preventive behavior was statistically evaluated using the logistic regression models.ResultsAcross the sites, the rates of CSA or CPA among men indicated that African men reflected the global prevalence (20%) with a range of 13-24%. The statistically significant effect of the intervention among these men was seen in their increased effort to receive their HIV test results (OR 2.71; CI: (1.08, 6.82); P: 0.034). The intervention effect on the other designated HIV prevention behaviors was less pronounced.ConclusionThe effect of the intervention on these men showed increased motivation to receive their HIV test results. However, more research is needed to understand the effects of community-based interventions on this group, and such interventions need to integrate other keys predictors of HIV including trauma, coping strategies, and intimate partner violence.
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- 2014
17. Qualitative interviews with mentor mothers living with HIV: potential impacts of role and coping strategies.
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Dhlamini, Lebohang, Knight, Lucia, van Rooyen, Heidi, van Heerden, Alastair, and Jane Rotheram-Borus, Mary
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Humans ,HIV Infections ,Adaptation ,Psychological ,Mothers ,Interview ,Psychological ,Mentors ,Adult ,South Africa ,Female ,Young Adult ,mentor mothers ,expert patient ,peer supporters ,living with HIV ,Adaptation ,Psychological ,Interview ,Clinical Sciences ,Public Health and Health Services ,Other Medical and Health Sciences - Abstract
IntroductionIn South Africa where HIV prevalence is high, mentor mother programmes have been used to promote the health and wellbeing of women enrolled in government programmes preventing vertical transmission. The Masihambisane Project trained mentors to be educators and facilitators as "expert patients" in self-help groups. While this and other similar interventions demonstrate positive outcomes for mothers and their children, the long-term repercussions for mentors delivering the intervention are seldom considered. This article explores the personal impact of being a mentor, the potentially traumatizing effects of repeatedly sharing their experiences of living with HIV and the coping strategies they adopt.ResultsTowards the end of the Masihambisane intervention, 10 semi-structured qualitative interviews were conducted with locally recruited mentors living with HIV and were thematically analysed. Mentors found the repeated telling of their stories a painful reminder of adverse personal experiences. In some cases, retelling caused a physical reaction. Mentors relied on coping strategies like taking breaks, writing their experiences down and debriefing sessions. Despite the difficulties associated with their role, some mentors found being advisors and the group sessions therapeutic and empowering.ConclusionsThese findings indicate that the inclusion of peer mentors comes with certain responsibilities. While the mentors were resilient and some found the experience therapeutic and empowering found creative ways to cope with secondary trauma, the negative implications cannot be ignored. To effectively deliver a mentor-driven intervention to mothers enrolled in a programme to prevent vertical transmission, the possibilities of secondary trauma should be considered and mentors provided with ongoing counselling, training on coping skills and regular debriefing sessions.
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- 2012
18. Digital delivery of behavioural activation therapy to overcome depression and facilitate social and economic transitions of adolescents in South Africa (the DoBAt study) : protocol for a pilot randomised controlled trial
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Moffett, Bianca D, Pozuelo, Julia R, Van Heerden, Alastair, O'Mahen, Heather A, Craske, Michelle, Sodi, Tholene, Lund, Crick, Orkin, Kate, Kilford, Emma J, Blakemore, Sarah-Jayne, Mahmud, Mahreen, Musenge, Eustasius, Davis, Meghan, Makhanya, Zamakhanya, Baloyi, Tlangelani, Mahlangu, Daniel, Chierchia, Gabriele, Fielmann, Sophie L, Gómez-Olivé, F Xavier, Valodia, Imraan, Tollman, Stephen, Kahn, Kathleen, Stein, Alan, Moffett, Bianca D [0000-0002-8887-1374], Pozuelo, Julia R [0000-0002-3058-0371], van Heerden, Alastair [0000-0003-2530-6885], Sodi, Tholene [0000-0001-7592-5145], Lund, Crick [0000-0002-5159-8220], Orkin, Kate [0000-0002-3447-9094], Kilford, Emma J [0000-0002-0360-3769], Blakemore, Sarah-Jayne [0000-0002-1690-2805], Chierchia, Gabriele [0000-0002-5623-4573], Gómez-Olivé, F Xavier [0000-0002-4718-9336], Valodia, Imraan [0000-0002-5607-6595], Tollman, Stephen [0000-0003-0744-7588], Kahn, Kathleen [0000-0003-3339-3931], Stein, Alan [0000-0001-8207-2822], and Apollo - University of Cambridge Repository
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Adolescent ,Depression ,Child & adolescent psychiatry ,Pilot Projects ,Public Health, Global Health, Social Medicine and Epidemiology ,General Medicine ,Depression & mood disorders ,South Africa ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Behavior Therapy ,Humans ,Single-Blind Method ,PUBLIC HEALTH ,Randomized Controlled Trials as Topic - Abstract
Peer reviewed: True, Acknowledgements: We would like to acknowledge the field supervisors Meriam Meritze, Princess Makhubela and Nokthula Mayindi, as well as all the fieldworkers, registered counsellor, Tinyiko Mafumo and peer mentors for their hard work and dedication. We would also like to thank all the adolescents who were involved in the formative work and participatory workshops that were integral to the design and development of the intervention, as well as the educators, healthcare workers and non-governmental organisations that provided valuable input into the trial design, particularly regarding recruitment and risk management strategies., INTRODUCTION: Scalable psychological treatments to address depression among adolescents are urgently needed. This is particularly relevant to low-income and middle-income countries where 90% of the world's adolescents live. While digital delivery of behavioural activation (BA) presents a promising solution, its feasibility, acceptability and effectiveness among adolescents in an African context remain to be shown. METHODS AND ANALYSIS: This study is a two-arm single-blind individual-level randomised controlled pilot trial to assess the feasibility, acceptability and initial efficacy of digitally delivered BA therapy among adolescents with depression. The intervention has been coproduced with adolescents at the study site. The study is based in the rural northeast of South Africa in the Bushbuckridge subdistrict of Mpumalanga province. A total of 200 adolescents with symptoms of mild to moderately severe depression on the Patient Health Questionnaire Adolescent Version will be recruited (1:1 allocation ratio). The treatment group will receive BA therapy via a smartphone application (the Kuamsha app) supported by trained peer mentors. The control group will receive an enhanced standard of care. The feasibility and acceptability of the intervention will be evaluated using a mixed methods design, and signals of the initial efficacy of the intervention in reducing symptoms of depression will be determined on an intention-to-treat basis. Secondary objectives are to pilot a range of cognitive, mental health, risky behaviour and socioeconomic measures; and to collect descriptive data on the feasibility of trial procedures to inform the development of a further larger trial. ETHICS AND DISSEMINATION: This study has been approved by the University of the Witwatersrand Human Research Ethics Committee (MED20-05-011) and the Oxford Tropical Research Ethics Committee (OxTREC 34-20). Study findings will be published in scientific open access peer-reviewed journals, presented at scientific conferences and communicated to participants, their caregivers, public sector officials and other relevant stakeholders. TRIAL REGISTRATION NUMBERS: This trial was registered on 19 November 2020 with the South African National Clinical Trials Registry (DOH-27-112020-5741) and the Pan African Clinical Trials Registry (PACTR202206574814636).
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- 2022
19. "I think it's communication and trust and sharing everything": Qualitative evidence for a model of healthy intimate relationships in Black women living with HIV and men in KwaZulu‐Natal, South Africa.
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Belus, Jennifer M., Bradley, Valerie D., van Heerden, Alastair, Msimango, Lindani I., Barnabas, Ruanne V., and van Rooyen, Heidi
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PSYCHOLOGY of Black people ,PROBLEM solving ,RURAL conditions ,RESEARCH methodology ,INTERVIEWING ,SPOUSES ,QUALITATIVE research ,INTERPERSONAL relations ,COMMUNICATION ,FAMILY relations ,THEMATIC analysis ,WOMEN'S health ,PSYCHOLOGY of HIV-positive persons - Abstract
Copyright of Family Process is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2022
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20. How community ART delivery may improve HIV treatment outcomes: Qualitative inquiry into mechanisms of effect in a randomized trial of community‐based ART initiation, monitoring and re‐supply (DO ART) in South Africa and Uganda.
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Gilbert, Hannah N., Wyatt, Monique A., Pisarski, Emily E., Asiimwe, Stephen, van Rooyen, Heidi, Seeley, Janet, Shahmanesh, Maryam, Turyamureeba, Bosco, van Heerden, Alastair, Adeagbo, Oluwafemi, Celum, Connie L., Barnabas, Ruanne V., and Ware, Norma C.
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ART & society ,TREATMENT effectiveness ,HIV-positive persons ,HIV infections ,HIV - Abstract
Introduction: UNAIDS fast track targets for ending the AIDS epidemic by 2030 call for viral suppression in 95% of people using antiretroviral therapy (ART) to treat HIV infection. Difficulties in linking to care following a positive HIV test have impeded progress towards meeting treatment targets. Community‐based HIV services may reduce linkage barriers and have been associated with high retention and favourable clinical outcomes. We use qualitative data from The Delivery Optimization of Antiretroviral Therapy (DO ART) Study, a three‐arm randomized trial of community ART initiation, monitoring and re‐supply conducted in western Uganda and KwaZulu‐Natal South Africa, to identify mechanisms through which community ART delivery may improve treatment outcomes, defined as viral suppression in people living with HIV (PLHIV). Methods: We conducted open‐ended interviews with a purposeful sample of 150 DO ART participants across study arms and study sites, from October 2016 to November 2019. Interviews covered experiences of: (1) HIV testing; (2) initiating and refilling ART; and (3) participating in the DO ART Study. A combined inductive content analytic and thematic approach was used to characterize mechanisms through which community delivery of ART may have contributed to viral suppression in the DO ART trial. Results: The analysis yielded four potential mechanisms drawn from qualitative data representing the perspectives and priorities of DO ART participants. Empowering participants to schedule, re‐schedule and select the locations of community‐based visits via easy phone contact with clinical staff is characterized as flexibility. Integration refers to combining the components of clinic‐based visits into single interaction with a healthcare provider. Providers" willingness to talk at length with participants during visits, addressing non‐HIV as well as HIV‐related concerns, is termed "a slower pace". Finally, increased efficiency denotes the time savings and increased income‐generating opportunities for participants brought about by delivering services in the community. Conclusions: Understanding the mechanisms through which HIV service delivery innovations produce an effect is key to transferability and potential scale‐up. The perspectives and priorities of PLHIV can indicate actionable changes for HIV care programs that may increase engagement in care and improve treatment outcomes. [ABSTRACT FROM AUTHOR]
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- 2021
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21. Correlates of children's travel to school in Johannesburg-Soweto—Evidence from the Birth to Twenty Plus (Bt20+) study, South Africa.
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de Kadt, Julia, van Heerden, Alastair, Richter, Linda, and Alvanides, Seraphim
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SOCIAL status , *GEOGRAPHY , *BLACK families , *TRAVEL , *MULTIVARIATE analysis - Abstract
Prior work on data obtained from the urban Johannesburg-Soweto based Birth to Twenty Plus (Bt20+) cohort has documented extensive levels of travel to school in the early post- apartheid era (1997–2003), with fewer than 20% of children attending the age-appropriate school closest to their home (de Kadt et al., 2014). These extremely high levels of schooling mobility impose costs on children and families, as well as the educational system more broadly, and have contributed to the evolution of contemporary enrolment patterns. This paper analyses the relationship between travel to school and potentially related variables at the individual, family and community level. Our analysis indicates that Black children, children attending higher quality schools, and those living in relatively poor areas were most likely to travel to school. However, while travel to school has a strong and positive univariate relationship with both maternal education and family socio-economic status (SES), this fades out in a multivariate analysis. Our findings highlight the significant costs incurred in the pursuit of high quality education by many Black children and families, as well as those living in poorer areas, in the early post- apartheid era. This is despite post- apartheid educational policy with an explicit aim of redress. The paper contributes to understanding the challenges of apartheid's inequitable geographical legacy in ensuring equitable access to high quality education for all in South Africa, as well as to the growing literatures on the geography of education and school choice in low and middle income countries. [ABSTRACT FROM AUTHOR]
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- 2019
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22. Support for the feasibility of the ages and stages questionnaire as a developmental screening tool: a cross-sectional study of South African and Zambian children aged 2-60 months.
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van Heerden, Alastair, Hsiao, Celia, Matafwali, Beatrice, Louw, Julia, and Richter, Linda
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CHILDREN ,ZAMBIANS ,CHILD development ,MOTOR ability in children ,COMMUNICATIVE competence ,HEALTH ,DIAGNOSIS of developmental disabilities ,COMPARATIVE studies ,DEVELOPING countries ,RESEARCH methodology ,MEDICAL cooperation ,PSYCHOLOGY of movement ,QUESTIONNAIRES ,RESEARCH ,PILOT projects ,EVALUATION research ,CROSS-sectional method - Abstract
Background: There is a growing global acknowledgement that improving child survival rates is no longer sufficient. Emphasis is shifting to the improvement of health and developmental trajectories in early childhood. Screening and measurement of these trajectories in low and middle income countries is difficult, however, as they currently rely on developmental tests standardised among populations of children growing up in resource rich environments.Methods: This paper presents a comparison of one such tool adapted for use with children living in Southern Africa to children from the United States, Norway, Korea and Spain. The Ages and Stages Questionnaire version 3 (ASQ-3) was adapted and administered to 853 children living in South Africa and Zambia.Results: Children in southern Africa were found to perform significantly better than children from other countries early in life, especially in the domains of communication, gross motor and fine motor skills. By the age of five, children in southern Africa were performing significantly worse than their peers in the domains of fine motor and problem-solving.Conclusion: The results indicate the applicability of the ASQ-3 in southern Africa and point to the importance of early interventions to protect the early good development of African children in order to promote positive life trajectories. [ABSTRACT FROM AUTHOR]- Published
- 2017
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23. Characteristics of sexually experienced HIV testers aged 18 to 32 in rural South Africa: baseline results from a community-based trial, NIMH Project Accept (HPTN 043).
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Knight, Lucia, McGrath, Nuala, van Rooyen, Heidi, Humphries, Hilton, van Heerden, Alastair, and Richter, Linda
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Background: Young people in South Africa are at high risk of HIV infection and yet may have more limited access to prevention and treatment services than others in the population. Testing facilitates the sharing of prevention messages but also enables the linkage to care and treatment of those who test positive and therefore has wider public health implications. Methods: This baseline survey conducted in 2005 for a community randomized trial in rural KwaZulu-Natal explored factors associated with a history of ever, repeat and recent testing amongst sexually debuted men and women aged 18 to 32 years. Results: Over 35% of this rural population ever tested for HIV, with men less likely to ever (unadjusted OR 0.26, 95% CI: 0.21-0.32) and repeatedly test than women (adjusted OR (aOR) 0.68, 95% CI: 0.48-0.97). Men aged 24–28 years (aOR 2.02, 95% CI: 1.10-3.71) and 29–32 years (aOR 2.69, 95% CI: 1.46-4.94) were more likely to ever test than those <20 years. Those who reported having discussed HIV with others had significantly greater odds of reporting ever (men’s aOR 2.83, 95% CI: 1.63-4.89; women’s aOR 3.36, 95% CI: 2.50-4.53), recent (irrespective of sex, aOR 2.87, 95% CI: 2.02-4.09) and repeat testing (aOR 2.02, 95% CI: 1.28-3.19). Conclusion: These findings highlight the need for novel youth- and men-friendly testing services and emphasises the importance of discussions about HIV in the home and community to encourage testing. [ABSTRACT FROM AUTHOR]
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- 2014
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24. Alcohol consumption among HIV-positive pregnant women in KwaZulu-Natal, South Africa: Prevalence and correlates
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Desmond, Katherine, Milburn, Norweeta, Richter, Linda, Tomlinson, Mark, Greco, Erin, van Heerden, Alastair, van Rooyen, Heidi, Comulada, W. Scott, and Rotheram-Borus, Mary Jane
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ALCOHOL drinking , *HIV-positive women , *PREGNANT women , *ECONOMIC status , *MENTAL health , *FETAL alcohol syndrome , *MEDICAL statistics , *DISEASE risk factors - Abstract
Abstract: Background: HIV-positive pregnant women who drink put their children at risk of both HIV and fetal alcohol spectrum disorders. The province of KwaZulu-Natal (KZN) has the highest prevalence of HIV in South Africa, but has not before been considered an area of high alcohol consumption among women. This paper analyzes a large sample of HIV+ pregnant women in KZN to examine alcohol consumption in that population. Methods: Data came from assessments of women enrolled in Prevention of Mother-To-Child Transmission programs at 8 clinics in KZN. Descriptive statistics and logistic regressions were used to examine the prevalence and correlates of alcohol consumption and binge drinking. Results: Of 1201 women assessed, 18% reported drinking during pregnancy, and 67% of drinkers usually binged when drinking (had 3+ drinks in one sitting). Over one-third of drinkers binged twice a month or more. Women living in urban and peri-urban locations were more likely to drink, as were those with indicators of higher economic status and greater social engagement. Married women were less likely to drink, while women who had poorer mental health, used tobacco, or had a greater history of sexual risk-taking were more likely to drink. Conclusion: Health care workers in KZN should be aware that pregnant women who drink are likely to do so at a level that is dangerous for their babies. Some factors associated with drinking indicate social/environmental influences that need to be counteracted by greater dissemination of information about the dangers of drinking, and greater support for abstinence or moderation. [Copyright &y& Elsevier]
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- 2012
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25. Understanding the Relationship between Socio-Economic Status, Physical Activity and Sedentary Behaviour, and Adiposity in Young Adult South African Women Using Structural Equation Modelling
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Richard J. Munthali, Lisa K. Micklesfield, Alessandra Prioreschi, Shane A. Norris, David B. Dunger, Alastair van Heerden, Stephen Tollman, Kathleen Kahn, Rihlat Said-Mohamed, van Heerden, Alastair [0000-0003-2530-6885], Dunger, David [0000-0002-2566-9304], and Apollo - University of Cambridge Repository
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Gerontology ,Rural Population ,Urban Population ,Cross-sectional study ,Health, Toxicology and Mutagenesis ,lcsh:Medicine ,physical activity ,Overweight ,South Africa ,0302 clinical medicine ,Weight management ,Prevalence ,030212 general & internal medicine ,Adiposity ,waist rcumference ,Public Health, Global Health, Social Medicine and Epidemiology ,waist circumference ,Female ,medicine.symptom ,Psychology ,socio-economic status ,urban ,rural ,sedentary ,body mass index ,Adult ,Adolescent ,Black People ,030209 endocrinology & metabolism ,Social class ,Article ,03 medical and health sciences ,Young Adult ,medicine ,Humans ,Socioeconomic status ,Exercise ,Sedentary lifestyle ,lcsh:R ,Public Health, Environmental and Occupational Health ,Models, Theoretical ,medicine.disease ,Obesity ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Cross-Sectional Studies ,Social Class ,Sedentary Behavior ,Body mass index - Abstract
Socio-economic status (SES) is an important predictor of obesity, but how it is associated with differences in physical activity and sedentary behaviour is less clear. This cross-sectional study examined the association between SES (sum of household assets), physical activity and sedentary time, and how they predict adiposity. Socio-demographic, anthropometric, and physical activity data on rural (n = 509) and urban (n = 510) South African women (18-23 years) were collected. Overweight and obesity prevalence, and sedentary time, were higher; and moderate-vigorous intensity physical activity (MVPA) was lower, in the urban sample. Structural equation models (SEMs) were constructed for BMI and waist circumference. In the urban sample SES had a direct inverse effect on MVPA (beta; 95% CI, -41.69; -73.40 to -9.98), while in the rural sample SES had a direct effect on BMI (beta; 95% CI, 0.306; 0.03 to 0.59). In the pooled sample, SES had a direct inverse effect on MVPA (beta; 95% CI, 144; -170.34 to -119.04), and MVPA was directly associated with BMI (beta; 95% CI, 0.04; 0.01 to 0.08). The influence of SES, and the role of physical activity and sedentary time on adiposity differs between the urban and rural samples, and the importance of other environmental and behavioural factors must be considered in the development of obesity and the design of effective interventions.
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- 2018
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