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BackgroundSouth Africa adopted a universal test and treatment program for HIV infection in 2015. The standard of care that people living with HIV receive consists of 3 sessions of readiness counseling delivered by lay counselors (LCs). In the largest antiretroviral therapy (ART) program worldwide, effective and early HIV and ART education and support are key for ensuring ART adoption, adherence, and retention in care. Having LCs to deliver readiness counseling allows for the wide task-sharing of this critical activity but carries the risks of loss of standardization, incomplete content delivery, and inadequate monitoring and supervision. Systems for ensuring that a minimum standard of readiness counseling is delivered to the growing number of people living with HIV are essential in the care cascade. In resource-constrained, high-burden settings, mobile health (mHealth) apps may potentially offer solutions to these treatment gaps by providing content structure and delivery records. ObjectiveThis study aims to explore, at a large Cape Town–based nonprofit HIV care organization, the staff’s perceived preimplementation barriers and facilitators of an mHealth intervention (Masivukeni) developed as a structured app for ART readiness counseling. MethodsMasivukeni is a laptop-based app that incorporates written content, graphics, short video materials, and participant activities. In total, 20 participants were included in this study. To explore how an mHealth intervention might be adopted across different staff levels within the organization, we conducted 7 semistructured interviews (participants: 7/20, 35%) and 3 focus groups (participants in 2 focus groups: 4/20, 20%; participants in 1 focus group: 3/20, 15%) among LCs, supervisors, and their managers. In total, 20 participants were included in this study. Interviews lasted approximately 60 minutes, and focus groups ranged from 90 to 120 minutes. The Consolidated Framework for Implementation Research was used to explore the perceived implementation barriers and facilitators of the Masivukeni mHealth intervention. ResultsSeveral potential facilitators of Masivukeni were identified. Multimedia and visual elements were generally regarded as aids in content delivery. The interactive learning components were notably helpful, whereas facilitated updates to the adherence curriculum were important to facilitators and managers. The potential to capture administrative information regarding LC delivery and client logging was regarded as an attractive feature. Barriers to implementation included security risks and equipment costs, the high volume of clients to be counseled, and variable computer literacy among LCs. There was uncertainty about the app’s appeal to older clients. ConclusionsmHealth apps, such as Masivukeni, were perceived as being well placed to address some of the needs of those who deliver ART adherence counseling in South Africa. However, the successful implementation of mHealth apps appeared to be dependent on overcoming certain barriers in this setting.

Young men in South Africa face the intersecting epidemics of HIV, substance use and endemic poverty. We tested the effectiveness of a behavioral intervention using soccer training to reduce the cluster of risks associated with HIV and substance use. This cluster randomized controlled trial was conducted with men aged 18-29 years old in 27 neighborhoods in the townships of Cape Town, South Africa. Neighborhoods were randomized to receive for 6 months either: (1) Soccer League (SL; n = 18 neighborhoods, n = 778 men) who attended soccer three times weekly (72 sessions; 94% uptake, 45.5% weekly attendance rate), combined with an HIV/substance use, cognitive-behavioral intervention; or (2) a Control Condition (CC; n = 9; 415 men) who received educational materials and referrals at 3 month intervals. The primary outcome was the number of significant changes in a cluster of outcomes including HIV-related risks, substance abuse, employment/income, mental health, violence, and community engagement. There was only one significant difference on the rapid diagnostic tests for mandrax at 6 months, an insufficient number of changes to indicate a successful intervention. A group-based behavioral intervention was ineffective in addressing multiple risk behaviors among at-risk young men, similar to the findings of several recent soccer-related interventions. Early adulthood may be too late to alter well-established patterns of risk behaviors.Clinical Trial Registration This trial was prospectively registered on 24 November 2014 with ClinicalTrials.gov NCT02358226.

This study set out to investigate the psychometric properties of the African Career Interest Inventory (ACII) in Ghana. The ACII is an interest measure developed in South Africa that operationalises Holland's model of vocational personality/interest types. We obtained 617 responses to the ACII from university students at a university in Ghana. Most of the items showed satisfactory fit to the Rasch model with only a few items showing poor fit. The ACII scale scores showed good reliability and the randomisation test of hypothesised order relations and covariance structure modelling supported circumplex structure of these scale scores. Implications for theory and practice are provided.

BackgroundEngaging and retaining young men in community-based interventions is highly challenging. The purpose of this study was to investigate the individual factors that predict intervention engagement and adherence in a sample of at-risk South African men.MethodsBaseline data were collected as a part of a cluster randomised control trial (RCT) situated in Khayelitsha and Mfuleni, two peri-urban settlements situated on the outskirts of Cape Town, South Africa. Neighbourhoods were randomised to one of three intervention conditions. We performed univariate descriptive statistics to report neighbourhood and individual socio-demographic factors, and ran multivariate models, adjusting for entry of study, to determine if high adherence and consistency of engagement with the intervention were associated with socio-behavioural demographics and risk behaviours, such as hazardous substance use, gangsterism, and criminal activity.ResultsTotal of 729 men were on average 22.5 years old (SD 2.8), with a mean of 10 years of education. More than half of the sample were single (94%), lived with their parents (66%) and had an income below ~$30 (52%). The overall mean of adherence is 0.41 (SD 0.24) and mean of consistency of engagement is 0.61 (SD 0.30). Our data indicated that completing more years of education, living with parents, and having higher socioeconomic status were significantly associated with higher rates of engagement and adherence. Men with a history of gang membership demonstrated higher levels of adherence and consistent engagement with the intervention, compared with other men who were recruited to the intervention. Crucially, our data show that young men with a history of substance use, and young men who report symptoms of depression and high levels of perceived stress are equally likely as other young men to adhere to the intervention and attend intervention sessions consistently.ConclusionOur results may contribute to a better understanding of young men's patterns of engagement and adherence to public health interventions. The results may have important implications for policy and practice, as they may be useful in planning more effective interventions and could potentially be used to predict which young men can be reached through community-based interventions.Trial registrationClinicalTrials.gov registration, NCT02358226. Prospectively registered 24 November 2014.

Despite empirical support for "Self-control theory" in criminology, there is controversy about how self-control should be operationalized. Working within the framework of "self-control theory," we investigated if violence and criminal behaviors are associated with nine distinct dimensions of cognitive control in a community sample of young men (n = 654) living in peri-urban townships in South Africa. Cognitive control was assessed using the Behavior Rating Inventory of Executive Function. Multivariate statistical analysis was used, to identify associations between violence and criminality, and deaggregated measures of nine distinct components of cognitive control. Fifteen percent of the sample reported recent violence, 27% had been in physical fights with family/friends in the preceding 6 months, 10% reported being arrested, 4% reported forced sexual contact, and 26% reported intimate partner violence (IPV). Controlling for substance use and sociodemographic variables, contact with the criminal justice system and violence were associated with deficits in all domains of cognitive control. Forced sexual contact was associated with behavioral dysregulation. IPV was associated with behavior dysregulation and executive control dysfunction. Future studies might utilize deaggregated measures of self-control to provide further insight into links between particular components of cognitive control and various forms of offending and violence.

In South African high schools, many learners have limited support in making career related decisions to prepare them for the world of work after school. An important early transition for career-related decision-making is at the end of Grade 9 when learners are expected to decide which subjects they will select for the last phase of high school. Grade 9 is also the juncture where adolescents may decide to exit their formal schooling and enter the labor market. To support Grade 9 learners in making informed career-related decisions, this study examined the effectiveness of a group-based career guidance intervention implemented in eight secondary schools located in resource-constrained communities in the Western Cape, South Africa. The intervention aimed to improve learners' career decision-making readiness and aid in making subject choices and subsequent career choices. The intervention consisted of interest assessment conducted in a group-format with the learners, after which a workshop was facilitated to share relevant information pertaining to their interests, other career attributes and pending subject choices. The results of this study demonstrate a significant impact of early adolescents' career adaptability and ability to engage in the career decision-making process. These results show promise in the implementation of group-based career intervention, supporting learners to make informed decisions in relation to their career paths.

BackgroundIn high-income countries, individual- and community-level factors are associated with increased contact with the criminal justice system. However, little is known about how these factors contribute to the risk of arrest in South Africa, which has one of the highest rates of arrests globally. We examine both individual- and community-level factors associated with arrests among young men living in the townships of Cape Town.MethodsData were collected from a stratified community sample of 906 young men aged 18-29 years old living in 18 township neighborhoods. Communities with high and low rates of arrest were identified. Logistic regression models were used to assess which individual-level (such as substance use and mental health status) and community-level (such as infrastructure and presence of bars and gangs) factors predict arrests.ResultsSignificant predictors of arrests were substance use, gang activity, being older, more stressed, and less educated. Living in communities with better infrastructure and in more recently established communities populated by recent immigrants was associated with having a history of arrests.ConclusionsWhen considering both individual- and community-level factors, substance use and gang violence are the strongest predictors of arrests among young men in South Africa. Unexpectedly, communities with better infrastructure have higher arrest rates. Community programs are needed to combat substance use and gang activity as a pathway out of risk among South African young men.Trial registrationClinicalTrials.gov registration #NCT02358226, registered Nov 24, 2014.

Career interest assessment is a vital component of career guidance and counseling. Ensuring fair and ethical assessment practice is, however, complex and challenging in a diverse multicultural setting such as South Africa. A myriad of factors--including culture, and language--may moderate individual performance on career interest assessments. For this reason, it is imperative to acknowledge these factors when developing career interest assessments in the South African context. Particular attention was paid to the issues of language and culture during the recent development of the South African Career Interest Inventory (SACII) and South African Career Interest Inventory-isiXhosa version (SACII-X). In this paper, we discuss some of the crucial considerations that informed the conceptualization and development of the SACII-X. The promising initial reliability and validity demonstrated by these assessments provide support for the use of career assessments based on imported career theories if sensitivity is afforded to contextual, language, and cultural considerations during the development of such assessment measures. [ABSTRACT FROM AUTHOR]

As demand for health services grows, task‐shifting to lay health workers has become an attractive solution to address shortages in human resources. Community health workers (CHWs), particularly in low‐resource settings, play critical roles in promoting equitable healthcare among underserved populations. However, CHWs often shoulder additional burdens as members of the same communities in which they work. We examined the experiences of a group of CHWs called Mentor Mothers (MMs) working in a maternal and child health programme, navigating the crossroads between personal and professional life in the rural Eastern Cape, South Africa. Semi‐structured qualitative interviews (n = 10) were conducted by an experienced isiXhosa research assistant, asking MMs questions about their experiences working in their own communities, and documenting benefits and challenges. Interviews were transcribed and translated into English and thematically coded. Emergent themes include balancing roles (positive, affirming aspects of the role) and blurring boundaries (challenges navigating between professional and personal obligations). While many MMs described empowering clients to seek care and drawing strength from being seen as a respected health worker, others spoke about difficulties in adequately addressing clients' needs, and additional burdens they adopted in their personal lives related to the role. We discuss the implications of these findings, on an immediate level (equipping CHWs with self‐care and boundary‐setting skills), and an intermediate level (introducing opportunities for structured debriefings and emphasising supportive supervision). We also argue that, at a conceptual level, CHW programmes should provide avenues for professionalisation and invest more up‐front in their workforce selection, training and support. [ABSTRACT FROM AUTHOR]

In South African high schools, many learners have limited support in making career related decisions to prepare them for the world of work after school. An important early transition for career-related decision-making is at the end of Grade 9 when learners are expected to decide which subjects they will select for the last phase of high school. Grade 9 is also the juncture where adolescents may decide to exit their formal schooling and enter the labor market. To support Grade 9 learners in making informed career-related decisions, this study examined the effectiveness of a group-based career guidance intervention implemented in eight secondary schools located in resource-constrained communities in the Western Cape, South Africa. The intervention aimed to improve learners' career decision-making readiness and aid in making subject choices and subsequent career choices. The intervention consisted of interest assessment conducted in a group-format with the learners, after which a workshop was facilitated to share relevant information pertaining to their interests, other career attributes and pending subject choices. The results of this study demonstrate a significant impact of early adolescents' career adaptability and ability to engage in the career decision-making process. These results show promise in the implementation of group-based career intervention, supporting learners to make informed decisions in relation to their career paths. [ABSTRACT FROM AUTHOR]

South African career counselling practices have predominantly been informed by vocational theories and models developed in the United States and Europe. In view of South Africa's peculiar history and its unique cultural and linguistic environment, the indiscriminate application of Western career models has become increasingly contentious, as the majority of these models fail to account for culture-specific values that influence an individual's career interests, decision-making, and development. The South African Career Interest Inventory was developed to address this contention, through operationalising John Holland's vocational personality theory in South Africa. This study adapted and translated the South African Career Interest Inventory into isiXhosa, in the process constructing the first career interest inventory in a South African indigenous language. Subsequently, we investigated the structural validity of the South African Career Interest Inventory, and therefore Holland's model, on a sample of isiXhosa-speaking secondary school learners (n = 266). The randomisation test of hypothesised order relations, multidimensional scaling, and covariance structure modelling were employed to examine the structural validity of the inventory. The results demonstrated the South African Career Interest Inventory–isiXhosa version to be a reliable and valid measure of vocational interest on an early isiXhosa adolescent sample, suggesting the tenability of Holland's model in the South African context. Implications for research and practice are discussed. [ABSTRACT FROM AUTHOR]