Research Publications (Health Sciences)

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Determinants and acceptability of HIV self-testing among vulnerable groups in sub-Saharan Africa : a scoping review protocol
(BMJ, 2024-01-29) Anyiam, Felix Emeka; Sibiya, Maureen Nokuthula; Oladimeji, Olanrewaju
HIV self-testing (HIVST) is where individuals collect their specimens and perform the HIV test privately. HIVST has improved testing uptake and coverage, especially among vulnerable groups of sub-Saharan Africa (SSA). Vulnerable groups include key populations such as men who have sex with men, sex workers, people who inject drugs, lesbian, gay, bisexual and transgender persons and young women. However, little is known about the determinants and acceptability of HIVST among these groups in SSA. Therefore, this scoping review aims to explore the determinants and acceptability of HIVST among vulnerable groups in SSA.
Methods
A scoping review will be conducted using the Arksey and O'Malley framework and further refined by Levac framework. The review will follow a six-step approach: (1) identifying the research question, (2) identifying relevant studies, (3) study selection eligibility, (4) charting the data, (5) collating, summarising and reporting the results and (6) consultation. A comprehensive search strategy will be developed, and the following electronic databases will be searched: MEDLINE, Embase, Global Health and the Cochrane Library. Grey literature will also be searched, including conference abstracts and reports. Eligibility criteria will include studies conducted in SSA, published between 2010 and 2023, focusing on vulnerable groups and exploring the determinants and acceptability of HIVST. Two independent reviewers will screen identified studies' titles, abstracts and full texts. Any disagreements will be resolved through discussion or consultation with a third reviewer. Data extraction will be conducted using a standardised form.
Ethics and dissemination
This review, not requiring ethical approval, aims to inform policy and intervention design to boost HIV testing adoption within vulnerable communities. We plan to disseminate our findings via a peer-reviewed journal, policy briefs, conference presentations and stakeholder engagement.
Motion palpation used as a postmanipulation assessment tool for monitoring end-feel improvement : a randomized controlled trial of test responsiveness
(Elsevier BV, 2009-09) Lakhani, Ekta; Nook, Brian; Haas, Mitchell; Docrat, Aadil
A tenet of motion palpation theory is the ability to confirm postadjustive segmental end-feel improvement (EFI). Only one previous trial has evaluated the responsiveness of EFI; this was a study of the thoracic spine. The purpose of this study was to evaluate the responsiveness of postadjustive end-feel for evaluating improvement in putative segmental spinal motion restriction after spinal manipulative therapy (SMT) of the cervical spine.
Methods
A prospective, blinded, randomized placebo-controlled pilot trial was conducted with 20 symptomatic and 10 asymptomatic participants recruited from a chiropractic teaching clinic. The treatment group received SMT, and the control group received placebo detuned ultrasound. Responsiveness was evaluated as the etiologic fraction (% of cases with EFI attributable to SMT) and as the sensitivity and specificity of change.
Results
For the entire sample, the etiologic fraction was 63% (P = .002), sensitivity was 93%, and specificity was 67%. For symptomatic participants, a strong relationship appeared to exist between receiving SMT and EFI (etiologic fraction = 78%, P = .006; sensitivity = 90%; specificity = 80%). A strong relationship was not found for asymptomatic participants (etiologic fraction = 40%, P = .444; sensitivity = 100%; specificity = 40%), where EFI was recorded frequently, whether participants received SMT or detuned ultrasound.
Conclusion
The findings of this study showed that motion palpation of end-feel assessment appears to be a responsive postmanipulation assessment tool in the cervical spine for determining whether perceived motion restriction found before treatment improves after SMT. This observation may be limited to symptomatic participants.
If you are here at the clinic, you do not know how many people need help in the community : perspectives of home-based HIV services from health care workers in rural KwaZulu-Natal, South Africa in the era of universal test-and-treat
(Public Library of Science (PLoS), 2018-01) Perriat, Delphine; Plazy, Mélanie; Gumede, Dumile; Boyer, Sylvie; Pillay, Deenan; Dabis, François; Seeley, Janet; Orne-Gliemann, Joanna; ANRS 12249 TasP Study Group
Limited engagement in clinic-based care is affecting the HIV response. We explored the field experiences and perceptions of local health care workers regarding home-based strategies as opportunities to improve the cascade of care of people living with HIV in rural South Africa as part of a Universal Test-and-Treat approach.
Methods
In Hlabisa sub-district, home-based HIV services, including rapid HIV testing and counselling, and support for linkage to and retention in clinic-based HIV care, were implemented by health care workers within the ANRS 12249 Treatment-as-Prevention (TasP) trial. From April to July 2016, we conducted a mixed-methods study among health care workers from the TasP trial and from local government clinics, using self-administrated questionnaires (n = 90 in the TasP trial, n = 56 in government clinics), semi-structured interviews (n = 13 in the TasP trial, n = 5 in government clinics) and three focus group discussions (n = 6-10 health care workers of the TasP trial per group). Descriptive statistics were used for quantitative data and qualitative data were analysed thematically.
Results
More than 90% of health care workers assessed home-based testing and support for linkage to care as feasible and acceptable by the population they serve. Many health care workers underlined how home visits could facilitate reaching people who had slipped through the cracks of the clinic-based health care system and encourage them to successfully access care. Health care workers however expressed concerns about the ability of home-based services to answer the HIV care needs of all community members, including people working outside their home during the day or those who fear HIV-related stigmatization. Overall, health care workers encouraged policy-makers to more formally integrate home-based services in the local health system. They promoted reshaping the disease-specific and care-oriented services towards more comprehensive goals.
Conclusion
Because home-based services allow identification of people early during their infection and encourage them to take actions leading to viral suppression, HCWs assessed them as valuable components within the panel of UTT interventions, aiming to reach the 90-90-90 UNAIDS targets, especially in the rural Southern African region.
Trial registration
The registration number of the ANRS 12249 TasP trial on ClinicalTrials.gov is NCT01509508.
Implementing universal HIV treatment in a high HIV prevalence and rural South African setting : field experiences and recommendations of health care providers
(Public Library of Science (PLoS), 2017-01) Plazy, Melanie; Perriat, Delphine; Gumede, Dumile; Boyer, Sylvie; Pillay, Deenan; Dabis, François; Seeley, Janet; Orne-Gliemann, Joanna
We aimed to describe the field experiences and recommendations of clinic-based health care providers (HCP) regarding the implementation of universal antiretroviral therapy (ART) in rural KwaZulu-Natal, South Africa.
Methods
In Hlabisa sub-district, the local HIV programme of the Department of Health (DoH) is decentralized in 18 clinics, where ART was offered at a CD4 count ≤500 cells/μL from January 2015 to September 2016. Within the ANRS 12249 TasP trial, implemented in part of the sub-district, universal ART (no eligibility criteria) was offered in 11 mobile clinics between March 2012 and June 2016. A cross-sectional qualitative survey was conducted in April-July 2016 among clinic-based nurses and counsellors providing HIV care in the DoH and TasP trial clinics. In total, 13 individual interviews and two focus groups discussions (including 6 and 7 participants) were conducted, audio-recorded, transcribed, and thematically analyzed.
Results
All HCPs reported an overall good experience of delivering ART early in the course of HIV infection, with most patients willing to initiate ART before being symptomatic. Yet, HCPs underlined that not feeling sick could challenge early ART initiation and adherence, and thus highlighted the need to take time for counselling as an important component to achieve universal ART. HCPs also foresaw logistical challenges of universal ART, and were especially concerned about increasing workload and ART shortage. HCPs finally recommended the need to strengthen the existing model of care to facilitate access to ART, e.g., community-based and integrated HIV services.
Conclusions
The provision of universal ART is feasible and acceptable according to HCPs in this rural South-African area. However their experiences suggest that universal ART, and more generally the 90-90-90 UNAIDS targets, will be difficult to achieve without the implementation of new models of health service delivery.
Exploring adolescents and young people's candidacy for utilising health services in a rural district, South Africa
(Springer Science and Business Media LLC, 2019-03-28) Nkosi, Busisiwe; Seeley, Janet; Ngwenya, Nothando; Mchunu, S. Lerato; Gumede, Dumile; Ferguson, Jane; Doyle, Aoife M.
We use the 'candidacy framework' to describe adolescents' and young people's (AYP) experiences of health services in a rural KwaZulu-Natal district, South Africa.
Methods
A qualitative approach was used including group discussions, in-depth and key informant interviews with a purposive sample of AYP (n = 70), community leaders (n = 15), school health teams (n = 10), and health service providers (n = 6).
Results
Findings indicate tacit understanding among AYP that they are candidates for general health services. However, HIV stigma, apprehensions and misconceptions about sexual and reproductive health, and socio-cultural views which disapprove of AYP pre-marital sex undermine their candidacy for sexual and reproductive services.
Conclusion
Consideration and understanding of the vulnerabilities and reasons AYP exclude themselves will inform interventions to address their health needs. AYP's participation in the design of health services will increase their acceptability and encourage uptake of services.
Community perceptions of the socio-economic structural context influencing HIV and TB risk, prevention and treatment in a high prevalence area in the era of antiretroviral therapy
(National Inquiry Services Center (NISC), 2018-03) Ngwenya, Nothando; Gumede, Dumile; Shahmanesh, Maryam; McGrath, Nuala; Grant, Alison; Seeley, Janet
Following calls for targeted HIV prevention interventions in so-called "hotspots", we explored subjective perceptions of community members in places considered to be high HIV and tuberculosis (TB) transmission areas and those with low prevalence. Although more people now have access to antiretroviral therapy (ART), some areas are still experiencing high HIV transmission rates, presenting a barrier to the elimination of HIV. A rapid qualitative assessment approach was used to access a sample of 230 people who contributed narratives of their experiences and perceptions of transmission, treatment and prevention of HIV and TB in their communities. Theoretical propositions case study strategy was used to inform and guide the thematic analysis of the data with Research Department of Epidemiology & Public Health, University College London, London, UK. Our results support the concept of linking perceived control to health through the identification of structural factors that increase communities' sense of agency. People in these communities did not feel they had the efficacy to effect change in their milieu. The few socio-economic opportunities promote social mobility in search of better prospects which may have a negative impact on community cohesion and prevention strategies. Communities were more concerned with improving their immediate social and economic situations and prioritised this above the prevention messages. Therefore approaches that focus on changing the structural and environmental barriers to prevention may increase people's perceived control. Multifaceted strategies that address the identified constructs of perceived control may influence the social change necessary to make structural interventions successful.
The impact of self-interviews on response patterns for sensitive topics : a randomized trial of electronic delivery methods for a sexual behaviour questionnaire in rural South Africa
(Springer Science and Business Media LLC, 2017-08-17) Harling, Guy; Gumede, Dumile; Mutevedzi, Tinofa; McGrath, Nuala; Seeley, Janet; Pillay, Deenan; Bärnighausen, Till W.; Herbst, Abraham J.
BackgroundSelf-interviews, where the respondent rather than the interviewer enters answers to questions, have been proposed as a way to reduce social desirability bias associated with interviewer-led interviews. Computer-assisted self-interviews (CASI) are commonly proposed since the computer programme can guide respondents; however they require both language and computer literacy. We evaluated the feasibility and acceptability of using electronic methods to administer quantitative sexual behaviour questionnaires in the Somkhele demographic surveillance area (DSA) in rural KwaZulu-Natal, South Africa.
Methods
We conducted a four-arm randomized trial of paper-and-pen-interview, computer-assisted personal-interview (CAPI), CASI and audio-CASI with an age-sex-urbanicity stratified sample of 504 adults resident in the DSA in 2015. We compared respondents' answers to their responses to the same questions in previous surveillance rounds. We also conducted 48 cognitive interviews, dual-coding responses using the Framework approach.
Results
Three hundred forty (67%) individuals were interviewed and covariates and participation rates were balanced across arms. CASI and audio-CASI were significantly slower than interviewer-led interviews. Item non-response rates were higher in self-interview arms. In single-paper meta-analysis, self-interviewed individuals reported more socially undesirable sexual behaviours. Cognitive interviews found high acceptance of both self-interviews and the use of electronic methods, with some concerns that self-interview methods required more participant effort and literacy.
Conclusions
Electronic data collection methods, including self-interview methods, proved feasible and acceptable for completing quantitative sexual behaviour questionnaires in a poor, rural South African setting. However, each method had both benefits and costs, and the choice of method should be based on context-specific criteria.
Experiences of facilitators regarding the extended curriculum programme offered at a higher education institution in the province of KwaZulu-Natal in South Africa
(AOSIS, 2018-09-20) Sibiya, Maureen Nokuthula; Mahlanze, Hazel Thokozani
BACKGROUND: Much like the rest of the world, student access and success are primary concerns of the South African higher education institutions, especially in the face of data that suggest that up to 50% of students do not successfully complete their course of study. Despite compulsory and free basic education for all South Africans, and increased government funding for education, there has been little impact on learner performance and the majority of primary schools remain poor. To improve access and success and in keeping with international practice, the Department of Nursing at the selected university of technology in 2013 offered for the first time the extended curriculum programme (ECP). To date, the impact of the programme has never been evaluated. OBJECTIVES: The aim of the study was to explore the experiences of the facilitators regarding ECP in the undergraduate nursing programme. METHOD: Guided by this, the current article describes a qualitative exploration of the experiences of six purposively selected facilitators regarding ECP in the Department of Nursing. In-depth interviews were conducted with the ECP facilitators. Tesch's method was used to analyse the data. RESULTS: Four main themes emerged from the data: stigmatisation and lack of confidence, lack of self-will, additional workload of facilitators and gradual improvement of students' performance. The participants reported that although students displayed and verbalised negative attitude towards the ECP, the performance of students showed gradual improvement and thus a need to continue to offer the programme to increase access and success in higher education institutions. CONCLUSION: It was concluded that ECP should continue to increase access and success in higher education institutions; however, there is a need for additional resources to support ECP students.
Experiences of facilitators regarding the extended curriculum programme offered at a higher education institution in the province of KwaZulu-Natal in South Africa
(AOSIS, 2018-09-20) Sibiya, Maureen Nokuthula; Mahlanze, Hazel Thokozani
Much like the rest of the world, student access and success are primary concerns of the South African higher education institutions, especially in the face of data that suggest that up to 50% of students do not successfully complete their course of study. Despite compulsory and free basic education for all South Africans, and increased government funding for education, there has been little impact on learner performance and the majority of primary schools remain poor. To improve access and success and in keeping with international practice, the Department of Nursing at the selected university of technology in 2013 offered for the first time the extended curriculum programme (ECP). To date, the impact of the programme has never been evaluated. OBJECTIVES: The aim of the study was to explore the experiences of the facilitators regarding ECP in the undergraduate nursing programme. METHOD: Guided by this, the current article describes a qualitative exploration of the experiences of six purposively selected facilitators regarding ECP in the Department of Nursing. In-depth interviews were conducted with the ECP facilitators. Tesch's method was used to analyse the data. RESULTS: Four main themes emerged from the data: stigmatisation and lack of confidence, lack of self-will, additional workload of facilitators and gradual improvement of students' performance. The participants reported that although students displayed and verbalised negative attitude towards the ECP, the performance of students showed gradual improvement and thus a need to continue to offer the programme to increase access and success in higher education institutions. CONCLUSION: It was concluded that ECP should continue to increase access and success in higher education institutions; however, there is a need for additional resources to support ECP students.