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van der Merwe LLA, Cloete A, Savva H, Skinner D, November G, Fisher ZZ. Engaging transgender women in HIV research in South Africa. BMC Public Health 2023; 23:990. [PMID: 37248495 DOI: 10.1186/s12889-023-15977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/23/2023] [Indexed: 05/31/2023] Open
Abstract
The Botshelo Ba Trans study was the first HIV bio-behavioral survey conducted with transgender women in South Africa. Engaging research with marginalized communities requires clear points of entry, reference points for understanding the internal culture, and establishing trust and understanding. The community-based participatory research approach guided the development and implementation of this study. We conducted a rapid qualitative and pre-surveillance formative assessment between August 2017 to January 2018 and a bio-behavioral survey between July 2018 and March 2019. At the start, a Steering Committee, comprising primarily of transgender women, was established and subsequently provided substantial input into the mixed methods study conducted in Buffalo City, Cape Town, and Johannesburg. Key to the study's success was building trust and establishing ownership of the survey by transgender women recognized as expert knowledge holders. Thus, a community-based participatory research-informed approach enhanced the validity of the data and ensured that we addressed relevant issues.
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Affiliation(s)
- L Leigh Ann van der Merwe
- Social, Health, and Empowerment (S.H.E) Feminist Collective of Transgender Women of Africa, East London, South Africa
| | - Allanise Cloete
- Public Health, Societies and Belonging (PHSB) the Human Sciences Research Council (HSRC), Cape Town, South Africa.
| | - Helen Savva
- Prevention Branch, U.S. Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Donald Skinner
- School of Public Health, Stellenbosch University, Stellenbosch, South Africa
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Cloete A, Mabaso M, Savva H, van der Merwe LLA, Naidoo D, Petersen Z, Kose Z, Mthembu J, Moyo S, Skinner D, Jooste S, Fellows IE, Shiraishi RW, Mwandingi SL, Simbayi LC. The HIV care continuum for sexually active transgender women in three metropolitan municipalities in South Africa: findings from a biobehavioural survey 2018-19. Lancet HIV 2023:S2352-3018(23)00059-0. [PMID: 37119825 DOI: 10.1016/s2352-3018(23)00059-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Despite high HIV prevalence in transgender women in sub-Saharan Africa, to our knowledge no study presents data across the HIV care continuum for this population in the region. The aim of this study was to estimate HIV prevalence and present data to develop the HIV care continuum indicators for transgender women in three South African metropolitan municipalities. METHODS Biobehavioural survey data were collected among sexually active transgender women in the metropolitan municipalities of Johannesburg, Buffalo City, and Cape Town, South Africa. Transgender women (aged ≥18 years, self-reporting consensual sex with a man in the 6 months before the survey) were recruited using respondent-driven sampling (RDS). An interviewer-administered questionnaire was used to determine awareness of HIV status; blood specimens were collected on dried blood spots to test for HIV antibodies, antiretroviral treatment (ART) exposure, and viral load suppression. Population-based estimates of HIV 95-95-95 cascade indicators were derived by use of individualised RDS weights with RDS Analyst software. Multivariate stepwise backward logistic regression modelling was used to determine factors associated with each cascade indicator. All eligible participants were included in the final analysis. FINDINGS Between July 26, 2018, and March 15, 2019, we enrolled 887 sexually active transgender women: 323 in Johannesburg, 305 in Buffalo City, and 259 in Cape Town. HIV prevalence was highest in Johannesburg where 229 (74·1%) of 309 tests were positive (weighted prevalence estimate 63·3%, 95% CI 55·5-70·5), followed by Buffalo City where 121 (43·7%) of 277 were positive (46·1%, 38·7-53·6), and then Cape Town where 122 (48·4%) of 252 were positive (45·6%, 36·7-54·7). In Johannesburg, an estimated 54·2% (95% CI 45·8-62·4) of transgender women with HIV knew their positive status, in Cape Town this was 24·2% (15·4-35·8), and in Buffalo City this was 39·5% (27·1-53·4). Among those who knew their status, 82·1% (73·3-88·5) in Johannesburg, 78·2% (57·9-90·3) in Cape Town, and 64·7% (45·2-80·2) in Buffalo City were on ART. Of those on ART, 34·4% (27·2-42·4) in Johannesburg, 41·2% (30·7-52·6) in Cape Town, and 55·0% (40·7-68·4) in Buffalo City were virally suppressed. INTERPRETATION Innovative strategies are needed to inform efforts to diagnose and to treat transgender women living with HIV promptly to achieve viral load suppression. Differentiated HIV services tailored to transgender women of race groups other than Black South African, and those with low education attainment and low outreach exposure, innovative testing, and adherence strategies should be developed to improve the HIV cascade for South African transgender women. FUNDING The US President's Emergency Plan For AIDS Relief and US Centers for Disease Control and Prevention.
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Affiliation(s)
- Allanise Cloete
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa.
| | - Musawenkosi Mabaso
- Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
| | - Helen Savva
- Prevention Branch, CDC, Pretoria, South Africa
| | - L Leigh-Ann van der Merwe
- Social, Health, and Empowerment Feminist Collective of Transgender Women of Africa, East London, South Africa
| | - Dhee Naidoo
- Department of Anthropology and Archaeology, University of Pretoria, Pretoria, South Africa; The Durban LGBTI Community and Health Centre, Durban, KwaZulu-Natal, South Africa
| | - Zaino Petersen
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | - Zamakayise Kose
- Research Support Department, North-West University, Potchefstroom, South Africa
| | - Jacqueline Mthembu
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | - Sizulu Moyo
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Donald Skinner
- School of Public Health, Stellenbosch University, Stellenbosch, South Africa
| | - Sean Jooste
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | - Ian E Fellows
- Health Informatics, Data Management, and Statistics Branch, Division of Global HIV and TB, CDC, Atlanta, GA, USA
| | - Ray W Shiraishi
- Health Informatics, Data Management, and Statistics Branch, Division of Global HIV and TB, CDC, Atlanta, GA, USA
| | | | - Leickness C Simbayi
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Cho D, Skinner D, Lim D, Zhang S, Grayson J, Swords W, Rocha E, Woodworth B, Kiedrowski M, Hunter R. 473 Acetate and propionate metabolism by Pseudomonas aeruginosa contributes to significant sinus inflammation in a rabbit model of sinusitis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Resilience shapes the experiences of adolescents living with HIV (ALWH), enabling them to come to terms with their diagnosis, have hope for the future and maintain meaningful relationships. Yet, little is known about contextual factors associated with resilience resources in South Africa. We aimed to describe individual, relational and community resilience resources, and identify contextual factors associated with resilience. We recruited 385 adolescents, aged 13-18, over a period of 5 months from 11 different public health HIV clinics. The Child and Youth Resilience Measure (CYRM-12) was used to measure resilience resources. Data on demographic variables, psychological attributes, and environmental factors such as HIV-related stigma and stressful life events were collected. ALWH lacked resilience in some aspects of the individual, relational and community domains. For every one-unit increase in the HIV-related stigma and stressful life events scores, resilience decreased by 0.29 (p = 0.01) and 0.37 (p = 0.04) units, respectively. Higher levels of resilience were associated with being virally suppressed (Mann-Whitney U, p = 0.028) although this association was no longer present in the regression model. Efforts to improve resilience amongst ALWH should be focused on fostering individual coping skills, interconnectedness, and positive relationships, to mitigate adverse environmental factors.
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Affiliation(s)
- Talitha Crowley
- Department of Nursing and Midwifery, Stellenbosch University, Cape Town, South Africa
| | - Anita S van der Merwe
- Department of Nursing and Midwifery, Stellenbosch University, Cape Town, South Africa
| | - Tonya Esterhuizen
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Donald Skinner
- Department of Public Health, Stellenbosch University, Cape Town, South Africa.,Human Sciences Research Council, Cape Town, South Africa
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van der Merwe LLA, Cloete A, Skinner D. How HIV advocacy can be used to ensure quality transgender health care: lessons from South Africa. Lancet 2022; 399:1099-1101. [PMID: 35131042 DOI: 10.1016/s0140-6736(22)00177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 11/19/2022]
Affiliation(s)
- L Leigh-Ann van der Merwe
- Social, Health and Empowerment Feminist Collective of Transgender Women of Africa, East London, South Africa.
| | - Allanise Cloete
- Human and Social Capabilities Division, Human Sciences Research Council, Pretoria, South Africa
| | - Donald Skinner
- Human and Social Capabilities Division, Human Sciences Research Council, Pretoria, South Africa
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Cho D, Skinner D, Zhang S, Lim D, Swords W, Hunter R, Rowe S, Woodworth B. 445: Adaptation of Pseudomonas aeruginosa isolates from cystic fibrosis patients to the anaerobic environment. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Crowley T, van der Merwe A, Skinner D. A Mixed-Methods Exploration of Adolescents' Lived Realities of HIV Stigma: "It's Something You Wear, Something That's Like a Shadow All Over Where You Go". J Assoc Nurses AIDS Care 2021; 32:e62-e76. [PMID: 33989246 DOI: 10.1097/jnc.0000000000000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This study aimed to explore how adolescents living with HIV experience stigma and the contextual factors influencing such. The authors used an exploratory, sequential, mixed-method design, including interpretive phenomenological individual interviews and focus groups with adolescents ages 13 to 18 years, their caregivers, and health care workers (n = 56) and a cross-sectional survey (n = 385) in health care facilities in the Western Cape, South Africa. Data were analyzed using an equal-status sequential mixed-methods analysis approach. Enacted, perceived, and anticipated stigma fueled fears of rejection and affected disclosure patterns of adolescents living with HIV. Experiencing HIV-related stigma was associated with being an older adolescent, being disclosed to after the age of 12 years, and residing with one's biological mother. Internalized stigma was associated with poor adherence and viral nonsuppression. Multifaceted interventions involving various individuals and groups across ecological systems are needed to interrupt the stigma process and mitigate its effects.
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Affiliation(s)
- Talitha Crowley
- Talitha Crowley, PhD, RN, is a Senior Lecturer, Department of Nursing and Midwifery, Stellenbosch University, Cape Town, South Africa. Anita S. van der Merwe, PhD, RN, is a Professor of Nursing, Department of Nursing and Midwifery, Stellenbosch University, Cape Town, South Africa. Donald Skinner, PhD, is a Director, Human Sciences Research Council and the Department of Public Health, Stellenbosch University, Cape Town, South Africa
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Cloete A, North A, Ramlagan S, Schmidt T, Makola L, Chikovore J, Skinner D, Reddy SP. "… It is like it has come up and stole our lives from us" The first 21 days: A rapid qualitative assessment of how different sectors of society experienced the COVID-19 lockdown in South Africa. Soc Sci Humanit Open 2021; 4:100167. [PMID: 34927060 PMCID: PMC8665353 DOI: 10.1016/j.ssaho.2021.100167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 03/22/2021] [Accepted: 04/29/2021] [Indexed: 01/08/2023]
Abstract
We examined how different sectors of society experienced the first 21 days of the stay-at-home lockdown following the onset of the coronavirus disease 2019 (COVID-19) pandemic in South Africa. This rapid qualitative assessment was conducted remotely with 60 key and community informants from different socio-cultural and economic backgrounds in Gauteng, KwaZulu-Natal and the Western Cape provinces of South Africa. Atlas.ti.8 was used to facilitate qualitative data analysis. Data revealed how the lockdown exacerbated social inequalities for the poor and marginalised. Fear of infection, and food and income insecurity were common concerns mentioned in key and community informant interviews. Despite the social and economic distress, the data also point to a narrative of social responsibility, resilience and social cohesion. The social responsibility and cohesion demonstrated by South African communities should be drawn upon to invoke community resilience, even in the absence of physical proximity.
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Affiliation(s)
- Allanise Cloete
- Human and Social Capabilities Division, Human Sciences Research Council (HSRC), South Africa
| | - Alicia North
- Human and Social Capabilities Division, Human Sciences Research Council (HSRC), South Africa
| | - Shandir Ramlagan
- Human and Social Capabilities Division, Human Sciences Research Council (HSRC), South Africa
| | - Tenielle Schmidt
- Human and Social Capabilities Division, Human Sciences Research Council (HSRC), South Africa
| | | | - Jeremiah Chikovore
- Human and Social Capabilities Division, Human Sciences Research Council (HSRC), South Africa
| | - Donald Skinner
- Human and Social Capabilities Division, Human Sciences Research Council (HSRC), South Africa
| | - Sasiragha Priscilla Reddy
- Human and Social Capabilities Division, Human Sciences Research Council (HSRC), South Africa
- Faculty of Health Sciences, Nelson Mandela University (NMU), South Africa
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Wise RD, de Vasconcellos K, Gopalan D, Ahmed N, Alli A, Joubert I, Kabambi KF, Mathiva LR, Mdladla N, Mer M, Miller M, Mrara B, Omar S, Paruk F, Richards GA, Skinner D, von Rahden R. Critical Care Society of Southern Africa adult patient blood management guidelines: 2019 Round-table meeting, CCSSA Congress, Durban, 2018. South Afr J Crit Care 2020; 36:10.7196/SAJCC.2020.v36i1b.440. [PMID: 37415775 PMCID: PMC10321416 DOI: 10.7196/sajcc.2020.v36i1b.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 07/08/2023] Open
Abstract
The CCSSA PBM Guidelines have been developed to improve patient blood management in critically ill patients in southern Africa. These consensus recommendations are based on a rigorous process by experts in the field of critical care who are also practicing in South Africa (SA). The process comprised a Delphi process, a round-table meeting (at the CCSSA National Congress, Durban, 2018), and a review of the best available evidence and international guidelines. The guidelines focus on the broader principles of patient blood management and incorporate transfusion medicine (transfusion guidelines), management of anaemia, optimisation of coagulopathy, and administrative and ethical considerations. There are a mix of low-middle and high-income healthcare structures within southern Africa. Blood products are, however, provided by the same not-for-profit non-governmental organisations to both private and public sectors. There are several challenges related to patient blood management in SA due most notably to a high incidence of anaemia, a frequent shortage of blood products, a small donor population, and a healthcare system under financial strain. The rational and equitable use of blood products is important to ensure best care for as many critically ill patients as possible. The summary of the recommendations provides key practice points for the day-to-day management of critically ill patients. A more detailed description of the evidence used to make these recommendations follows in the full clinical guidelines section.
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Affiliation(s)
- R D Wise
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - K de Vasconcellos
- Department of Critical Care, King Edward VIII Hospital, Durban; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - D Gopalan
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - N Ahmed
- Surgical ICU, Tygerberg Academic Hospital; Department of Surgical Sciences and Department of Anaesthesiology and Critical Care, Stellenbosch University, Cape Town, South Africa
| | - A Alli
- Department of Anaesthesia, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - I Joubert
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - K F Kabambi
- Department of Anaesthesia and Critical Care, Nelson Mandela Academic Hospital, Mthatha; Department of Surgery, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - L R Mathiva
- Intensive Care Unit, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - N Mdladla
- Dr George Mukhari Academic Hospital; Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - M Mer
- Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M Miller
- Department of Anaesthesia and Peri-operative Medicine, Division of Critical Care, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - B Mrara
- Anaesthesia Department, Walter Sisulu University, Mthatha, South Africa
| | - S Omar
- Department of Critical Care, Chris Hani Baragwanath Academic Hospital and School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - F Paruk
- Department of Critical Care, Steve Biko Academic Hospital and Critical Care, School of Medicine, University of Pretoria, South Africa
| | - G A Richards
- Department of Critical Care, Charlotte Maxeke Johannesburg Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - D Skinner
- Department of Critical Care, King Edward VIII Hospital, Durban; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - R von Rahden
- Private practice (Critical Care), Rodseth and Partners, Pietermaritzburg, South Africa
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Crowley T, van der Merwe A, Kidd M, Skinner D. Adolescent human immunodeficiency virus self-management: Associations with treatment adherence, viral suppression, sexual risk behaviours and health-related quality of life. South Afr J HIV Med 2020; 21:1054. [PMID: 32391177 PMCID: PMC7203195 DOI: 10.4102/sajhivmed.v21i1.1054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/27/2020] [Indexed: 01/04/2023] Open
Abstract
Background With the advent of access to antiretroviral treatment (ART), human immunodeficiency virus (HIV) has become a chronic disease and self-management is an important component of its care. Research to date has not explored associations between adolescent HIV self-management and treatment adherence, viral suppression, sexual risk behaviour and health-related quality of life (HRQoL). Objectives To explore the associations between adolescent HIV self-management and treatment adherence, viral suppression, sexual risk behaviour and HRQoL. Methods A quantitative cross-sectional study of 385 adolescents living with HIV (ALHIV) aged 13–18 years, who were recruited from 11 healthcare facilities between March and August 2017 in the Cape Metropole of the Western Cape, South Africa, provided the data that were examined in this self-completed questionnaire. Validated scales were used to measure key variables. The most recent viral load (VL) was obtained from the participants’ clinic folder, taking into account that VL is done annually. Results Adolescents who reported higher HIV self-management were more likely to be adherent to treatment (t = 4.435 [336], p < 0.01), virally suppressed (t = 2.376 [305], p = 0.02) and to practise consistent condom use (t = 1.947 [95], p = 0.54). Structural equation modelling (SEM) indicated a significant relationship between self-management and HRQoL (r = 0.43, p < 0.01), whilst non-adherent treatment taking behaviour, correlated with elevated VL log values. No significant correlation was found between self-management and sexual risk behaviour. Conclusion Targeting adolescents’ skills related to HIV self-management in the clinical setting may improve adolescents’ treatment taking behaviour, viral suppression rates and their HRQoL.
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Affiliation(s)
- Talitha Crowley
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anita van der Merwe
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Stellenbosch University, Cape Town, South Africa
| | - Donald Skinner
- Department of Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Marais L, Toefy Y, Thompsen S, Diwan V, Skinner D, Mofolo N, Lenka M, Cloete J. Targeting for male medical circumcision: profiles from two South African cities. AIDS Care 2020; 33:448-452. [PMID: 32070119 DOI: 10.1080/09540121.2020.1728215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Male circumcision is considered by some to be an acceptable global approach to reduce HIV infections. Consequently, many governments in sub-Saharan Africa run voluntary male circumcision programmes. South Africa also provides male circumcision for free at state clinics and hospitals. Very little is known about the men who use this service. This study uses data from Cape Town, a sample of 1194 in 2016, and from Mangaung, a sample of 277 in 2017 and 2018, to fill this gap. The study finds that age targeting is inadequate, risk targeting is absent, and religious and cultural factors have a negative effect on the cost-efficiency of the service in the long run.
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Affiliation(s)
- Lochner Marais
- Centre for Development Support, University of the Free State, Bloemfontein, South Africa
| | - Yoesrie Toefy
- Research on Health and Society Unit, Stellenboach University, Cape Town, South Africa
| | - Sarah Thompsen
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Vinod Diwan
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Donald Skinner
- Research on Health and Society Unit, Stellenboach University, Cape Town, South Africa.,Social Aspects of Public Health, Human Sciences Research Council, Cape Town, South Africa
| | - Nathaniel Mofolo
- School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
| | - Molefi Lenka
- Centre for Development Support, University of the Free State, Bloemfontein, South Africa
| | - Jan Cloete
- Centre for Development Support, University of the Free State, Bloemfontein, South Africa
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Crowley T, Van der Merwe A, Skinner D. Development of a cultural and contextual appropriate HIV self-management instrument using interpretive phenomenology and focus group cognitive interviews. International Journal of Africa Nursing Sciences 2020. [DOI: 10.1016/j.ijans.2020.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Skinner D, Sharp C, Marais L, Serekoane M, Lenka M. A qualitative study on teachers' perceptions of their learners' mental health problems in a disadvantaged community in South Africa. Curationis 2019; 42:e1-e7. [PMID: 31793308 PMCID: PMC6890560 DOI: 10.4102/curationis.v42i1.1903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 11/03/2022] Open
Abstract
Background The combination of extensive poverty, violence and HIV has potential mental health impacts on children in Southern Africa. This article is nested in a broader study to evaluate the strength and difficulties questionnaire (SDQ) among Sotho speakers, and assess the mental health status of children made orphans by AIDS. Objectives The aim of this study was to describe the mental health problems that the teachers perceive among learners in their classrooms, to understand what the teachers saw as causing these problems and to identify potential approaches to address these problems within the school setting. Method As part of the larger study, 10 teachers were purposively selected to write a report describing the mental health problems among learners in their class. These findings were discussed at two later meetings with a larger grouping of teachers to validate the findings and obtain additional input. Results The teachers were concerned about the emotional state of their pupils, especially in relation to depression, anxiety, substance abuse, scholastic problems and aggression. These problems were felt to arise from the children’s lived context; factors such as poverty, death of parents and caregivers from AIDS and trauma, parental substance abuse and child abuse. The teachers expressed a desire to assist the affected learners, but complained that they did not get support from the state services. Conclusion Many learners were evaluated by teachers as struggling with mental health issues, arising from their social context. The teachers felt that with support, schools could provide assistance to these learners.
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Affiliation(s)
- Donald Skinner
- Research on Health and Society, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Social Aspects of Public Health, Human Sciences Research Council, Cape Town.
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van den Bosch CM, Cronjé L, de Vasconcellos K, Skinner D. Paediatric postoperative analgesia prescribing report card: “could do better”. South Afr J Anaesth Analg 2019. [DOI: 10.36303/sajaa.2019.25.4.2257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: A key element of paediatric pain management is prescribing and dispensing analgesia. This process differs in children, putting them at greater risk of drug error.
Methods: This study was a retrospective postoperative analgesia prescription chart review of children who had orthopaedic surgery in a tertiary hospital in Durban, South Africa. Patient records of 202 children, aged 6 months to 12 years, with 232 theatre visits were reviewed. Prescription charts were inspected for patient characteristics, evidence of good prescribing practice and data regarding the prescribing and administration of analgesia.
Results: Of the 257 analysed charts 254 (99%) had paracetamol, 208 (81%) had an opioid and 49 (19%) had a nonsteroidal antiinflammatory drug (NSAID) prescribed. Underdosing was evident in all groups of analgesics prescribed. Opioids were more often prescribed with a pro-re-nata caveat and were the least correctly dispensed. There were no prescription charts in which all the requirements for good prescribing practice were complete.
Conclusions: This study demonstrates a high rate of paediatric drug error in both the prescribing and dispensing of analgesia. Potential under-utilisation of NSAIDs in this orthopaedic population is also noted. Lack of knowledge or confidence needed by clinicians to adhere to principles of paediatric dosing and multimodal analgesia may be contributing factors. Issues pertaining to paediatric analgesia prescribing and dispensing are highlighted and should be targeted by institution and population specific interventions.
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Crowley T, van der Merwe A, Skinner D. Adolescent HIV Self-management: Lived Experiences of Adolescents, Caregivers, and Health Care Workers in a South African Context. J Assoc Nurses AIDS Care 2019; 30:e7-e19. [PMID: 31241512 DOI: 10.1097/jnc.0000000000000098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Adolescence is a complex developmental phase, made more complex by chronic disease. When dealing with treatment and the health impact of chronic diseases, adolescents need to learn to self-manage an array of challenges. Unfortunately, there is a gap in the literature related to chronic disease self-management in adolescents living with HIV. We describe the phenomenon from the perspectives of adolescents, caregivers, and health care workers (HCWs) in South Africa. Individual interviews were conducted with 6 adolescents, 6 caregivers, and 6 HCWs, followed by 5 adolescent focus groups. Interpretive phenomenology guided exploration of social and cultural experiences and found that adolescent self-management required an understanding of HIV and hope for the future. Adolescents also needed skills to prioritize and negotiate care while managing stigma. These processes were facilitated by love and support, primarily from immediate family, and by the adolescent engaging with family, HCWs, and peers.
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Moodley K, Staunton C, Rossouw T, de Roubaix M, Duby Z, Skinner D. The psychology of "cure" - unique challenges to consent processes in HIV cure research in South Africa. BMC Med Ethics 2019; 20:9. [PMID: 30678664 PMCID: PMC6346569 DOI: 10.1186/s12910-019-0348-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Consent processes for clinical trials involving HIV prevention research have generated considerable debate globally over the past three decades. HIV cure/eradication research is scientifically more complex and consequently, consent processes for clinical trials in this field are likely to pose a significant challenge. Given that research efforts are now moving toward HIV eradication, stakeholder engagement to inform appropriate ethics oversight of such research is timely. This study sought to establish the perspectives of a wide range of stakeholders in HIV treatment and research to inform consent processes for cure research. METHODS In total, 68 South African stakeholders participated in two qualitative research modalities. In-depth interviews (IDIs) were conducted with a purposive sample of 42 individuals - audiotaped with consent. Twenty-six stakeholders participated in three focus group discussions (FGDs). Thematic analysis of transcribed IDIs and FGDs was conducted. RESULTS The majority of respondents indicated that there could be unique challenges in HIV cure research requiring special attention. In particular, given the complexity of cure science, translation of concepts into lay language would be critical for potential participants to adequately appreciate risks and benefits in early phase research with experimental interventions. Furthermore, to aid understanding of risks and benefits against a background of desperation for a cure, specially trained facilitators would be required to assist with a psychological assessment prior to consent to avoid curative misconceptions. Long-term participant engagement to assess durability of a cure would mean that the consent process would be prolonged, necessitating annual re-consent. Building trust to maintain such long-term relationships would be critical to retain study participants. CONCLUSION Unique consent requirements for cure research in South Africa would include significant efforts to maximise understanding of trial procedures, risks and the need for long-term follow-up. However, the psychological dimension of cure must not be underestimated. Beyond an understanding of cure science, the emotional impact of HIV cure advances the discourse from cure to healing. Consequently, the consent process for cure research would need to be enhanced to include psychological support and counselling. This has several important implications for research ethics review requirements for consent in HIV cure research.
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Affiliation(s)
- Keymanthri Moodley
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ciara Staunton
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Theresa Rossouw
- Institute for Cellular and Molecular Medicine, Department of Immunology, University of Pretoria, Pretoria, South Africa
| | - Malcolm de Roubaix
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Zoe Duby
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Donald Skinner
- HIV AIDS STDs and TB, Human Sciences Research Council, Cape Town, South Africa
- Dept. of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Abstract
Children affected by HIV/AIDS are at high risk for poor mental health outcomes. Social and psychological connectedness to school has been identified as an important resilience factor for youth affected by adversity (Centers for Disease Control and Prevention. (2009). School connectedness: Strategies for increasing protective factors among youth. Atlanta, GA: U.S. Department of Health and Human Services). Defined as "the belief by students that adults in the school care about their learning as well as about them as individuals" (Centers for Disease Control and Prevention. (2009). School connectedness: Strategies for increasing protective factors among youth. Atlanta, GA: U.S. Department of Health and Human Services), school connectedness has been shown to be associated with higher academic performance, increased mental health, and quality of life. However, few studies have examined school connectedness in sub-Saharan Africa, and none have examined school connectedness in relation to mental health in children orphaned by HIV/AIDS. Further, existing studies have relied on self-report measures. Against this background, the aim of the current study was to examine orphan status, school connectedness, and their interaction in relation to child mental health by using a multimethod design. 750 children between the ages of 7-11, recruited through South African community-based organizations (224 AIDS/HIV orphans, 276 non-AIDS/HIV orphans, 250 non-orphans; 51.2% girls), completed measures of school connectedness; children, caregivers, and teachers reported on child well-being using the Strengths and Difficulties Questionnaire. AIDS/HIV and non-AIDS/HIV orphans reported lower school connectedness than non-orphans. However, results demonstrated significant relations between school connectedness and overall mental health regardless of group, suggesting that school connectedness buffers against negative mental health outcomes regardless of orphan status. This study identifies a strategic point of intervention to build resilience against the cascading effects of HIV/AIDS and poverty in children in sub-Saharan Africa.
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Affiliation(s)
- Carla Sharp
- a Department of Psychology , University of Houston , Houston , TX , USA.,b Center for Development Support , University of the Free State , Bloemfontein , South Africa
| | - Francesca Penner
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Lochner Marais
- b Center for Development Support , University of the Free State , Bloemfontein , South Africa
| | - Donald Skinner
- c Unit for Research on Health and Society, Department of Medicine and Health Sciences , Stellenbosch University , Stellenbosch , South Africa.,d Department of HIV/AIDS, STIs, and TB , Human Sciences Research Council , Cape Town , South Africa
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18
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Engelbrecht JG, Mukinda FK, Green B, Skinner D. How clinicians experience a simulated antiretroviral therapy adherence exercise: A qualitative study. Afr J Prim Health Care Fam Med 2018; 10:e1-e7. [PMID: 30456973 PMCID: PMC6244187 DOI: 10.4102/phcfm.v10i1.1836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/02/2018] [Accepted: 08/07/2018] [Indexed: 11/13/2022] Open
Abstract
Background With the shift of paediatric antiretroviral therapy (ART) from tertiary to primary health care, there has been a need to train clinicians working in primary health care facilities to support adherence to treatment. An adherence simulation exercise was included in a course on paediatric human immunodeficiency virus (HIV) and tuberculosis (TB) to stimulate health care providers’ awareness and generate empathy of complex paediatric adherence practices. Aim The aim of this study was to describe the experience of clinicians completing the simulation exercise and to assess whether enhancing their empathy with patients and treatment supporters would improve their perceived clinical and counselling skills. Setting The study was conducted at the Faculty of Medicine and Health Sciences, Stellenbosch University, and a guesthouse in Cape Town. Methods The adherence module used blended learning methodology consisting of face-to-face contact sessions and distance learning. A qualitative thematic approach was used to understand the participant experiences through focus-group discussions and semi-structured interviews. Results Three thematic clusters emerged, namely, experiences of the simulated exercise, patient–provider relationships and adherence strategies. Their experiences were both positive and challenging, especially when a ‘caregiver and/or treatment supporter’ scenario encouraged participants to reflect on their own relationships with their patients. Clinicians had also considered how empathy fits into their scope of responsibilities. Text messaging and adherence counselling strategies were identified. Conclusion Simulated learning activities have the potential to create awareness of relationships between clinicians and their patients and generate ideas and discussion that could lead to improvements in clinical practice, and adherence promotion strategies.
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Tarantino N, Goodrum NM, Salama C, LeCroix RH, Gaska K, Cook SL, Skinner D, Armistead LP. South African Adolescents' Neighborhood Perceptions Predict Longitudinal Change in Youth and Family Functioning. J Early Adolesc 2018; 38:1142-1169. [PMID: 30344359 PMCID: PMC6191187 DOI: 10.1177/0272431617725196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This study examined South African early adolescent youth (aged 10 to 14) and their female caregivers (N = 99 dyads) participating in an HIV prevention intervention over a period of eight months. We examined youth perceptions of neighborhood cohesion, safety, and collective monitoring as they related to concurrent and longitudinal associations with youth (externalizing behavior and hope about the future) and family (parent-youth relationship quality, parental involvement, and parental responsiveness to sex communication) functioning while controlling for baseline characteristics. Neighborhood perceptions were significantly associated (p < .05) with short- and longer-term outcomes. Gender differences suggested a greater protective association of perceived neighborhood conditions with changes in functioning for boys versus girls. Unexpected associations were also observed, including short-term associations suggesting a link between better neighborhood quality and poorer family functioning. We account for the culture of this South African community when contextualizing our findings and conclude with recommendations for interventions targeting neighborhood contexts.
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Affiliation(s)
- Nicholas Tarantino
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nada M. Goodrum
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Christina Salama
- Kennedy Krieger Institute, John Hopkins School of Medicine, Baltimore, Maryland
| | | | - Karie Gaska
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Sarah L. Cook
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Donald Skinner
- Unit for Research on Health & Society, Stellenbosch University, Stellenbosch, South Africa
| | - Lisa P. Armistead
- Department of Psychology, Georgia State University, Atlanta, Georgia
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20
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Skinner D, Delobelle P, Pappin M, Pieterse D, Esterhuizen TM, Barron P, Dudley L. User assessments and the use of information from MomConnect, a mobile phone text-based information service, by pregnant women and new mothers in South Africa. BMJ Glob Health 2018; 3:e000561. [PMID: 29713504 PMCID: PMC5922495 DOI: 10.1136/bmjgh-2017-000561] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/29/2017] [Accepted: 12/09/2017] [Indexed: 12/03/2022] Open
Abstract
MomConnect was designed to provide crucial health information to mothers during pregnancy and in the early years of child rearing in South Africa. The design drew on the success of the Mobile Alliance for Maternal Action’s programme in South Africa, as well as a growing list of mobile health (mHealth) interventions implemented internationally. Services such as MomConnect are dependent on user acceptability as all engagements are voluntary, meaning that tools have to be easy to use and useful to be successful. This paper describes the evaluation of the tool by pregnant women and new mothers using the tool. A purposive sample of 32 individual semistructured interviews and 7 focus groups were conducted, across five provinces in South Africa. All the sessions were transcribed and then analysed using a contextualised interpretative approach, with the assistance of Atlas.ti. The women were consistently positive about MomConnect, attaching high value to the content of the messages and the medium in which they were delivered. The system was found to work well, with minor problems in some language translations. Respondents were enthusiastic about the messages, stating that the information was of great use and made them feel empowered in their role as a mother, with some saving the messages to use as a resource or to share with others. The most significant problems related to network coverage. There was strong support for this intervention to continue. Given the user acceptability of mHealth interventions, MomConnect appeared to meet the target of identifying and responding to the recipient’s needs.
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Affiliation(s)
- Donald Skinner
- Research on Health and Society Unit, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,HIV, AIDS, STD and TB, Human Sciences Research Council, Pretoria, South Africa
| | - Peter Delobelle
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Michele Pappin
- Community Health Division, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Desiree Pieterse
- Research on Health and Society Unit, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Research Unit, Ndlovu Care Group, Groblersdal, Limpopo, South Africa
| | - Tonya Marianne Esterhuizen
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Peter Barron
- HIV/AIDS, TB and MCWH, National Department of Health, Pretoria, Gauteng, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lilian Dudley
- Community Health Division, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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21
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Goodrum NM, Armistead LP, Tully EC, Cook SL, Skinner D. Parenting and youth sexual risk in context: The role of community factors. J Adolesc 2017; 57:1-12. [PMID: 28278431 PMCID: PMC5415416 DOI: 10.1016/j.adolescence.2017.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 02/12/2017] [Accepted: 02/26/2017] [Indexed: 11/25/2022]
Abstract
Black South African youth are disproportionately affected by HIV, and risky sexual behaviors increase youths' vulnerability to infection. U.S.-based research has highlighted several contextual influences on sexual risk, but these processes have not been examined in a South African context. In a convenience sample of Black South African caregivers and their 10-14-year-old youth (Mage = 11.7, SD = 1.4; 52.5% female), we examined the relation between parenting and youth sexual risk within the context of community-level processes, including neighborhood quality and maternal social support. Hypotheses were evaluated using structural equation modeling. Results revealed that better neighborhood quality and more social support predicted positive parenting, which in turn predicted less youth sexual risk. There was a significant indirect effect from neighborhood quality to youth sexual risk via parenting. Results highlight the importance of the community context in parenting and youth sexual risk in this understudied sample. HIV prevention-interventions should be informed by these contextual factors.
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Affiliation(s)
- Nada M Goodrum
- Department of Psychology, Georgia State University, United States.
| | - Lisa P Armistead
- Department of Psychology, Georgia State University, United States
| | - Erin C Tully
- Department of Psychology, Georgia State University, United States
| | - Sarah L Cook
- Department of Psychology, Georgia State University, United States
| | - Donald Skinner
- Department of Interdisciplinary Health Sciences, Stellenbosch University, South Africa
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22
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Jervis S, Saunders T, Belcher J, Skinner D. Evaluating three hundred and fifty-two admissions and predictors of re-admissions for epistaxis - is it time to re-evaluate tranexamic acid in epistaxis? Clin Otolaryngol 2017; 42:439-442. [DOI: 10.1111/coa.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2015] [Indexed: 11/29/2022]
Affiliation(s)
- S. Jervis
- ENT Dept; Princess Royal Hospital; Telford UK
| | - T. Saunders
- ENT Dept; Princess Royal Hospital; Telford UK
| | - J. Belcher
- Department of Mathematics and Computing; Keele University; Stoke-on-Trent UK
| | - D. Skinner
- ENT Dept; Princess Royal Hospital; Telford UK
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Russell R, Price D, Mares R, Burden A, Skinner D, Mikkelsen H, Chavannes NH, Kocks JWH, Stephens JW, Haughney J. Effect of ICS on glycaemic control in patients with COPD and comorbid type 2 diabetes: historical case-matched cohort study. Pneumologie 2017. [DOI: 10.1055/s-0037-1598312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- R Russell
- Nuffield Department of Medicine, University of Oxford
| | - D Price
- Academic Primary Care, University of Aberdeen, United Kingdom; Observational and Pragmatic Research Institute, Changi, Singapore
| | | | | | | | | | - NH Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center
| | - JWH Kocks
- Department of General Practice and Griac Research Institute, University Medical Center Groningen
| | - JW Stephens
- Diabetes Research Group, Institute of Life Sciences, Swansea University
| | - J Haughney
- Academic Primary Care, University of Aberdeen
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24
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Purchase S, Cunningham J, Esser M, Skinner D. Keeping kids in care: virological failure in a paediatric antiretroviral clinic and suggestions for improving treatment outcomes. Afr J AIDS Res 2017; 15:301-9. [PMID: 27681154 DOI: 10.2989/16085906.2016.1210656] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The burden of paediatric HIV in South Africa is extremely high. Antiretrovirals (ARVs) are now widely accessible in the country and the clinical emphasis has shifted from initiation of treatment to retention in care. This study describes the cumulative virological failure rate amongst children on ARVs in a peri-urban clinic, and suggests ways in which clinics and partners could improve treatment outcomes. The study was conducted by the non-profit organisation HOPE Cape Town Association. A retrospective file audit determined the cumulative virological failure rate, that is, the sum of all children with a viral load >1000 copies/ml, children on monotherapy, children who had stopped treatment, children lost to follow-up (LTFU) and children who had died. Interviews were conducted with a purposive sample of 12 staff members and a random sample of 21 caregivers and 4 children attending care. Cumulative virological failure rate was 42%, with most of those children having been LTFU. Both staff and caregivers consistently identified pharmacy queues, ongoing stigma and unpalatable ARVs as barriers to adherence. Staff suggestions included use of adherence aids, and better education and support groups for caregivers. Caregivers also requested support groups, as well as "same day" appointments for caregivers and children, but rejected the idea of home visits. Simple, acceptable and cost-effective strategies exist whereby clinics and their partners could significantly reduce the cumulative virological failure rate in paediatric ARV clinics. These include actively tracing defaulters, improving education, providing support groups, and campaigning for palatable ARV formulations.
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Affiliation(s)
- Susan Purchase
- a HOPE Cape Town Association and Trust , Cape Town , South Africa
| | - Jayne Cunningham
- a HOPE Cape Town Association and Trust , Cape Town , South Africa
| | - Monika Esser
- b Immunology Unit, Division of Medical Microbiology, Department of Pathology , NHLS and Stellenbosch University , Cape Town , South Africa
| | - Donald Skinner
- c Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
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25
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Pitpitan EV, Kalichman SC, Eaton LA, Sikkema KJ, Watt MH, Skinner D, Pieterse D. Men's Behavior Predicts Women's Risks for HIV/AIDS: Multilevel Analysis of Alcohol-Serving Venues in South Africa. Prev Sci 2016; 17:472-82. [PMID: 26768432 DOI: 10.1007/s11121-015-0629-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
South Africa has among the highest rates of HIV infection in the world, with women disproportionately affected. Alcohol-serving venues, where alcohol use and sexual risk often intersect, play an important role in HIV risk. Previous studies indicate alcohol use and gender inequity as drivers of this epidemic, yet these factors have largely been examined using person-level predictors. We sought to advance upon this literature by examining venue-level predictors, namely men's gender attitudes, alcohol, and sex behavior, to predict women's risks for HIV. We recruited a cohort of 554 women from 12 alcohol venues (6 primarily Black African, and 6 primarily Coloured [i.e., mixed race] venues) in Cape Town, who were followed for 1 year across four time points. In each of these venues, men's (N = 2216) attitudes, alcohol use, and sexual behaviors were also assessed. Men's attitudes and behaviors at the venue level were modeled using multilevel modeling to predict women's unprotected sex over time. We stratified analyses by venue race. As predicted, venue-level characteristics were significantly associated with women's unprotected sex. Stratified results varied between Black and Coloured venues. Among Black venues where men reported drinking alcohol more frequently, and among Coloured venues where men reported meeting sex partners more frequently, women reported more unprotected sex. This study adds to the growing literature on venues, context, and HIV risk. The results demonstrate that men's behavior at alcohol drinking venues relate to women's risks for HIV. This novel finding suggests a need for social-structural interventions that target both men and women to reduce women's risks.
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Affiliation(s)
- Eileen V Pitpitan
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, USA. .,Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA. .,Department of Psychology, University of Connecticut, 2006 Hillside Rd, Unit 1248, Storrs, CT, 06269-1020, USA.
| | - Seth C Kalichman
- Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA. .,Department of Psychology, University of Connecticut, 2006 Hillside Rd, Unit 1248, Storrs, CT, 06269-1020, USA.
| | - Lisa A Eaton
- Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
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Skinner D, Claassens M. Why test for tuberculosis? A qualitative study from South Africa. Public Health Action 2016; 6:212-216. [PMID: 28123955 DOI: 10.5588/pha.16.0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/13/2016] [Indexed: 11/10/2022] Open
Abstract
Setting: Early testing and treatment initiation are crucial for controlling the tuberculosis (TB) epidemic, especially in high-burden countries such as South Africa. Objective: To explore reasons why patients opted to test for TB and the context in which they were tested. Design: This qualitative study was nested in a larger study evaluating patients who did not initiate anti-tuberculosis treatment after diagnosis. In-depth interviews were conducted with 41 patients across five provinces of South Africa. Results: While most patients presented for testing because of their symptoms, unfortunately many waited until their symptoms were severe and thus remained infectious for longer. Outreach campaigns and TB screening at primary health care facilities were perceived favourably, although some respondents were unclear as to the nature of the tests being performed and had concerns about the implications. Positive health care worker attitudes towards presumptive TB patients contributed towards prompt testing and treatment initiation. Conclusion: As patients often delayed presenting for testing, strategies to engage early with presumptive TB patients so that testing and treatment can commence without delay should be a priority for TB programmes.
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Affiliation(s)
- D Skinner
- Research on Health and Society, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - M Claassens
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Cape Town, South Africa
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27
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Skinner D, Claassens M. It's complicated: why do tuberculosis patients not initiate or stay adherent to treatment? A qualitative study from South Africa. BMC Infect Dis 2016; 16:712. [PMID: 27887646 PMCID: PMC5124309 DOI: 10.1186/s12879-016-2054-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 11/21/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Individuals who test positive for active tuberculosis (TB) but do not initiate treatment present a challenge to TB programmes because they contribute to ongoing transmission within communities. To better understand why individuals do not initiate treatment, or are adherent after initiating treatment, South African respondents were approached to obtain insights as to which factors enabled and inhibited the treatment process. METHODS This qualitative work was nested in a larger study investigating initial loss to follow-up (LTFU) amongst new smear positive TB patients across five provinces of South Africa. In-depth interviews were done with 41 adherent and initial LTFU respondents. RESULTS Key issues contributing to initial LTFU appeared to be a poor knowledge, or low awareness of TB treatment; stigma around TB including its connection to HIV; immediate problems in the respondents' lives particularly poverty, lack of access to transport and the need to continue working; and problems in the healthcare facilities including under resourced facilities, poor functioning health systems and negative staff attitudes. In contrast the reasons given for being adherent related to the level of illness, support received at home and healthcare facilities, a belief in the health system and positive experiences in the health service including positive attitudes from staff. CONCLUSIONS Key changes need to be made to the healthcare system to enable patients to initiate treatment and remain adherent, but the six month regimen of daily observed treatment presents real practical and personal challenges to patients. Alternative strategies to DOTS at facility level should be investigated to bring services closer to communities to encourage patients to access care, initiate and adhere to treatment.
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Affiliation(s)
- Donald Skinner
- Research on Health and Society, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Mareli Claassens
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, PO Box 241, Cape Town, 8000, South Africa.
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28
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Choi KW, Watt MH, Skinner D, Kalichman SC, Sikkema KJ. "Wine you get every day, but a child you can't replace": The perceived impact of parental drinking on child outcomes in a South African township. J Child Adolesc Ment Health 2016; 27:173-87. [PMID: 26890399 DOI: 10.2989/17280583.2015.1113974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study explored the perceived impact of parental drinking on children in a South African township where alcohol abuse is prevalent and high levels of existing poverty and violence may exacerbate potential consequences on children. METHOD Qualitative in-depth interviews were conducted with 92 male and female participants recruited from alcohol-serving venues in Cape Town, South Africa. RESULTS Grounded theory analyses revealed three major aspects of parental drinking - intoxication, venue attendance and expenditures on alcohol - which participants linked to negative proximal outcomes (e.g., child neglect, abuse and exposure to alcohol culture) and long-term outcomes (e.g., fractured parent-child relationships and problematic youth behaviours). In addition, preliminary accounts from some participants suggested that parents may experience tensions between desires to reduce drinking for child-related reasons and complex factors maintaining their drinking behaviour, including the use of alcohol to cope with stressors and trauma. CONCLUSIONS This study provides novel insights into the consequences and motivations of parental drinking in a high-risk context. Contextual risks (e.g., poverty and violence) that exacerbate the impact of parental drinking on children may be the same factors that continue to shape intergenerational alcohol use in this community. Findings highlight opportunities for further research and interventions to support child protection in South Africa.
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Affiliation(s)
- Karmel W Choi
- a Duke University , Department of Psychology and Neuroscience , Durham , North Carolina , USA.,b Duke University , Duke Global Health Institute , Durham , North Carolina , USA
| | - Melissa H Watt
- b Duke University , Duke Global Health Institute , Durham , North Carolina , USA
| | - Donald Skinner
- c Stellenbosch University , Unit for Research on Health and Society , Tygerberg , South Africa
| | - Seth C Kalichman
- d University of Connecticut , Department of Psychology , Storrs , Connecticut , USA
| | - Kathleen J Sikkema
- a Duke University , Department of Psychology and Neuroscience , Durham , North Carolina , USA.,b Duke University , Duke Global Health Institute , Durham , North Carolina , USA
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Atkins S, Yan W, Meragia E, Mahomed H, Rosales-Klintz S, Skinner D, Zwarenstein M. Student experiences of participating in five collaborative blended learning courses in Africa and Asia: a survey. Glob Health Action 2016; 9:28145. [PMID: 27725077 PMCID: PMC5056983 DOI: 10.3402/gha.v9.28145] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 12/03/2015] [Accepted: 01/08/2016] [Indexed: 02/06/2023] Open
Abstract
Background As blended learning (BL; a combination of face-to-face and e-learning methods) becomes more commonplace, it is important to assess whether students find it useful for their studies. ARCADE HSSR and ARCADE RSDH (African Regional Capacity Development for Health Systems and Services Research; Asian Regional Capacity Development for Research on Social Determinants of Health) were unique capacity-building projects, focusing on developing BL in Africa and Asia on issues related to global health. Objective We aimed to evaluate the student experience of participating in any of five ARCADE BL courses implemented collaboratively at institutions from Africa, Asia, and Europe. Design A post-course student survey with 118 students was conducted. The data were collected using email or through an e-learning platform. Data were analysed with SAS, using bivariate and multiple logistic regression. We focused on the associations between various demographic and experience variables and student-reported overall perceptions of the courses. Results In total, 82 students responded to the survey. In bivariate logistic regression, the course a student took [p=0.0067, odds ratio (OR)=0.192; 95% confidence interval (CI): 0.058–0.633], male gender of student (p=0.0474, OR=0.255; 95% CI: 0.066–0.985), not experiencing technical problems (p<0.001, OR=17.286; 95% CI: 4.629–64.554), and reporting the discussion forum as adequate for student needs (p=0.0036, OR=0.165; 95% CI: 0.049–0.555) were found to be associated with a more positive perception of BL, as measured by student rating of the overall helpfulness of the e-learning component to their studies. In contrast, perceiving the assessment as adequate was associated with a worse perception of overall usefulness. In a multiple regression, the course, experiencing no technical problems, and perceiving the discussion as adequate remained significantly associated with a more positively rated perception of the usefulness of the online component of the blended courses. Discussion The results suggest that lack of technical problems and functioning discussion forums are of importance during BL courses focusing on global health-related topics. Through paying attention to these aspects, global health education could be provided using BL approaches to student satisfaction.
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Affiliation(s)
- Salla Atkins
- Department of Public Health Sciences (Global Health/IHCAR), Karolinska Institutet, Stockholm, Sweden;
| | - Weirong Yan
- Department of Public Health Sciences (Global Health/IHCAR), Karolinska Institutet, Stockholm, Sweden.,Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, China
| | - Elnta Meragia
- Department of Public Health Sciences (Global Health/IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Hassan Mahomed
- Division of Community Health, Department of Interdisciplinary Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Metro District Health Services, Western Cape Government, Cape Town, South Africa
| | - Senia Rosales-Klintz
- Department of Public Health Sciences (Global Health/IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Donald Skinner
- Research on Health and Society, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Merrick Zwarenstein
- Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Watt MH, Eaton LA, Dennis AC, Choi KW, Kalichman SC, Skinner D, Sikkema KJ. Alcohol Use During Pregnancy in a South African Community: Reconciling Knowledge, Norms, and Personal Experience. Matern Child Health J 2016. [PMID: 26197733 DOI: 10.1007/s10995-015-1800-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Due to high rates of fetal alcohol spectrum disorder (FASD) in South Africa, reducing alcohol use during pregnancy is a pressing public health priority. The aim of this study was to qualitatively explore knowledge and attitudes about maternal alcohol consumption among women who reported alcohol use during pregnancy. METHODS The study was conducted in Cape Town, South Africa. Participants were pregnant or within 1 year postpartum and self-reported alcohol use during pregnancy. In-depth interviews explored personal experiences with drinking during pregnancy, community norms and attitudes towards maternal drinking, and knowledge about FASD. Transcripts were analyzed using a content analytic approach, including narrative memos and data display matrices. RESULTS Interviews revealed competing attitudes. Women received anti-drinking messages from several sources, but these sources were not highly valued and the messages often contradicted social norms. Women were largely unfamiliar with FASD, and their knowledge of impacts of fetal alcohol exposure was often inaccurate. Participants' personal experiences influenced their attitudes about the effects of alcohol during pregnancy, which led to internalization of misinformation. The data revealed a moral conflict that confronted women in this setting, leaving women feeling judged, ambivalent, or defensive about their behaviors, and ultimately creating uncertainty about their alcohol use behaviors. CONCLUSIONS Data revealed the need to deliver accurate information about the harms of fetal alcohol exposure through sources perceived as trusted and reliable. Individual-level interventions to help women reconcile competing attitudes and identify motivations for reducing alcohol use during pregnancy would be beneficial.
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Affiliation(s)
- Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
| | - Alexis C Dennis
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Karmel W Choi
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Donald Skinner
- Unit for Research on Health and Society, Stellenbosch University, Cape Town, South Africa
| | - Kathleen J Sikkema
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
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Jardin C, Marais L, Bakhshaie J, Skinner D, Neighbors C, Zvolensky M, Sharp C. Caregiver alcohol use and mental health among children orphaned by HIV/AIDS in South Africa. AIDS Care 2016; 29:399-407. [PMID: 27569763 DOI: 10.1080/09540121.2016.1220477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Research in the developed world suggests that parental alcohol use negatively impacts child mental health. However, little research has examined these relations among children in the developing world and no studies to date have done so in the context of AIDS-orphanhood. Therefore, the present study tested the interactive effect of AIDS-orphan status with caregiver alcohol use on child mental health. The sample included 742 children (51.2% female; Mage = 9.18; age range: 7-11 years; 29.8 AIDS-orphans; 36.8% orphaned by causes other than AIDS; 33.4% non-orphaned) recruited from Mangaung in the Free State Province of South Africa. Child mental health was assessed via child self-report, caregiver, and teacher reports; and caregiver alcohol use via self-report. Path analyses, via structural equation modeling, revealed significant direct effects for AIDS-orphan status on caregiver-reported child mental health; and for caregiver alcohol-use problems on teacher-reported child mental health. However, the interaction effect of AIDS-orphan status with caregiver alcohol use did not reach significance on all three reports of child mental health problems. These results suggest that orphan status and caregiver alcohol use may independently relate to mental health problems in children and that the effects of both should be considered in the context of the mental health needs of children in AIDS-affected countries.
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Affiliation(s)
- Charles Jardin
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Lochner Marais
- b Department of Behavioral Sciences , University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jafar Bakhshaie
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Donald Skinner
- c Department of Interdisciplinary Health Sciences, Research on Health and Society , University of Stellenbosch , Cape Town , South Africa
| | - Clayton Neighbors
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Michael Zvolensky
- a Department of Psychology , University of Houston , Houston , TX , USA.,b Department of Behavioral Sciences , University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Carla Sharp
- a Department of Psychology , University of Houston , Houston , TX , USA.,d Center for Community Development , University of the Free State , Bloemfontein , South Africa
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Toefy Y, Skinner D, Thomsen S. “Please Don’t Send Us Spam!” A Participative, Theory-Based Methodology for Developing an mHealth Intervention. JMIR Mhealth Uhealth 2016; 4:e100. [PMID: 27535589 PMCID: PMC5007380 DOI: 10.2196/mhealth.6041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/17/2016] [Accepted: 07/31/2016] [Indexed: 11/24/2022] Open
Abstract
Background Mobile health solutions have the potential of reducing burdens on health systems and empowering patients with important information. However, there is a lack of theory-based mHealth interventions. Objective The purpose of our study was to develop a participative, theory-based, mobile phone, audio messaging intervention attractive to recently circumcised men at voluntary medical male circumcision (VMMC) clinics in the Cape Town area in South Africa. We aimed to shift some of the tasks related to postoperative counselling on wound management and goal setting on safe sex. We place an emphasis on describing the full method of message generation to allow for replication. Methods We developed an mHealth intervention using a staggered qualitative methodology: (1) focus group discussions with 52 recently circumcised men and their partners to develop initial voice messages they felt were relevant and appropriate, (2) thematic analysis and expert consultation to select the final messages for pilot testing, and (3) cognitive interviews with 12 recent VMMC patients to judge message comprehension and rank the messages. Message content and phasing were guided by the theory of planned behavior and the health action process approach. Results Patients and their partners came up with 245 messages they thought would help men during the wound-healing period. Thematic analysis revealed 42 different themes. Expert review and cognitive interviews with more patients resulted in 42 messages with a clear division in terms of needs and expectations between the initial wound-healing recovery phase (weeks 1–3) and the adjustment phase (weeks 4–6). Discussions with patients also revealed potential barriers to voice messaging, such as lack of technical knowledge of mobile phones and concerns about the invasive nature of the intervention. Patients’ own suggested messages confirmed Ajzen’s theory of planned behavior that if a health promotion intervention can build trust and be relevant to the recipient’s needs in the first contacts, then the same recipients will perceive subsequent motivational messages more favorably. The health action process approach was also a useful tool for guiding the phasing of the messages. Participants were more positive and salutogenic than public health experts. Conclusions The system showed how a process of consultation can work with a set of potential recipients of an mHealth service to ensure that their needs are included. Classic behavioral theories can and should be used to design modern mHealth interventions. We also believe that patients are the best source of messaging, ensuring that messages are culturally relevant and interesting to the recipient.
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Affiliation(s)
- Yoesrie Toefy
- Research on Community and Health, Department of Community Health Sciences, Faculty of Medicine, Stellenbosch University, Cape Town, South Africa.
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Thomsen SC, Skinner D, Toefy Y, Esterhuizen T, McCaul M, Petzold M, Diwan V. Voice-Message-Based mHealth Intervention to Reduce Postoperative Penetrative Sex in Recipients of Voluntary Medical Male Circumcision in the Western Cape, South Africa: Protocol of a Randomized Controlled Trial. JMIR Res Protoc 2016; 5:e155. [PMID: 27460771 PMCID: PMC4978861 DOI: 10.2196/resprot.5958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 12/01/2022] Open
Abstract
Background There is an increased risk of transmission of sexually transmitted infections (STIs), including HIV, in the postoperative period after receiving voluntary medical male circumcision (VMMC). In South Africa, over 4 million men are being targeted with VMMC services but the health system is not able to offer quality counseling. More innovative strategies for communicating with and altering behavior in men and their partners in the postoperative period after VMMC are needed. Objective This paper presents a study protocol to test the effectiveness of an mHealth intervention designed to task-shift behavior change communication from health care personnel to an automated phone message system, encouraging self-care. Methods A single-blind, randomized controlled trial will be used. A total of 1188 participants will be recruited by nurses or clinicians at clinics in the study districts that have a high turnover of VMMC clients. The population will consist of men aged 18 years and older who indicate at the precounseling session that they possess a mobile phone and consent to participating in the study. Consenting participants will be randomized into either the control or intervention arm before undergoing VMMC. The control arm will receive the standard of care (pre- and postcounseling). The intervention arm will received standard of care and will be sent 38 messages over the 6-week recovery period. Patients will be followed up after 42 days. The primary outcome is self-reported sexual intercourse during the recovery period. Secondary outcomes include nonpenetrative sexual activity, STI symptoms, and perceived risk of acquiring HIV. Analysis will be by intention-to-treat. Results Enrollment is completed. Follow-up is ongoing. Loss to follow-up is under 10%. No interim analyses have been conducted. Conclusions The intervention has the potential of reducing risky sexual behavior after VMMC. The platform itself can be used for many other areas of health that require task shifting to patients for better efficiency and access. Trial Registration Pan-African Clinical Trial Registry: PACTR201506001182385
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Affiliation(s)
- Sarah C Thomsen
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.
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Moodley K, Duby Z, Staunton C, Hendricks M, Nair G, Roubaix M, Skinner D. OA1-2 Ethical and social implications of proposed HIV cure research: stakeholder perspectives from South Africa. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)31006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Watt MH, Guidera KE, Hobkirk AL, Skinner D, Meade CS. Intimate partner violence among men and women who use methamphetamine: A mixed-methods study in South Africa. Drug Alcohol Rev 2016; 36:97-106. [PMID: 27246967 DOI: 10.1111/dar.12420] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/25/2016] [Accepted: 03/03/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The prevalence of methamphetamine use has risen dramatically in parts of South Africa. Globally, methamphetamine has been linked to intimate partner violence (IPV) and other forms of aggression. The aim of this mixed-methods study was to examine the experiences of physical IPV and its contextual factors among methamphetamine users in an urban community in Cape Town, South Africa. METHODS Active methamphetamine users were recruited using respondent driven sampling. All participants (n = 360) completed structured surveys, and a subset (n = 30) completed in-depth interviews with discussions of personal IPV experiences. Quantitative data were examined separately by gender, and regression models were used to identify factors that were associated with physical IPV victimisation and perpetration. Qualitative data were analysed to provide contextual understanding. RESULTS In the past 3 months, 47% of women and 31% of men reported being a victim of IPV, and 30% of women and 28% men reported being a perpetrator of IPV. Victimisation and perpetration were highly correlated, and both were significantly associated with histories of other traumas. Although the survey data suggests gender equivalence in IPV, the qualitative data provides a more nuanced context, with female victimisation by male partners being particularly frequent and intense. In narratives, IPV was a product of male aggression while using methamphetamine, norms around sex trading and gender-based attitudes endorsing violence against women. CONCLUSION Addiction to methamphetamine creates heightened risks of IPV, especially among those with previous traumas. The findings emphasise the importance of identifying and addressing IPV among methamphetamine users in South Africa. [Watt MH, Guidera KE, Hobkirk AL, Skinner D, Meade CS. Intimate partner violence among men and women who use methamphetamine: A mixed-methods study in South Africa. Drug Alcohol Rev 2017;36:97-106].
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Affiliation(s)
- Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, USA
| | | | - Andréa L Hobkirk
- Duke Global Health Institute, Duke University, Durham, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, USA
| | - Donald Skinner
- Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Christina S Meade
- Duke Global Health Institute, Duke University, Durham, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, USA
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Watt MH, Kimani SM, Skinner D, Meade CS. "Nothing Is Free": A Qualitative Study of Sex Trading Among Methamphetamine Users in Cape Town, South Africa. Arch Sex Behav 2016; 45:923-933. [PMID: 25567071 PMCID: PMC4496309 DOI: 10.1007/s10508-014-0418-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/22/2014] [Accepted: 10/06/2014] [Indexed: 06/04/2023]
Abstract
South Africa is facing an established epidemic of methamphetamine, known locally as "tik." Globally, methamphetamine has been linked to high rates of sexual risk behaviors, including sex trading. The goal of this study was to qualitatively examine the experiences of sex trading among methamphetamine users in Cape Town, South Africa. Individual in-depth interviews were conducted with 30 active methamphetamine users (17 men and 13 women) recruited from the community. Interviews were conducted in local languages using a semi-structured guide that included questions on sex trading experiences and perceptions of sex trading among methamphetamine users. Interviews were audio-recorded, transcribed, and analyzed using analytic memos and coding with constant comparison techniques. The data revealed that in a setting of high levels of addiction and poverty, sex was an important commodity for acquiring methamphetamine. Women were more likely to use sex to acquire methamphetamine, but men reported opportunistic cases of trading sex for methamphetamine. Four models of sex trading emerged: negotiated exchange, implicit exchange, relationships based on resources, and facilitating sex exchange for others. The expectation of sex trading created a context in which sexual violence against female methamphetamine users was common. Multiple sexual partners and inconsistent condom use in acts of sex trading put methamphetamine users at high risk of HIV. Interventions in this setting should address addiction, which is the primary driver of sex trading among methamphetamine users. Harm reduction interventions may include education about HIV and other sexually transmitted infections, availability of condoms and HIV testing, and sexual violence prevention.
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Affiliation(s)
- Melissa H Watt
- Duke Global Health Institute, Duke University, Duke Box 90519, Durham, NC, 27708, USA.
| | - Stephen M Kimani
- Duke Global Health Institute, Duke University, Duke Box 90519, Durham, NC, 27708, USA
| | - Donald Skinner
- Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Christina S Meade
- Duke Global Health Institute, Duke University, Duke Box 90519, Durham, NC, 27708, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Nachega JB, Skinner D, Jennings L, Magidson JF, Altice FL, Burke JG, Lester RT, Uthman OA, Knowlton AR, Cotton MF, Anderson JR, Theron GB. Acceptability and feasibility of mHealth and community-based directly observed antiretroviral therapy to prevent mother-to-child HIV transmission in South African pregnant women under Option B+: an exploratory study. Patient Prefer Adherence 2016; 10:683-90. [PMID: 27175068 PMCID: PMC4854240 DOI: 10.2147/ppa.s100002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the acceptability and feasibility of mobile health (mHealth)/short message service (SMS) and community-based directly observed antiretroviral therapy (cDOT) as interventions to improve antiretroviral therapy (ART) adherence for preventing mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). DESIGN AND METHODS A mixed-method approach was used. Two qualitative focus group discussions with HIV-infected pregnant women (n=20) examined the acceptability and feasibility of two ART adherence interventions for PMTCT: 1) SMS text messaging and 2) patient-nominated cDOT supporters. Additionally, 109 HIV-infected, pregnant South African women (18-30 years old) receiving PMTCT services under single-tablet antiretroviral therapy regimen during pregnancy and breastfeeding and continuing for life ("Option B+") were interviewed about mobile phone access, SMS use, and potential treatment supporters. SETTING A community primary care clinic in Cape Town, South Africa. PARTICIPANTS HIV-infected pregnant women. MAIN OUTCOMES Acceptability and feasibility of mHealth and cDOT interventions. RESULTS Among the 109 women interviewed, individual mobile phone access and SMS use were high (>90%), and 88.1% of women were interested in receiving SMS ART adherence support messages such as reminders, motivation, and medication updates. Nearly all women (95%) identified at least one person close to them to whom they had disclosed their HIV status and would nominate as a cDOT supporter. Focus group discussions revealed that cDOT supporters and adherence text messages were valued, but some concerns regarding supporter time availability and risk of unintended HIV status disclosure were expressed. CONCLUSION mHealth and/or cDOT supporter as interventions to improve ART adherence are feasible in this setting. However, safe HIV status disclosure to treatment supporters and confidentiality of text messaging content about HIV and ART were deemed crucial.
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Affiliation(s)
- Jean B Nachega
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Department of Medicine, Centre for Infectious Diseases, and ACTG Clinical Trial Unit (CTU)/Family Clinical Research Unit (FAMCRU), Stellenbosch University, Cape Town, South Africa
| | - Donald Skinner
- Research on Health and Society, Department of Interdisciplinary Health Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Larissa Jennings
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica F Magidson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Frederick L Altice
- Division of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Jessica G Burke
- Department of Behavioral and Community Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Richard T Lester
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
- Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark F Cotton
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jean R Anderson
- Department of Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Gerhard B Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Skinner D, Tadros BJ, Bray E, Elsherbiny M, Stafford G. Clinical outcome following primary total hip or knee replacement in nonagenarians. Ann R Coll Surg Engl 2016; 98:258-64. [PMID: 26924477 DOI: 10.1308/rcsann.2016.0095] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction The Elective Orthopaedic Centre in Epsom has an established patient reported outcome measures programme, into which all patients are enrolled. Postoperative complications, Oxford hip/knee scores (OHS/OKS) and EQ-5D™ (EuroQol, Rotterdam, Netherlands) scores are collected up to the second postoperative year. Our population is ageing and the number of joint replacements being performed on the very elderly is rising. The aim of this study was to investigate the outcome of joint replacements in a nonagenarian population. Methods Our dataset was reviewed retrospectively for a cohort of nonagenarians undergoing either a primary total hip replacement (THR) or total knee replacement (TKR) between April 2008 and October 2011. Postoperative complications, mortality rates and functional outcomes were compared with those of a time matched 70-79-year-old cohort. Results Nonagenarians requiring a THR presented with a lower preoperative OHS (p=0.020) but made a greater improvement in the first postoperative year than the younger cohort (p=0.040). The preoperative OKS was lower for nonagenarians than for the control group (p=0.022). At one and two years after TKR, however, there was no significant difference between the age groups. The nonagenarians had a greater risk of requiring a blood transfusion following both THR (p=0.027; 95% confidence interval [CI]: 1.11-5.75) and TKR (p=0.037; 95% CI: 1.08-16.65) while the latter cohort also required a longer stay than their younger counterparts (p=0.001). Mortality rates were higher in the nonagenarian group but these were in keeping with the life expectancy projections identified by the Office for National Statistics. Conclusions Over a two-year period, the functional outcome and satisfaction rates achieved by nonagenarians following a THR or TKR are comparable with 70-79-year-olds.
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Affiliation(s)
- D Skinner
- Elective Orthopaedic Centre , Epsom , UK
| | - B J Tadros
- Elective Orthopaedic Centre , Epsom , UK
| | - E Bray
- Elective Orthopaedic Centre , Epsom , UK
| | | | - G Stafford
- Elective Orthopaedic Centre , Epsom , UK
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Abstract
Neonatal male circumcision is safer, easier and cheaper than adult male circumcision, but is not widely practised in Swaziland. It has been suggested as one of several ways of controlling the spread of HIV. We conducted research aimed at assessing mothers' knowledge, attitudes and perceptions towards circumcision and reasons why mothers have their newly born male children circumcised. A cross-sectional study was conducted at Hlatikulu Government Hospital, a rural hospital in Shiselweni region, Swaziland. The target population was mothers with children younger than 6 months old who presented at the hospital. Of the 392 participants who were interviewed, 43 (11.2%) had circumcised their children. The participants' ages ranged from 15 to 44 with a mean age of 25.3 years. All the respondents had a mean knowledge score of 7.8 out of a maximum possible of 11, a mean attitudes score of 3.6 out of 6 and a mean perception score of 1.8 out of 3. The main reasons for mothers circumcising their children were to keep the penile organ clean (97.7%), to reduce sexually transmitted infections when one is sexually active (97.7%) and to reduce HIV transmission (97.7%). Participants who did not circumcise their children cited mainly that their spouses did not approve (84.5%), that they were anxious about complications after the operation (44.4%) and fear that their newborns would feel pain (54.4%). The mothers in this study had high knowledge, positive attitudes and perceptions towards male neonatal circumcision, but the circumcision levels are still very low. Interventions need to be directed towards providing accurate information and resources that facilitate mothers, and to a greater extend fathers, in making the decision to circumcise their male children and being able to act on that decision.
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Glasman LR, Skinner D, Bogart LM, Kalichman SC, McAuliffe T, Sitzler CA, Toefy Y, Weinhardt LS. Do Assessments of HIV Risk Behaviors Change Behaviors and Prevention Intervention Efficacy? An Experimental Examination of the Influence of Type of Assessment and Risk Perceptions. Ann Behav Med 2016; 49:358-70. [PMID: 25385202 DOI: 10.1007/s12160-014-9659-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Behavioral assessments may change behaviors and responses to behavioral interventions, depending on assessment type and respondents' motivations. PURPOSE We observed effects on sexual behavior and human immunodeficiency virus (HIV) prevention intervention efficacy of interviews assessing recent HIV risk behavior frequency or HIV risk behavior events among respondents with different perceptions of their risk for HIV. METHODS Young South African sexually transmitted infection (STI) clinic clients (N=1,728) participated in a 3 (event-based vs. frequency-based vs. no interview) by 2 (evidence-based vs. standard of care risk-reduction session) RCT. RESULTS The interviews increased reported safer sexual behavior among youth with higher but not lower risk perceptions. The intervention session was less effective when combined with interviews, particularly among lower risk perception youth. Patterns replicated for both interviews. CONCLUSIONS HIV risk behavior assessments may increase resistance to interventions among unmotivated youth and enhance safer sexual behavior among motivated youth. Behavioral assessments may reduce HIV risk among motivated individuals.
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Affiliation(s)
- Laura R Glasman
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA,
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Skinner D, Lipworth B, Devereux G, Thomas V, Ling J, Martin J, Carter V, Price D. P24 Underuse of beta-blockers in patients with heart failure and COPD. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jones R, Martin J, Thomas V, Skinner D, Marshall J, Price D. P130 Effectiveness and safety of initiating treatment with fluticasone/salmeterol via MDI versus DPI in COPD: Abstract P130 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Velloza J, Watt MH, Choi KW, Abler L, Kalichman SC, Skinner D, Pieterse D, Sikkema KJ. HIV/AIDS-related stigma in South African alcohol-serving venues and its potential impact on HIV disclosure, testing and treatment-seeking behaviours. Glob Public Health 2015; 10:1092-106. [PMID: 25630531 PMCID: PMC4519431 DOI: 10.1080/17441692.2014.1001767] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Alcohol-serving venues in South Africa are sites for high-risk behaviours that may lead to HIV transmission. Prevention and treatment interventions are sorely needed in these settings, but HIV-related stigma may limit their effectiveness. This study explored expressions of stigma among alcohol-serving venue patrons in Cape Town and examined the potential impact of stigma on HIV disclosure, testing and treatment-seeking behaviours. A total of 92 in-depth interviews with male and female, black and coloured patrons were conducted. Transcripts were analysed via memo-writing and diagramming techniques. Many participants mentioned knowing other patrons living with HIV/AIDS (PLWH), and this visibility of HIV impacted expressions of HIV-related stigma. Participants discussed four forms of HIV-related stigma in the venues: fearing PLWH, fearing HIV acquisition, blaming others for spreading HIV and isolating PLWH. HIV visibility and expressions of HIV-related stigma, particularly fear of isolation, influenced participants' willingness to disclose their status. HIV-related stigma in the venues also appeared to indirectly influence testing and treatment-seeking behaviour outside the venue. Results suggest that efforts to change norms and reduce expressions of HIV-related stigma in alcohol-serving venues are necessary to successfully deliver tailored HIV prevention interventions and increase uptake of HIV testing and care in this important social setting.
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Affiliation(s)
| | - Melissa H. Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Karmel W. Choi
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Laurie Abler
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Seth C. Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Donald Skinner
- Unit for Research on Health and Society, Stellenbosch University, Tygerberg, South Africa
| | - Desiree Pieterse
- Unit for Research on Health and Society, Stellenbosch University, Tygerberg, South Africa
| | - Kathleen J. Sikkema
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
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Skinner D, Hesseling AC, Francis C, Mandalakas AM. It's hard work, but it's worth it: the task of keeping children adherent to isoniazid preventive therapy. Public Health Action 2015; 3:191-8. [PMID: 26393028 DOI: 10.5588/pha.13.0010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 05/20/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING Isoniazid preventive therapy (IPT) offers children protection against tuberculosis (TB), but it has been difficult to implement, particularly in developing countries. OBJECTIVE To understand what encourages or inhibits children from adhering to IPT. DESIGN In-depth interviews were conducted with two parents of children adherent to IPT and two staff members from three primary health care clinics in high TB prevalence communities. Themes explored were knowledge and attitudes towards IPT, problems in accessing and adhering to treatment, and community responses. RESULTS Parents administering treatment valued it positively, realised their children's risk of TB, and were positive about the clinic. Nurses acknowledged that resistance to treatment remained, with some parents not wanting to acknowledge risk nor willing to make the effort for their children; there was also considerable misinformation about IPT. Clinic nurses acknowledged problems of staff shortages, lengthy waiting times and conflict between staff and community members. Adherence was affected by social problems, stigma about TB and its link to the human immunodeficiency virus, and the extended treatment period. CONCLUSION Parents who maintained adherence to the IPT regimen showed that it was possible even in very difficult circumstances. Further effort is required to improve some of the clinic services, correct misinformation, reduce stigma and provide support to parents.
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Affiliation(s)
- D Skinner
- Research on Health and Society, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - C Francis
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - A M Mandalakas
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Cape Town, South Africa ; Section on Retrovirology and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA ; The TB Initiative, Texas Children's Hospital, Houston, Texas, USA
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Meade CS, Towe SL, Watt MH, Lion RR, Myers B, Skinner D, Kimani S, Pieterse D. Addiction and treatment experiences among active methamphetamine users recruited from a township community in Cape Town, South Africa: A mixed-methods study. Drug Alcohol Depend 2015; 152:79-86. [PMID: 25977205 PMCID: PMC4498803 DOI: 10.1016/j.drugalcdep.2015.04.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/15/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Since 2000, there has been a dramatic increase in methamphetamine use in South Africa, but little is known about the experiences of out-of-treatment users. This mixed-methods study describes the substance use histories, addiction symptoms, and treatment experiences of a community-recruited sample of methamphetamine users in Cape Town. METHODS Using respondent driven sampling, 360 methamphetamine users (44% female) completed structured clinical interviews to assess substance abuse and treatment history and computerized surveys to assess drug-related risks. A sub-sample of 30 participants completed in-depth interviews to qualitatively explore experiences with methamphetamine use and drug treatment. RESULTS Participants had used methamphetamine for an average of 7.06 years (SD=3.64). They reported using methamphetamine on an average of 23.49 of the past 30 days (SD=8.90); 60% used daily. The majority (90%) met ICD-10 criteria for dependence, and many reported severe social, financial, and legal consequences. While only 10% had ever received drug treatment, 90% reported that they wanted treatment. In the qualitative interviews, participants reported multiple barriers to treatment, including beliefs that treatment is ineffective and relapse is inevitable in their social context. They also identified important motivators, including desires to be drug free and improve family functioning. CONCLUSION This study yields valuable information to more effectively respond to emerging methamphetamine epidemics in South Africa and other low- and middle-income countries. Interventions to increase uptake of evidence-based services must actively seek out drug users and build motivation for treatment, and offer continuing care services to prevent relapse. Community education campaigns are also needed.
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Affiliation(s)
- Christina S Meade
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences and Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Sheri L Towe
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences and Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Melissa H Watt
- Duke University, Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Ryan R Lion
- Duke University, Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Box 19070, Tygerberg 7505, South Africa.
| | - Donald Skinner
- Stellenbosch University, Faculty of Medicine and Health Sciences, Box 19063, Tygerberg 7505, South Africa.
| | - Stephen Kimani
- Duke University, Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Desiree Pieterse
- Stellenbosch University, Faculty of Medicine and Health Sciences, Box 19063, Tygerberg 7505, South Africa.
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Shah SH, Movassaghi K, Skinner D, Dalag L, Miranda G, Cai J, Schuckman A, Daneshmand S, Djaladat H. Ureteroenteric Strictures After Open Radical Cystectomy and Urinary Diversion: The University of Southern California Experience. Urology 2015; 86:87-91. [DOI: 10.1016/j.urology.2015.03.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 11/25/2022]
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Abstract
We assessed the frequency and causes of neurological deterioration in 59 patients with spinal cord injury on whom reports were prepared for clinical negligence litigation. In those who deteriorated neurologically we assessed the causes of the change in neurology and whether that neurological deterioration was potentially preventable. In all 27 patients (46%) changed neurologically, 20 patients (74% of those who deteriorated) had no primary neurological deficit. Of those who deteriorated, 13 (48%) became Frankel A. Neurological deterioration occurred in 23 of 38 patients (61%) with unstable fractures and/or dislocations; all 23 patients probably deteriorated either because of failures to immobilise the spine or because of inappropriate removal of spinal immobilisation. Of the 27 patients who altered neurologically, neurological deterioration was, probably, avoidable in 25 (excess movement in 23 patients with unstable injuries, failure to evacuate an epidural haematoma in one patient and over-distraction following manipulation of the cervical spine in one patient). If existing guidelines and standards for the management of actual or potential spinal cord injury had been followed, neurological deterioration would have been prevented in 25 of the 27 patients (93%) who experienced a deterioration in their neurological status.
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Affiliation(s)
- N V Todd
- Northern Medical Services, Sandyford, Newcastle upon Tyne, NE2 1DJ, UK
| | - D Skinner
- Oxford University Hospitals, Oxford, UK
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Watt MH, Sikkema KJ, Abler L, Velloza J, Eaton LA, Kalichman SC, Skinner D, Pieterse D. Experiences of forced sex among female patrons of alcohol-serving venues in a South African township. J Interpers Violence 2015; 30:1533-1552. [PMID: 24981006 PMCID: PMC4280349 DOI: 10.1177/0886260514540807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
South Africa has among the highest rates of forced sex worldwide, and alcohol use has consistently been associated with risk of forced sex in South Africa. However, methodological challenges affect the accuracy of forced sex measurements. This study explored the assessment of forced sex among South African women attending alcohol-serving venues and identified factors associated with reporting recent forced sex. Women (n = 785) were recruited from 12 alcohol-serving venues in a peri-urban township in Cape Town. Brief self-administered surveys included questions about lifetime and recent experiences of forced sex. Surveys included a single question about forced sex and detailed questions about sex by physical force, threats, verbal persuasion, trickery, and spiked drinks. We first compared the single question about forced sex to a composite variable of forced sex as unwanted sex by physical force, threats, or spiked drinks. We then examined potential predictors of recent forced sex (demographics, drinking behavior, relationship to the venue, abuse experiences). The single question about forced sex had low sensitivity (0.38); more than half of the respondents who reported on the detailed questions that they had experienced forced sex by physical force, threats, or spiked drinks reported on the single question item that they had not experienced forced sex. Using our composite variable, 18.6% of women reported lifetime and 10.8% reported recent experiences of forced sex. In our adjusted logistic regression model, recent forced sex using the composite variable was significantly associated with hazardous drinking (OR = 1.92), living farther from the venue (OR = 1.81), recent intimate partner violence (OR = 2.53), and a history of childhood sexual abuse (OR = 4.35). The findings support the need for additional work to refine the assessment of forced sex. Efforts to prevent forced sex should target alcohol-serving venues, where norms and behaviors may present particular risks for women who frequent these settings.
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Skinner D, Sharp C, Marais L, Serekoane M, Lenka M. Assessing the value of and contextual and cultural acceptability of the Strength and Difficulties Questionnaire (SDQ) in evaluating mental health problems in HIV/AIDS affected children. Int J Ment Health 2015; 43:76-89. [PMID: 27087701 DOI: 10.1080/00207411.2015.1009314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Strengths and Difficulties Questionnaire (SDQ) is a robust, powerful and internationally recognised diagnostic screening tool for emotional and behaviour problems among children, with the particular advantage that it can be used by non-health professionals. This makes it useful in a South African context characterized by shortages of professional mental health carers. However the cultural and contextual acceptability and potential uses of the SDQ have not yet been examined in the South African context. METHODS The aim of the current study was to evaluate the acceptability of the SDQ in a Sesotho speaking area of South Africa. As part of a larger study to standardise the SDQ for use among Sotho speakers, teachers were asked to use the tool to assess learners in their class. Ten teachers were then asked to write a report on their experience of the SDQ and how useful and applicable they found it for their school setting. These findings were discussed at two later meetings with larger groupings of teachers. Reports were analysed using a modified contextualised interpretative content analysis method. RESULTS Teachers found the SDQ very useful in the classroom and easy to administer and understand. They found it contextually relevant and particularly useful in gaining an understanding of the learners and the challenges that learners were facing. It further allowed them to differentiate between scholastic and emotional problems, assisting them in developing relationships with the pupils and facilitating accurate referrals. There were very few concerns raised, with the major problem being that it was difficult to assess items concerning contexts outside of the school setting. The teachers expressed interest in obtaining further training in the interpretation of the SDQ and a greater understanding of diagnostic labels so as to assist their learners. CONCLUSION The SDQ was found to be acceptable and useful in the context of this very disadvantaged community. The teachers felt it assisted them in their role as teachers by providing a greater understanding of emotional and behaviour problems among learners. However, lack of places for referral and their own lack of appropriate skills and time did generate frustration.
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Affiliation(s)
- Donald Skinner
- Research on Health and Society, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Carla Sharp
- Department of Psychology, University of Houston
| | - Lochner Marais
- Centre for Development Support, University of the Free State, South Africa
| | | | - Molefi Lenka
- Centre for Development Support, University of the Free State, South Africa
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Skinner D, Mfecane S, Gumede T, Henda N, Davids A. Barriers to accessing PMTCT services in a rural area of South Africa. Afr J AIDS Res 2015; 4:115-23. [PMID: 25870888 DOI: 10.2989/16085900509490350] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite good intentions and commitment from providers, prevention-of-mother-to-child-transmission of HIV (PMTCT) services can be difficult for pregnant women to access, despite the provision of free health services for women and children. We examined the introduction of PMTCT services in a very poor rural area of the Eastern Cape, South Africa, to assess the context's impact on the provision of this service. Our approach involved 13 individual in-depth interviews and 26 focus group discussions, spread over six clinics in a single district, supplemented by situational observations. Our goal was to suggest how access to PMTCT services at the clinics may be improved. Poor roads, an underdeveloped transport system and poor telecommunications typify the pervasive poverty in the study area. Families have few resources for travel and most live a long distance from a clinic. Accessing emergency transport is especially difficult and expensive. Poor infrastructure also means that many families do not have access to clean water, which complicates the use of infant formula. PMTCT services had been recently added to several clinics that provide general services to the local population, but that were already understaffed and over-pressured. Since the PMTCT services were new, some elements of the intervention and staff training were delayed, thus inhibiting full implementation. New staff had not been added to ease accumulated pressures. Thus, socio-economic context can present a formidable barrier to the provision of PMTCT services. Improvement in services to rural areas will require creative thinking, perhaps including the use of mobile services and the development of community structures, such as contributions to community health education by traditional birth attendants and local volunteer groups.
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