Research Articles (Family Medicine)

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A realist-informed evaluation of the implementation of complex HIV treatment support strategies for female sex workers living with HIV
(Elsevier, 2025-09) Comins, Carly A.; Mcingana, Mfezi; Genberg, Becky; Mulumba, Ntambue; Geng, Elvin; Mishra, Sharmistha; Phetlhu, Deliwe R.; Lujintanon, Sita; Shipp, Lily; Steingo, Joel; Hausler, Harry; Baral, Stefan; Schwartz, Sheree
PURPOSE : In South Africa, female sex workers (FSW) living with HIV have suboptimal treatment outcomes. The Siyaphambili trial tested two strategies to promote viral suppression. This paper identifies why and under what conditions the strategies were appropriate, feasible, implemented with fidelity, and ultimately effective for FSW living with HIV. METHODS : Guided by the Consolidated Framework for Implementation Research, we conducted in-depth interviews with 36 Siyaphambili participants using maximum variation sampling and purposively selected 12 key informant implementors. We generated ‘Context + Mechanism = Outcome’ configurations using deductive coding and retroductive inference. RESULTS : Overall, strategy appropriateness for FSW reflected how “the needs of innovation recipients” enhanced/challenged the “relative advantage” of the strategies. Feasibility of implementation resulted from the interaction of the “work infrastructure”, “available resources”, and access to “knowledge and resources,” which activated/dampened the “design” of the strategies. Fidelity of implementation relied on how “partnerships”, “relational connections” and “communication” influenced strategy “complexity” and “adaptability.” Strategy effectiveness depended on the influence of FSW “capability” on their “motivation and opportunity.” CONCLUSIONS : Understanding the conditions in which these strategies did or did not work aids in understanding the why this pragmatic trial failed to achieve anticipated results and informs potential success that can be taken forward to better optimize treatment outcomes for FSW.
Longitudinal trajectories of engagement with HIV treatment support strategies among female sex workers living with HIV in South Africa
(Lippincott, Williams & Wilkins, 2025) Comins, Carly A.; Genberg, Becky L.; McIngana, Mfezi; Bandeen-Roche, Karen Bandeen; Phetlhu, René Deliwe; Steingo, Joel; Mishra, Sharmistha; Wang, Linwei; Baral, Stefan David; Hausler, Harry; Schwartz, Sheree
BACKGROUND : Tailored implementation strategies to promote the uptake and scale-up of antiretroviral therapy (ART) among female sex workers (FSW) in South Africa are needed, as <50% of FSW living with HIV are on ART and <40% are virally suppressed. SETTING : We conducted a randomized trial testing two HIV treatment support strategies (decentralized treatment provision (DTP); individualized case management (ICM)) among 777 FSW living with HIV and not virally suppressed (≥50 copies/mL) in Durban, South Africa, June 2018 - January 2022. METHODS : We defined strategy engagement in a six-month interval if the monthly strategy session was delivered and the FSW participated. Group-based trajectory modeling with logit response function was used to identify engagement trajectories and describe correlates of trajectories. We used Poisson regression analysis with robust variance estimation to assess the association between assigned trajectory group and 18-month retention and viral suppression (<50 copies/mL). RESULTS : We identified four trajectories: no engagement (12%), late engagement (10%), engagement corresponding with study visits (53%), and consistent engagement (25%). FSW who were older, unmarried, receiving ART at enrollment, and DTP assignment were more likely to be classified in the consistently engaged trajectory compared to the no engagement trajectory. The prevalence of 18-month retention and viral suppression was higher among FSW assigned to the consistent engagement trajectory compared to the no engagement trajectory (prevalence ratio [PR]= 3.2, 95%CI 1.6-6.3). CONCLUSION : Person-centered HIV services that address unmet treatment needs could improve health, viral suppression, and subsequently reduce population-level HIV transmission.
Factors linked to virological failure in people on a dolutegravir-based regimen in Mamelodi
(AOSIS, 2024-10-04) Mmatsoku, Moloko S.; Ngcobo, Sanele; sanele.ngcobo@up.ac.za
BACKGROUND : Since 2019, the World Health Organization has recommended dolutegravir-containing regimens for HIV in low- and middle-income countries because of its high genetic barriers to resistance, lower drug interactions, fewer side effects, higher viral load (VL) suppression rates and cost-effectiveness compared to efavirenz. OBJECTIVES : This study investigates factors associated with unsuppressed VLs in people living with HIV on tenofovir-lamivudine and dolutegravir (TLD) in South Africa (SA). METHOD : A cross-sectional study was conducted between October 2023 and February 2024 at Mamelodi Regional Hospital’s Ntshembo Clinic. Participants were people living with HIV aged 18 years and older, more than 6 months on TLD, with either suppressed (≤ 50 copies/mL) or unsuppressed (> 50 copies/mL) VLs. RESULTS : Significant associations were found between unsuppressed VL and factors such as sex, marital status, occupation and education level. Male participants were less likely to achieve VL suppression than female participants (odds ratio: 0.45, p = 0.0007). Poor antiretroviral therapy adherence was linked to higher unsuppressed VL (p < 0.05). Newly initiated patients had significantly lower suppression rates (p < 0.05). The use of traditional or herbal and religious products was also linked to unsuppressed VL (p < 0.05). CONCLUSION : The study highlights the importance of addressing adherence factors to improve VL suppression rates among people living with HIV on TLD. CONTRIBUTION : Tailored interventions targeting adherence, especially among newly initiated patients, and addressing the use of traditional or herbal and religious products are warranted to enhance treatment outcomes.
Perspectives and attitudes of South African medical professionals towards active euthanasia
(AOSIS, 2024-09-27) Steyn, Willem-Johan; Bondo, M.C.
BACKGROUND : Active euthanasia is a controversial subject both globally and in South Africa. Recent legal cases have kept this topic in the public discourse. Yet, there remains a dearth of quality local research on this issue. This study aimed to explore the views of medical professionals towards active euthanasia to gain a better understanding of this phenomenon in South Africa. METHODS : A descriptive-interpretive qualitative research design, using semi-structured in-depth interviews of purposively sampled South African medical professionals, was used to collect the data. The data were analysed using an inductive thematic analysis framework, which included familiarisation, coding, summarising, theme development and thematic review, revision and interpretation. RESULTS : Four general themes, with sub-themes, were identified and inductively analysed: modern medical practice and euthanasia; the problem of suffering in end-of-life care; euthanasia is complex; palliative care in South Africa is poor. Some themes and sub-themes were common to all participants while other themes underscored more diverse views - often because of religious factors. CONCLUSION : Active euthanasia is a complex and nuanced issue. An understanding of the perceptions and attitudes of medical professionals will contribute to the overall discussion of this phenomenon in ethical, legal, social and political spheres in South Africa. This is of utmost importance given the relevance of this topic in South Africa in the 21st century. CONTRIBUTION : This study highlights the complex nature of active euthanasia in South Africa among medical professionals while providing a greater understanding of its nuances and the strengths and weaknesses of arguments for or against it.
Knowledge and awareness of cervical cancer and human papillomavirus vaccination among female university students
(AOSIS, 2024-07-16) Ndubuisi, Charles C.; Maphasha, Olga; Okeke, Sunday O.
BACKGROUND : Prevention strategies for reducing cervical cancer incidence rely on informed populations, particularly those most at risk. This study assesses the knowledge and awareness of female university students towards cervical cancer, human papillomavirus (HPV) and its vaccination. METHODS : A validated self-administered questionnaire was used in a descriptive cross-sectional study among female university students. The data were analysed with Statistical Package for Social Sciences version 26, and p < 0.05 was considered significant. RESULTS : The total participants were 190 with a mean age of 22.6 ± 4.35 years. The majority (90%) were aware of cervical cancer, and 78.9% agreed it is a terminal illness, but fewer participants knew it was associated with infection (63.7%), and that it had effective risk-reducing methods (70.5%). Only 32.6% were aware of the Pap smear test, less than half (43.2%) were aware of the cervical cancer vaccine and only 43.7% knew it was available locally. Although fewer (39.5%) considered themselves susceptible to cervical cancer, many (62.1%) would like a Pap smear test. Overall, 88.9% of the participants possessed adequate knowledge of cervical cancer, 67.9% of the HPV vaccine and only 33.7% of HPV. Ethnicity (p = 0.03), year of study (p = 0.001) and institution (p = 0.002) were all significantly associated with knowledge levels, vaccine awareness and Pap smear test awareness. CONCLUSION : Participants showed low HPV knowledge and varying awareness levels regarding cervical cancer, HPV and HPV vaccine. CONTRIBUTION : This study provides insights into female university students’ knowledge and awareness gaps, highlighting the need for targeted interventions.
Medical interns' training in family medicine at a district hospital and primary health care clinics in Middelburg, Mpumalanga
(AOSIS, 2024-05-04) Nkombua, Lushiku; Rahimi, Ami; lushiku.nkombua@up.ac.za
Training of medical interns at the Middelburg district hospital has been introduced as part of the mandatory 6 months’ rotation in Family Medicine department since 2021. This report provides an overview of what has been attained in 2021 and 2022. It covers various aspects of the activities medical interns have been exposed to in the Middelburg hospital and the surrounding primary health care clinics. CONTRIBUTION : Sharing experiences of family medicine training for medical interns in district hospitals is essential because the 6 months’ rotation is new for most family physician trainers, especially those in small hospitals and primary health care clinics. Taking into account the paucity of evidence on the topic, the report brings current information that supports that training medical interns in district hospitals and primary health care clinics prepares them to be comfortable and competent clinicians for the generalist work during the community service year ahead.
Brain drain in South Africa is affecting health care
(AOSIS, 2024-01) Govender, Indiran
The effective functioning of any health sector requires the availability of skilled and competent medical professionals, and South Africa is experiencing a shortage of medical professionals exacerbated by the phenomenon of ‘brain drain’, namely the depletion or loss of intellectual and technical personnel who migrate to other areas. The United Nations describes it as a one-way movement of highly skilled people that only benefits the host. Today, brain drain is a major problem facing less developed countries. Brain drain is reported to have direct negative impacts on the population’s health status in the donor country, with associated consequences for the productivity and welfare of the population. Many African countries face huge losses of human skills, and this, in turn, has affected their development. From health professionals to teachers, academics and engineers, the continent has lost numerous skilled personnel who ought to be contributing to its socio-economic development.
Immunogenicity and safety following a homologous booster dose of a SARS-CoV-2 recombinant spike protein vaccine with Matrix-MTM adjuvant (NVX-CoV2373) versus a primary series in people living with and without HIV-1 infection in South Africa : a randomized crossover phase 2a/2b trial
(Taylor and Francis, 2024-12) Shinde, Vivek; Koen, Anthonet Lombard; Hoosain, Zaheer; Archary, Moherndran; Bhorat, Qasim; Fairlie, Lee; Lalloo, Umesh; Masilela, Mduduzi S.L.; Moodley, Dhayendre; Hanley, Sherika; Fouche, Leon Frederik; Louw, Cheryl; Tameris, Michele; Singh, Nishanta; Goga, Ameena; Dheda, Keertan; Grobbelaar, Coert; Joseph, Natasha; Lombaard , Johan J.; Mngqibisa, Rosie; Bhorat, As’ad Ebrahim; Benade, Gabriella; Lalloo, Natasha; Pitsi, Anna; Vollgraaff, Pieter-Louis; Luabeya, Angelique; Esmail, Aliasgar; Petrick, Friedrich G.; Jose, Aylin Oommen; Foulkes, Sharne; Ahmed, Khatija; Thombrayil, Asha; Kalonji, Dishiki; Cloney-Clark, Shane; Zhu, Mingzhu; Bennett, Chijioke; Albert, Gary; Marcheschi, Alex; Plested, Joyce S.; Neal, Susan; Chau, Gordon; Cho, Iksung; Fries, Louis; Glenna, Greg M.; Madhi, Shabir A.
COVID-19 remains a global public health issue and an improved understanding of vaccine performance in immunocompromised individuals, including people living with HIV (PLWH), is needed. Initial data from the present study's pre-crossover/booster phase were previously reported. This phase 2a/b clinical trial in South Africa (2019nCoV-501/NCT04533399) revisits 1:1 randomly assigned HIV-negative adults (18-84 years) and medically stable PLWH (18-64 years) who previously received two NVX-CoV2373 doses (5 μg recombinant Spike protein with 50 μg Matrix-M™ adjuvant) or placebo. During the 6-month blinded crossover/booster phase, NVX-CoV2373 recipients could receive a single NVX-CoV2373 booster dose and placebo recipients a 2-dose NVX-CoV2373 primary series. NVX-CoV2373 safety and immunogenicity were assessed according to prior SARS-CoV-2 infection and HIV status. Post-crossover, 1900/3793 NVX-CoV2373 recipients were assigned another dose, and 1893/3793 placebo recipients were assigned NVX-CoV2373 primary series. Approximately 56% of the participants were SARS-CoV-2-seropositive ("seropositive") at crossover (6% PLWH). In seropositive participants (HIV-negative and PLWH), booster-dose anti-spike IgG, MN50 and hACE2 inhibition responses increased to similar levels, exceeding those in seronegative participants. In primary-series and booster cohorts, seronegative PLWH showed higher neutralizing responses (4.9- to 5.5-fold, respectively) versus peak pre-crossover primary-series responses. The safety profile was similar among the pre-crossover/booster phase groups; solicited and unsolicited adverse events were infrequent in all groups. A single NVX-CoV2373 booster dose substantially increased antibodies. All baseline seropositive participants showed higher immune responses than seronegative participants. These findings support use of NVX-CoV2373, including in immunocompromised individuals.
Response to 'Response to doctors for life on assisted suicide'
(South African Medical Association, 2024-08) Van Eeden, Albu; Nemutandani, Simon; Meiring, Michelle; Mabuza, Langalibalele Honey; Steinberg, Hannes (W.J.); Hardcastle, Timothy; Bac, Martin; Larsen, Jonathan V .; Michael, Keith; Louw, Murray; Sieling, Willi
No abstract available.
Assisted suicide : ethical considerations and the South African debate
(South African Medical Association, 2024-06) Van Eeden, Albu; Nemutandani, Simon; Meiring, Michelle; Mabuza, Langalibalele Honey; Steinberg, Hannes (W.J.); Hardcastle, Timothy; Bac, Martin; Larsen, Jonathan V.; Michael, Keith; Louw, Murray
No abstract available.
An investigation of factors associated with antenatal care attendance in Gauteng in 2015
(South African Medical Association, 2024-06) Mostert, J.; Webb, Elizabeth M.; Girdler-Brown, B.V. (Brendan); Ngcobo, Sanele
BACKGROUND : Many studies have shown that South African women tend to initiate antenatal care late in their pregnancies. This presents challenges in the provision of quality healthcare to both mother and child. There are several studies on the social and cultural reasons for late booking. However, understanding the factors in a woman's choice to initiate antenatal care is important in informing healthcare strategies and policies. METHODS : This study was an analytical cross-sectional study of household and general health factors associated with attendance of antenatal care by pregnant women in Tshwane in 2015. It was a secondary data analysis from complete data sampling households registered on AitaHealth™. Univariate and multivariate logistic regression was used to assess which factors are associated with antenatal care attendance. RESULTS : The age of the head of the household was a significant factor in the attendance of antenatal care. The odds of attending antenatal care were 3.3, 2.1 and 1.8 times higher in households where the head of the household was 30 - 39 years of age, 20 - 29 or 40-49 years of age, respectively, than when between 10-19 years of age. Factors that increased the odds of attending antenatal care were living in households that had electricity and piped water, and running a business from home. Residing in a permanent dwelling and being food secure increased the odds of antenatal care attendance. CONCLUSION : The identified health and household factors should inform policies and programmes geared towards improving services around antenatal care provision.
High burden of abnormal cervical smears in South African primary health care : health programmes implications
(Oxford University Press, 2025-02) Omole, Olufemi B.; Francis, Joel M.; Musonda, John M.; Sodo, Pumla P.; Reji, Elizabeth; Phukuta, Nyundu S.J.; Mabuza, Honey L.M.; Musonda, Joyce Sikwese; Akii, Jimmy; Ndimande, John V.; Ayo-Yusuf, Olalekan Abdulwahab
Cervical cancer is the second most common malignancy among South African women and the load of abnormal cervical smears has clinical, programmatic and policy implications. This cross-sectional study of women who presented for cervical cancer screening aimed to determine the prevalence of abnormal cervical smears and associated factors in primary health care (PHC) facilities in Gauteng—the most densely populated province in South Africa. A questionnaire collected data on socio-demography, tobacco use, sexual behaviours, HIV status, past treatment for sexually transmitted infections (STI) and cervical cancer screening in the past 10 years. Cytology reports were extracted from the laboratory reports. Of 749 participants, most were black (89.7%), aged 30–49 years (62.2%), single (57.5%) and attained high school education (76.8%). About 43.9% were HIV positive with almost all (97.2%) on antiretroviral therapy. Cytology results were available for 612 (81.9%) participants. Of these, 25.8% (159) were abnormal: 13.2% low-grade squamous intraepithelial lesion; 5.7% atypical squamous cells of undetermined significance and 4.9% high-grade squamous intraepithelial lesion. In bivariate and multivariable analysis, abnormal cervical cytology was not associated with any sociodemographic characteristics, HIV status, tobacco use status, sexual behaviours or past treatment for STI. In conclusion, the prevalence of abnormal cervical smears is high across all demographic groups and irrespective of HIV status and highlights the need to increase screening uptake, including advocacy for self-sampling. It also calls for capacity building to allow for the devolution of some downstream clinical care from specialist to district hospitals and large PHC facilities.
Experiences of women who inject Nyaope residing in the City of Tshwane Municipality, Gauteng
(AOSIS, 2025-05) Lefoka, Moganki H.; Netangaheni, Robert T.
BACKGROUND : Substance use disorder (SUD) is a serious public health concern in South Africa and throughout the world. Substance use disorder manifests itself as repeated use of a substance causes health problems and social dysfunction, such as health issues, impairment and failure to meet obligations. People who inject drugs (PWIDs) are a particularly vulnerable population with high rates of illness and early deaths. The experiences of women who inject Nyaope (WWIN) are not well understood because they are not often the subject of studies. Therefore, it is important to understand the experience of WWIN in order to understand their needs. AIM : This study explored the experiences of WWIN who reside in the City of Tshwane Municipality, Gauteng. SETTING : The study was conducted in the Community-Oriented Substance Use Programme. METHODS : A qualitative research method using exploratory and descriptive designs was employed. Twenty-four women, ages from 19 years - 35 years, with a history of injecting Nyaope were interviewed using a semi-structured interview guide. Data were analysed thematically. RESULTS : Women who inject Nyaope engage in high-risk behaviours such as sex work, transactional sex, inconsistent condom use and sharing of needles. They further experience stigma in different social settings, like family, community, health settings and with the police, and they also self-stigmatise. They experience a variety of unmet needs. CONCLUSION : Women who inject Nyaope engage in high-risk behaviour and experience stigma across social settings, including self-stigma, and because of their lifestyle, they have a variety of unmet needs. CONTRIBUTION : There is a scarcity of literature on WWIN in a South African context. The findings add to the existing literature on WWIN.
Fertility awareness, perceived factors and approaches to improve contraceptive uptake among sexually active adolescent girls in Phalombe, Malawi
(BioMed Central, 2024-11-12) Hajison, Precious L.; Mpachika‑Mfipa, Felistas; Pitso, Lerato; Tshotetsi, Lumbani; Chimatiro, Chancy Skenard
BACKGROUND : Healthcare practitioners and policymakers in Sub-Saharan Africa face a significant health challenge due to the insufficient fertility awareness and other perceived health outcomes in contraceptive use among adolescent girls. This has resulted in a rise in unplanned pregnancies and other adverse fertility-related health consequences for adolescent girls in Malawi. Consequently, this research examines fertility awareness, perceived factors, and strategies in contraceptive adoption among adolescent girls in Malawi’s Phalombe district. METHODS : The study utilized a mixed-methods approach, with the quantitative component employing structured questionnaires administered in person to collect data from school-going adolescent girls in three traditional authorities in Phalombe district, Malawi. The research employed multivariate logistic regression analysis, and its findings were corroborated with qualitative data obtained through focus group discussions involving adolescent girls in the same environment. RESULTS : The majority of adolescent females were unaware that their fertile period occurs in the middle of their menstrual cycle, indicating a lack of knowledge regarding their reproductive health. The study examined data from 102 sexually active adolescent females in the quantitative component and 72 adolescent girls in the qualitative component. For the quantitative strand, participants' ages ranged from 13 to 19 years, with a mean age of 16.5 and a standard deviation of 1.5. In the qualitative portion, the study conducted interviews with adolescent females aged between 10 and 19 years, with a median age of 15 years. Services that were not tailored to youth needs served as barriers to contraceptive use. Factors that facilitated contraceptive use included a preference for receiving contraceptives from peers, which was associated with a higher probability of usage (AOR: 4.80, 95% CI 1.31–17.32). Moreover, adolescent females who were identified as Catholic (AOR: 14.01, 95% CI 2.50–78.47) or belonged to other Christian denominations (AOR: 5.85, 95% CI 1.20–28.25) exhibited a greater likelihood of using contraceptives compared to their Muslim counterparts. The focus group discussions suggested making contraceptives available in educational institutions, analogous to the distribution of iron supplements. CONCLUSION : Adolescent girls in the Phalombe district seemingly have low awareness and knowledge of their fertility, which may lead to unintended pregnancies. Adolescent girls are unable to access modern contraceptives, and there is a need for youth-friendly structures when delivering contraceptive services. Additionally, participants indicated that community midwives and health surveillance assistants should provide contraceptives within the communities to reduce distance. PLAIN LANGUAGE SUMMARY : This study assessed fertility awareness and perceived factors and approaches to improve contraceptive uptake among sexually active adolescents in Phalombe, Malawi. This mixed-methods study was conducted among adolescent girls in three traditional authorities in the Phalombe District. Most adolescent girls demonstrated limited knowledge of female fertility. Inadequate comprehension of female reproductive physiology is associated with decreased contraceptive utilization and increased risks of unplanned pregnancies, and other adverse reproductive health outcomes. Furthermore, girls with Catholic and other Christian faiths are more likely to use contraceptives than Muslim girls. Most adolescent girls suggested that contraceptives should be delivered via peers, community midwives, and health surveillance assistants to improve the use of contraceptives among adolescents.
ART coverage and viral suppression among female sex workers living with HIV in eThekwini, South Africa : baseline findings from the Siyaphambili study
(Public Library of Science, 2024-05-22) Comins, Carly A.; Baral, Stefan; Mcingana, Mfezi; Shipp, Lily; Phetlhu, Deliwe Rene; Young, Katherine; Guddera, Vijayanand; Hausler, Harry; Schwartz, Sheree
In South Africa >60% of female sex workers (FSW) are living with HIV, the majority of whom are not virally suppressed. Identifying multi-level determinants of viral suppression is central to developing implementation strategies to promote retention in HIV care and viral suppression among FSW with unmet treatment needs. Adult cisgender FSW living with HIV for ≥6 months, conducting sex work as their primary source of income, and residing in Durban (South Africa) were enrolled into the Siyaphambili Study, a sequential multiple assignment randomized trial. Baseline viral load and CD4 were assessed, and an interviewer-administered survey was conducted, capturing socio-demographic, reproductive and sexual history and behaviors, vulnerabilities, substance use, mental health, and stigma. We assessed baseline determinants of viral suppression (<50 copies/mL) using bivariate and multivariable robust poisson regression, considering associations across the individual, network, environmental and macrostructural levels. From June 2018 –March 2020, 1,644 women were screened, with 1,391 eligible FSW living with HIV enrolled. The analyses were conducted among the 1,373 participants with baseline data. Overall, 65% (889/1,373) of participants were reported to be on antiretroviral therapy and 38% (520/1,373) were virally suppressed. In the multivariable model, FSW who experienced a lack of housing in the prior six months were less likely to be virally suppressed (aPR: 0.72, 95%CI 0.56–0.91), while older FSW (aPR: 1.46 95%CI: 1.16–1.83 for 30–39 years old vs. 18–29 years old; aPR: 2.15 95%CI: 1.64–2.80 for 40+ years vs. 18–29 years old) and FSW reporting hormonal or long-acting contraception use were more likely to be virally suppressed (aPR: 1.19 95% CI: 1.00–1.43). We found vulnerability to be high among FSW living with HIV in South Africa and identified individual and structural determinants associated with viral suppression. Taken together these results suggest optimizing HIV treatment outcomes necessitates supporting younger sex workers and addressing housing instability.
Assessing clinical associate students’ views on learning opportunities and involvement during primary health care placements : a mixed methods study in Tshwane
(BioMed Central, 2025-03) Ngcobo, Sanele; Louw, Murray; Bayeni, Luvuyo; Madela-Mntla, Edith
BACKGROUND : The training model for Clinical Associates (Clin-As), initially centered on district hospitals, has increasingly involved primary healthcare (PHC) facilities over the past few years. This study explore and compare the perceptions and experiences of Clin-A students regarding learning opportunities and involvement during hospital and clinic rotations. METHODOLOGY : This cross-sectional mixed-methods study involved two primary data collection techniques: the administration of the validated medical education instructional questionnaire (MedIQ) questionnaire and the facilitation of focus group discussions. RESULTS : A total of 74 Clin-A students participated in the quantitative study, including 20 s-year students from 2022, 35 s-year students from 2023, and 19 third-year students from 2023. The only statistically significant difference was noted in follow-up care, where student involvement was significantly higher in clinics (M = 3.39) compared to hospitals (M = 2.96), with a t-value of 2.933 (p = 0.002). For learning opportunities, the highest mean difference was observed in ‘participation in patient education’, where clinics (M = 4.38) had a higher mean than hospitals (M = 3.96), but without statistically significance (t = 1.715, p = 0.089). Students perceived better learning diversity and proficiency development in clinics (M: 3.91, SD: 1.31; M: 4.18, SD: 1.203) compared to hospitals (M: 4.00, SD: 1.489; M: 3.97, SD: 1.385). Clinics generally outscored hospitals, especially in involvement in patient education, chronic illness, and procedures. Ten students attended two focus group discussion: one with 2023 third-years (n = 5) and one with 2023 s-years (n = 5). Students valued clinics for skill development and patient journey exposure but faced challenges such as feeling like employees, disrupted learning from frequent rotations, patient overcrowding, and poor communication between the program and healthcare staff. CONCLUSION : This study underscores the importance of primary healthcare settings in Clin-A training, demonstrating that clinics provide learning opportunities and involvement in patient care comparable to hospitals. To address challenges such as high workload areas where students feel like employees, insufficient teaching, lack of staff awareness, limited learning in low-volume clinics, and disrupted rotations requires, structured rotations, enhanced preceptor training, and improved communication between programs and clinical sites are essential.
Characteristics of women on opioid substitution therapy in primary healthcare in Tshwane (South Africa) : a retrospective observational study
(Royal College of General Practitioners, 2025-04) Goeieman, Daniela S.; Mash, Robert; Gloeck, Natasha R.; Scheibe, Andrew
BACKGROUND : Women who use drugs face specific challenges compared with men such as higher rates of HIV infection, unsafe injecting practices, and intimate partner violence (IPV). However, this population’s access to drug dependence treatment and gender-sensitive interventions remains limited, leading to unmet needs and increased vulnerability. AIM : To investigate the characteristics of and associations with retention in care among women on opioid substitution therapy (OST) in a community-based primary care setting. DESIGN & SETTING : A descriptive observational study within the Community Orientated Substance Use Programme in Tshwane, South Africa. METHOD : Data from 199 women (aged >18 years) on OST was extracted from an electronic database and paper-based files. Data were analysed descriptively, and inferential analysis looked for association of variables with retention on OST for ≥6 months. RESULTS : The majority of participants were unemployed, with 44.3% aged 20–29 years. During the initiation and course of OST, 39.2% of women had an intimate partner of which 37.2% reported IPV, and 19.2% were pregnant. Retention on OST was significantly associated with increasing age at initiation (P = 0.047), knowledge of HIV status (P = 0.029), an increase in the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) score (P = 0.023), and methadone dose (P<0.001). Factors such as race, employment status, health-system level, pregnancy, intimate partner using substances, IPV, route of administering opioids, and having tuberculosis and/or hepatitis C exposure did not show a significant relationship with retention on OST (P>0.05). CONCUSION : This study reveals specific vulnerabilities in women receiving OST, emphasising the need for the integration of interventions to address reproductive health, violence mitigation, infectious disease, and polydrug use into care.
PrEP discontinuation, cycling, and risk : understanding the dynamic nature of PrEP use among female sex workers in South Africa
(Public Library of Science, 2024-09-26) Shipp, Lillian M.; Ryan, Sofia; Comins, Carly A.; Mcingana, Mfezi; Mulumba, Ntambue; Guddera, Vijayanand; Phetlhu, Deliwe Rene; Hausler, Harry; Baral, Stefan D.; Schwartz, Sheree R.
PrEP cycling among women is thought to be safe when there are distinct “seasons of risk.” However, cyclical PrEP use over short periods may be associated with increased risk of HIV acquisition. We aimed to characterize key social ecological factors contributing toward PrEP cycling among female sex workers (FSW) in the context of high HIV risk. Semi-structured, in-depth interviews were conducted with 36 FSW at risk for HIV acquisition and 12 key informant (KI) service providers in eThekwini (Durban), South Africa from January-October 2020. FSW identified key factors driving temporary discontinuation of PrEP including relocation, lack of information on or difficulty coping with side effects, and delays in accessing PrEP. In many cases, FSW were motivated to restart PrEP once barriers were overcome. In contrast, KIs emphasized the importance of individual adherence to PrEP and reliance on personal risk assessments when counselling FSW on cycling decisions. FSW and KI perspectives highlight a disconnect between providers’ recommendations on the potential for cyclical use of PrEP during periods of minimal risk and actual drivers among FSW causing temporary PrEP discontinuation. Further interventions supporting safe PrEP cycling are needed to ensure decisions around cycling are deliberate and guided by changes in HIV risk rather than external factors.
Exploring prioritization of wellbeing and health impacts for mining communities during the mining life cycle within the sub-Saharan Africa context : a systematic review
(BioMed Central, 2025-03) Pieters, Josephine N.; Ndaba, Nomsa S.; Ngcobo, Sanele; u24090299@tuks.co.za
INTRODUCTION : Sub-Saharan African countries possess rich mineral resources that offer socio-economic development opportunities for mining communities. However, the prioritization of health and wellbeing impacts during the mining life cycle remains unclear. This review examines the focus on health and wellbeing in mining communities within the sub-Saharan African context. METHODS : An online literature search was conducted across four databases (Scopus, PubMed, ProQuest, Web of Science) using the PICOS framework for eligibility criteria. The Rayyan tool was used for screening and data extraction. RESULTS : 45 studies were included (20 qualitative, 25 quantitative, including mixed methods). Most studies were from South Africa. Health impacts identified included: (a) HIV/AIDS, (b) Tuberculosis (TB), (c) Hypertension, and (d) Health Impact Assessment (HIA). The study also explored the mining life cycle stages—Exploration, Development, Production, and Closure—focusing on health and wellbeing prioritization. CONCLUSIONS : While mining offers socio-economic benefits, health and wellbeing impacts are not prioritized, especially in the exploration stage. Tools like HIAs provide valuable insights, but mining communities continue to face health challenges, both positive and negative. PROSPERO : CRD42023474494.
Pilot of methadone for recently incarcerated people with human immunodeficiency virus and opioid use in South Africa
(Mary Ann Liebert, 2025-06) Bhoora, Urvisha; An, Yangxi; Owczarzak, Jill; Ndini, Pretty; Moyo, Derrick; Shelly, Shaun; Marcus, Tessa S.; Steiner, Laura; Corcoran, Peter C.; Pollock, Sarah; Lefoka, Moganki H.; Mabuto, Tonderai; Hugo, J.F.M. (Jannie); Hoffmann, Christopher J.
In South Africa, there is no provision of medication for opioid use disorder (MOUD) for people who are incarcerated or were recently incarcerated. This study aimed to describe MOUD uptake and barriers among people living with human immunodeficiency virus and using illicit opioids reentering the community from incarceration. A mixed-method exploratory study was conducted between September 2021 and September 2022 in South Africa, during which we offered low-barrier MOUD and harm reduction services. We followed 23 participants postrelease and observed a low uptake of MOUD after release (8 of 23, 35%). Reported barriers to MOUD included perceived ineffectiveness, a preference for residential withdrawal management, and delays in initiating MOUD. Innovation is needed in strategies to deliver MOUD and harm reduction in South Africa.

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