PI: Dr Wanga Zembe, Dr Vundli Ramokolo, Prof Tanya Doherty, Prof David Sanders, Prof Rina Swart
A longitudinal birth cohort study identifying women during pregnancy and following them up with their children from birth until 2 years to assess the nutritional status and dietary patterns of recipients and non-recipients of the CSG in Langa Township, Western Cape. This study builds upon the qualitative study outlined under Study 3. It is partially funded by the Centre of Excellence for Food Security and will run from 2016-2019.

The birth cohort commenced in March 2016. Fieldwork is in progress with the aim to recruit and follow up 500 mothers and their children.

Collaboration: The Centre of Excellence for Food Security, and UWC School of Public Health,

Contact person
Dr. Wanga Zembe (wanga.zembe@mrc.ac.za)
Dr Vundli Ramokolo (Vundli.ramokolo@mrc.ac.za)

The ACHIEVE project aims to address research capacity gaps in global child, adolescent and family health disparities utilising implementation and data sciences among vulnerable populations in resource-limited settings. The programme has a special focus on children, adolescents, and their caregiving families; parenting; HIV/AIDS; mental health; cancer; nutrition; and environmental health.

ACHIEVE provides trainees with dissemination and implementation, and data-science research skills and knowledge through experiential learning, mentoring, and ‘hands-on’ immersion in global health implementation and data-science research and methodologies. It is funded by the Fogarty International Center at the US National Institutes of Health and is a consortium of ten institutions: Washington University in St. Louis, Boston College, New York University, University of Illinois Chicago, University of Makeni, University of Kwazulu-Natal, University of Rwanda, University of Ghana, Makerere University and University of Nairobi.

The aims include providing a research-training programme for five cohorts of healthcare professionals from the US and sub-Saharan Africa; bringing together an interprofessional network of committed mentors from the global north and the global south to promote equitable bi-directional learning and collaboration and ensure quality training; and delineate key factors that underlie successful mentorship and training of new investigators.

For more information see https://sites.wustl.edu/achieve

arvin.bhana@mrc.ac.za

Executive Summary

The Academy of Science for South Africa (ASSAf) commissioned a consensus study on achieving good governance and management in the South African health system. ASSAf holds a mandate within South Africa to generate evidence-based solutions to national and global challenges and consensus studies provide evidence-based advice to government and other stakeholders to support policy development and practice. A seven-member consensus Panel was drawn from a multidisciplinary group of South African public health and health systems researchers, academics and practitioners. The Panel contributed their time and expertise on a voluntary basis over a three-year period, from September 2020, with the overall brief to:

1. Determine and describe the magnitude, the spread, and the effects of the governance challenges in the health system.
2. Identify any effective strategies or best practices/interventions that can be adapted and/or leveraged to address these governance challenges; and
3. Make implementable recommendations on how to improve governance, management, and decision-making in the overall health system for better performance and sustainability.

The Panel explored relevant conceptual frameworks to guide the investigation, identified experts to serve as key informants, and invited them to individual consultative meetings. The key informants were chosen purposively from across different sectors including the State, Service Providers, and Citizens/Clients. Key informants included senior health managers who had extensive experience in public sector governance at national and provincial levels, academics, and key actors representing civil society, health worker unions, non-governmental organisations, and patient advocate groups. Information was supplemented by a review of relevant peer-reviewed literature on governance in South Africa and globally

View the complete Achieving Good Governance and Management in the South African Health System Report

Published by the: Academy of Science of South Africa (ASSAf)

This consensus study report is the result of the collaborative work of several people who are acknowledged as follows: The members of the panel: Emeritus A/Professor Lilian Dudley, panel chairperson, Stellenbosch University (SU); Professor Flavia Senkubuge, University of Pretoria (UP); Professor Sharon Fonn, University of the Witwatersrand (Wits); Professor Leslie London, University of Cape Town (UCT); Dr Mark Blecher, National Treasury; Dr Guinevere Lourens, Stellenbosch University (SU); A/ Professor Catherine Mathews, South African Medical Research Council (SAMRC). These members volunteered their time and expertise for this study and are acknowledged.

Task sharing is a promising strategy to expand mental-health service provision and reduce the mental-health treatment gap, which is especially severe in low-resource settings and in low- and middle-income countries (LMICs). This study seeks to validate across three LMIC countries (Chile, Nepal and South Africa) a multi-dimensional, multi-stakeholder measure to assess barriers and facilitators for implementing task sharing mental-health strategies (TSMH). 

Using qualitative data collected by three National Institute of Mental Health-funded LMIC-based research hubs, and a systematic review of the literature on barriers and facilitators identified in other LMIC-based TSMH studies, the project has developed the Barriers and Facilitators in the Implementation of Task Sharing Mental Health strategies (BeFITS-MH) measure that includes items designed to assess acceptability, appropriateness, feasibility and cost-related domains from the perspective of clients, care providers and supervisors and administrators. 

This study will evaluate the psychometric properties of the BeFITS-MH tool cross-sectionally and longitudinally, and will assess the reliability, validity and utility of the tool in projects implementing task-sharing interventions.

Funded by the National Institute of Mental Health (NIMH). of the US National Institutes of Health.

arvin.bhana@mrc.ac.za

Collaborative child and adolescent mental health at the intersections of service delivery in South Africa: Towards responsive systems of care.

The aims are:

1. To explore mental health-related experiences, perceptions and suggestions of children and adolescents in a South African district.
2. To explore the perspectives of parents and caregivers on child and adolescent mental health services in a South African district.
3. To review an existing Theory of Change model to inform the development of a district children and adolescent mental health plan.

The outcome is to establish the contextual knowledge required for targeted intersectoral policy development towards improving CAMH in South Africa.

SAMRC SIR grant.

arvin.bhana@mrc.ac.za

Cochrane Africa is a network of sub-Saharan African regional hubs (West, Francophone, Southern and East Africa) managed by experienced Cochrane Review contributors. Cochrane Africa is an innovative, African-led response to the need to increase the use of evidence in Africa and the recognition that where disease burden and health system challenges are greatest, the need for evidence to support decision-making and resource use is most critical. Cochrane Africa aims to increase the use of Cochrane evidence to inform healthcare decision-making in the sub-Saharan region by supporting the production of high-quality reviews, making relevant evidence accessible; advocating for evidence; and, building a sustainable network.

The Cochrane Nutrition Field is under the leadership of Health Systems Research Unit, the South African Medical Research Council, and the Centre for Evidence-based Health Care (CEBHC), Faculty of Medicine and Health Sciences, Stellenbosch University, along with international partners.

Cochrane Nutrition aims to coordinate activities related to nutrition reviews within Cochrane; to ensure that priority nutrition reviews are conducted with rigorous methodological approaches; and, to promote the use of evidence from nutrition systematic reviews to inform healthcare decision making.

The Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) is a research network funded by the German Ministry of Education and Research. This network intends to translate the principles of evidence based public health by ensuring that the priority research questions are relevant and fill a real gap, through conducting robust research and through overcoming the disconnect between primary research, evidence synthesis and implementation into policy-and-practice.

CEBHA+ comprises six partner institutions in Africa, in Uganda, Malawi, Rwanda, Ethiopia, and South Africa, and two partner institutions in Germany. Cochrane SA is one of the African partners, contributing toward all work packages of the network, including:

• Leading systematic reviews on population-level interventions to increase physical activity to prevent cardiovascular diseases; and screening strategies for diabetes and hypertension and contributing to other research projects.
• Building capacity and providing methodological support to conduct high quality evidence syntheses, and to translate evidence into policy and practice.
• Networking, to increase connectivity between all partners and with relevant stakeholders to enhance evidence informed policymaking.

South Africa is introducing wide-scale health system reforms towards people-centred universal healthcare with the introduction of National Health Insurance and re-engineering of primary health care. At the heart is a substantial investment in Ward-based PHC Outreach Teams as well as strengthening of the community sub-system necessary for a people-centred health approach. KwaZulu-Natal is playing a pioneering role in promoting household champions and ward-based intersectoral forums called Operation Sukhuma Sakhe. The success is dependent on understanding ‘on-the-ground’ implementation and operational challenges to inform health-system modifications necessary to enable such reforms. The project has therefore partnered with the KZN Department of Health and Office of the Premier in a Primary Health Care Transformation Committee to provide evidence-based research and academic direction to this endeavour.

The aim of this grant is to conduct formative research to explore mechanisms for strengthening the key pillars of the health system for a people-centred, community orientation.

The objectives of this foundation grant are to:

1. Examine barriers, needs and opportunities for strengthening the key health-system pillars (including multisectoral engagement) for a people-centred community orientation.
2. Co-design Initial Programme Theories for strengthening the key pillars of the health system for a people-centred community orientation.

Funded by the United Kingdom Medical Research Council (UKRI).

arvin.bhana@mrc.ac.za

Strengthening the impact of South Africa's COVID-19 Social Relief Distress Grant among unpaid caregivers of adolescents living with HIV.

This project is a collaboration between the Health Systems Unit and Simon Fraser University in Canada. It evaluates a cash transfer plus a gender-transformative economic livelihoods intervention for improving psychological wellbeing and gender equality among woman caregivers of children and adolescents living with HIV (CALHIV) in KwaZulu-Natal, South Africa. The mixed-methods research approach consists of a cluster randomised trial among HIV clinic caregivers of CALHIV. Intervention clusters will receive a monthly cash transfer and undergo a 10-session economic livelihoods intervention while the control clusters will only receive the monthly cash transfer. Qualitative interviews on economic evaluation will assess the feasibility, acceptability and cost-effectiveness of the intervention.

The expected results include assessing pre- and post-intervention impacts on outcomes of psychological wellbeing, intimate partner violence, depressive symptoms, gender attitudes and earnings. The results will improve understanding of economic livelihood-based interventions in strengthening caregivers’ psychological wellbeing and the evidence generated will inform and strengthen the government’s COVID-19 recovery efforts.

The project is supported by Women’s health and economic empowerment for a COVID-19 Recovery that is Inclusive, Sustainable and Equitable (Women RISE), a partnership between the Canadian International Development Research Centre, the Canadian Institutes of Health Research, and the Social Sciences and Humanities Research Council. Its aim is to support global action-oriented, gender-transformative research by researchers from low- and middle-income countries and Canada.

Local co-PI: Darshini Govindasamy. Email: darshini.govindasamy@mrc.ac.za

Project manager: Stanley Carries. Email: stanley.carries@mrc.ac.za

Collaborating institutions:

• Simon Fraser University-Canada
• University of Exeter- United Kingdom
• Stellenbosch University-South Africa
• Project Empower- South Africa
• IDRC - International Development Research Centre (idrc-crdi.ca)

PI: Professor Crick Lund

Co-PI: Donela Besada (SAMRC) and Sumaiyah Docrat (UCT)

Aim
To develop an investment case for mental health to determine the costs and returns of a prioritized package of system and service-level interventions to reach important targets related to South African mental health services.

Study methods
The study will involve a mixed method approach including qualitative interviews with key stakeholders to identify the priorities on a package of interventions for the South African mental health system, a review of the evidence base for known interventions for mental health, calculating the total budget needed to implement the package of prioritized investments and carrying out an economic evaluation to estimate the returns on these investments linked to key outcomes.

Collaboration
National and Provincial Departments of Health

Project status
Project underway

PI: Dr Wanga Zembe-Mkabile, Dr Vundli Ramokolo, Prof Tanya Doherty

Overview
The advent of the Covid-19 pandemic in South Africa and across the globe, with associated national lockdowns, poses special challenges and implications for household food security, and child health and wellbeing among poor households. It is important to assess how Child Support Grant-eligible but non-recipient, and recipient households are experiencing and coping with the threat of Covid-19 and the accompanying restrictions on movement, as well as potential loss and or reduction of income.

Study Aim

To explore the experiences of Covid-19 among recipients and non-recipients of the CSG in Langa Township, Western Cape

For this qualitative study we are conducting twenty  telephonic qualitative interviews over two time points with participants (mother-child pairs) that we have been following up for two years in a longitudinal cohort study assessing the impact of the CSG on child nutritional status and food security. For this additional piece of research we are exploring  participants’ experiences of accessing social grants in the time of Covid-19; their experiences of securing food for their children and households, experiences of restrictions to movement, loss of earnings due to not working and social distancing while living in informal settlements and or small housing structures with small or no yard space; experiences with safety; perspectives and concerns they might have for themselves and their children and families at this time; and what they see as the role of social grants and the CSG in particular in providing support to impoverished and vulnerable households and communities in the time of Covid-19.

The study will provide learnings and lessons on how poor households reliant on small social grants cope during pandemics such as Covid-19 and the ways in which the social security system in South Africa can better respond to and support children and families from poor households.

Collaboration
SAMRC

Project status
Qualitative interviews are in progress. As part of this study we have published an Op-Ed in the Daily Maverick which communicates emerging results and the implications thereof for policy and practice. Link to the article: https://www.dailymaverick.co.za/article/2020-05-26-covid-19-and-social-grants-relief-measures-welcome-but-not-enough/#gsc.tab=0

Contact person
Dr. Wanga Zembe-Mkabile: wanga.zembe@mrc.ac.za

PI: Prof Yanga Zembe,

Co-PI: Dr Wanga Zembe

Aim: To explore the engagement of poor people with public health policies, interventions and food knowledge systems, including social media, and how these shape their food experiences and eating practices in Langa Township, Cape Town

Objectives

• To explore the food experiences and eating practices of CSG recipients and non-recipients
• To examine the kind of nutrition education that CSG recipients and non-recipients, and their sources of health information and knowledge regarding nutrition
• To explore how the CSG recipients and non-recipients regard these sources of information, including their considerations regarding their accessibility, credibility, usefulness and impact
• To determine the perceptions CSG recipients and non-recipients have regarding the influence of the food and nutrition messaging and education that they are exposed to, on what and how they eat
• To explore CSG recipients and non-recipients’ knowledge of and familiarity with policies on nutrition and healthy food practices, and how they interpret and apply these
• To determine the role of socio-cultural knowledge systems about food on gender-based food practices, as well as the influence of such gender norms on how public health nutrition education and interventions are interpreted and applied by CSG recipients and non-recipients
• To understand the ways in which Covid-19 has affected the resourcefulness and capabilities of CSG recipients and non-recipients in their quest to ensure adequacy of food in their households

Methods:

For this qualitative study 20 telephonic qualitative interviews will be conducted with participants (primary caregivers) and five with spaza shop owners from a cohort of mother-child pairs that we have been following up for two years in a longitudinal cohort study assessing the impact of the CSG on child nutritional status and food security

Collaborators: CoE for Food Security

Project status: Awaiting ethical approval; data collection soon to commence.

HERStory Study

PI: Dr Catherine Mathews

Overview

From 2016 to the present day, the Global Fund to Fight AIDS, TB and Malaria has invested in a combination HIV prevention intervention for adolescent girls and young women in South Africa (AGYW), with the aim of reducing HIV incidence, teenage pregnancy, gender-based violence, and increasing retention in school and access to economic opportunities. The intervention is being implemented in several districts with high HIV burden by a range of South African organisations, with the support of the South African National AIDS Council. It is aligned with the She Conquers campaign, and the South African National Strategic Plan for HIV, STI’s and TB (2017-2022).

Combination HIV prevention interventions merge effective biomedical, behavioural and structural interventions for combined delivery. They are one of the key strategies for reaching the UNAIDS 90-90-90 targets and achieving the Sustainable Development Goal (SDG) of ending the HIV epidemic by 2030.

The HERStory Study is an evaluation of the combination HIV prevention intervention for AGYW, conducted by the South African Medical Research Council (SAMRC) and partners.

Aims

The aim of the evaluation is to determine the impact of the Global-Funded AGYW intervention on HIV incidence among AGYW aged 15 to 24 years living in the intervention districts. The study also evaluates the impact of the intervention on the cognitions, behaviours and social environments of AGYW.

Collaboration

• National Institute for Communicable Diseases
• Brown University
• University of Cape Town
• Centers for Disease Control and Prevention
• Epicentre AIDS Risk Management (Pty) Limited

Project status

First survey of two consecutive representative household surveys has been completed and published.  Second phase of research is in the planning phase.

Contact person

Dr. Catherine Mathews (Catherine.Mathews@mrc.ac.za)

Tracy McClinton Appollis (tmappollis@mrc.ac.za)

https://www.samrc.ac.za/intramural-research-units/HealthSystems-HERStory

PIs: Dr Catherine Mathews, Dr Kim Jonas, and Dr Zoe Duby

Overview

From 2016 to the present day, the Global Fund to Fight AIDS, TB and Malaria has invested in a combination HIV prevention intervention for adolescent girls and young women in South Africa (AGYW), with the aim of reducing HIV incidence, teenage pregnancy, and gender-based violence and increasing retention in school and access to economic opportunities. Combination HIV prevention interventions, which merge effective biomedical, behavioural and structural interventions for combined delivery, are one of the key strategies for reaching the UNAIDS 90-90-90 targets and achieving the Sustainable Development Goal (SDG) of ending the HIV epidemic by 2030.

Scientists in the Health Systems Research Unit have been requested to conduct a process evaluation of the AGYW combination intervention being implemented during the 2019 to 2022 Global Fund grant period.

Aims

To investigate:

1. Whether the coverage of the intervention is aligned to the theory of change, by conducting “coverage cascades” for HIV prevention and care interventions and for pregnancy prevention interventions.
2. The extent to which the intervention is acceptable to AGYW and key stakeholders in schools and communities, and why they participate in it, or decline to participate in aspects of the intervention.
3. The extent to which the context of the intervention is conducive to intervention implementation, and to what extent key gatekeepers in the intervention context are supportive of implementation.
4. Whether the theory of change is appropriately specified to achieve the intervention goals and to what extent is it being implemented as theorized.

Collaboration

• Brown University
• University of Cape Town
• South African National AIDS Council
• Data Yarn
• Stellenbosch University

Project status

Protocol development

Contact person

Dr. Catherine Mathews (Catherine.Mathews@mrc.ac.za)

Dr Kim Jonas (Kim.Jonas@mrc.ac.za)

https://www.samrc.ac.za/intramural-research-units/HealthSystems-HERStory

PI: Dr Kim Jonas

Overview

To alleviate the HIV burden among adolescent girls and young women (AGYW), the Global Fund to Fight AIDS, TB and Malaria has invested in a combination HIV prevention intervention, now called the My Journey Programme, for AGYW in South Africa from 2016 through to 2022 and beyond. Combination HIV prevention interventions, which merge effective biomedical, behavioural and structural interventions for combined delivery, are one of the key strategies for reaching the 90-90-90 targets and achieving the SDG goal of ending the HIV epidemic by 2030.

The HERStory 3 Study is an evaluation of the impact of The My Journey Programme, conducted by the South African Medical Research Council (SAMRC) and partners.

Aims/Objectives

The primary objective of the HERStory 3 Study is to determine the intervention impact on HIV prevalence by age. The secondary objectives include assessing the intervention impact on HIV prevention and care coverage, pregnancy prevention coverage, behaviours that put AGYW at risk of HIV and unintended pregnancy, and on the cognitions and social environments of AGYW, including access to economic opportunities, their well-being and health-related quality of life.

Collaboration

• National Institute for Communicable Diseases (NICD)
• American University
• Geospace International (Pty) Ltd
• Networking HIV & AIDS Community of Southern Africa (NACOSA)
• South African National AIDS Council (SANAC)

Protocol status

Data collection started January 2024 and is projected to end in May 2024

Contact person

Dr Kim Jonas (Kim.Jonas@mrc.ac.za)

https://www.samrc.ac.za/intramural-research-units/HealthSystems-HERStory

PIs: Dr Fareed Abdullah, Dr Catherine Mathews, and Dr Zoe Duby

Overview

Adolescent girls and young women (AGYW) in South Africa face multiple challenges that significantly limit their prospects of health and wellbeing later in life. A myriad of social, structural but also behavioural challenges are driving high rates of HIV infections and unintended pregnancies among young women while simultaneously hindering the uptake and adherence to available prevention, treatment and care.

The South African Medical Research Council’s (SAMRC) Office of AIDS and TB Research (OATB Research) has proposed a novel intervention, the Imagine Programme, to improve HIV and pregnancy related outcomes for school-going adolescent girls and young women (AGYW). The programme will focus on grade 8 to 12 female learners in 14 schools in the Moretele sub-district of the North West Province and the Newcastle sub-district of Kwa Zulu Natal over a 2,5-year period commencing in the second half of 2021.  The comprehensive package of services identifies both services and enablers “wrapped around” the life of the school-going young woman. These services can roughly be categorised as clinical sexual and reproductive health (SRH) services, psycho-social support services and social structural services. Services and products will be delivered through Imagine Programme School teams, Mobile Clinic teams and Community teams at either the school or at a government facility in the sub-district or at a partner’s community facility.

Scientists in the Office of AIDS and TB Research and the Health Systems Research Unit will evaluate the Imagine Programme.

Aims

The aims of the evaluation include:

1. To assess whether the programme is being implemented as planned and whether the implementers are on a trajectory to achieve the outcomes, with reference to the theory of change for the Imagine intervention
2. To describe the acceptability and uptake of, and participation in the programme among AGYW
3. To investigate the impact of the programme on the HIV and pregnancy prevention and care interventions and other health outcomes among AGYW
4. To calculate the cost-effectiveness and cost-benefit of the programme

Collaboration

• Brown University
• University of Cape Town
• South African National AIDS Council (SANAC)
• Department of Basic Education
• National Department of Health
• Department of Science and Innovation

Project status

Pilot study and preintervention formative research underway

Contact person

Dr. Catherine Mathews (Catherine.Mathews@mrc.ac.za)

Dr Kim Jonas (Kim.Jonas@mrc.ac.za)

Website: https://www.samrc.ac.za/intramural-research-units/HealthSystems-imagine-evaluation

The project seeks to adapt Critical Time Intervention (CTI) and explore its feasibility, acceptability and preliminary effectiveness to support people with severe and persistent mental disorders who transition to community settings following discharge from acute psychiatric hospitalization in a South African district.  CTI is a time-limited, evidence-based practice that mobilizes community resources and networks to support vulnerable individuals during times of transition, particularly from institutional to community settings.

Funded by the National Institute for Mental Health (R03) of the US National Institutes of Health.

arvin.bhana@mrc.ac.za

PIs: Lieve Vanleeuw, Wanga Zembe

Overview

Amid the COVID-19 crisis TB patients face increased vulnerability due to the consequences of the COVID-19 response such as loss of income, challenges to access healthcare services and anti-TB medication, increased stigma, and a loss of social support structures. Many of them are already poor, and many depend on informal work or have lost their jobs. The COVID-19 social and economic response in South Africa, however, might also offer some alleviation to TB patients’ burden by accessing the Covid-19 Social Relief of Distress Grant (SRDG) designed for unemployed working age adults who are destitute because of the virus. Our study will explore how the COVID-19 epidemic and response have affected the social, economic, and health situation of TB patients, as well as how COVID-19 measures to alleviate the social and economic effects of the COVID-19 epidemic and response such as the Social Relief of Distress Grant have affected TB patients’ vulnerability.

Aims

1. Explore how the COVID-19 epidemic and response, such as the lockdown measures, have affected the health, social and economic burden of TB patients in Cape Town, South Africa.
2. Explore how COVID-19 measures to alleviate the social and economic effects of the COVID-19 epidemic and response such as the Social Relief of Distress Grant have affected TB patients’ vulnerability.
3. Explore perceptions of healthcare workers working with TB patients of two primary healthcare clinics in Cape Town on how the COVID-19 crisis has affected TB patients in Cape Town, South Africa.
4. Explore perceptions of SASSA officials on the Social Relief of Distress grant and other forms of assistance for TB patients in Cape Town, South Africa.

Collaboration

Tampere University Finland

Tampere TB Foundation Finland

Project status

Protocol approved by the SAMRC Ethics Committee. Interviews to start in October 2020.

Contact person

PIs: Lieve Vanleeuw, Wanga Zembe

Overview

TB remains a major health problem and the number one cause of death in South Africa. While TB is closely associated with poverty, it can also push households into worsening impoverishment through costs associated with the disease such as the cost of food and travel and the loss of income. In addition, household contacts of TB patients have an increased risk of developing TB. Transmission of TB can infect multiple members of the household which in turn can aggravate the social and economic burden of TB and diminish household resilience over time. TB patients frequently also suffer from chronic conditions like HIV and diabetes. The coordination of health and social services for each of these conditions can put an extra burden on the patient. The co-occurrence of TB and chronic conditions, in the context of a broader set of socio-economic factors such as household vulnerability to multiple and recurring transmission of TB, fragmented social and healthcare services, and poverty can have a syndemic effect on the burden of TB for patients.

Aim

The study aims to explore patient experiences of the multiplicative burden of TB caused by the co-occurrence of TB and chronic conditions such as HIV and diabetes, in the context of a broad set of socio-economic factors such as household vulnerability to multiple and recurring transmission of TB, poverty, overcrowding, stigma, and fragmented social and healthcare services. It furthermore aims to explore patient experiences of existing interventions like contact screening, integration of services and the disability grant that can potentially alleviate the syndemic burden of TB in the Western Cape, South Africa.

Project status

Semi-structured interviews have been conducted with TB patients and healthcare workers at 2 clinics and officials from the South African Social Security Agency (SASSA) in Cape Town. Collected data is currently being analysed and written up for publication.

Collaboration

Tampere University Finland

Tampere TB Foundation Finland

Contact person

Lieve Vanleeuw: Lieve.vanLeeuw@mrc.ac.za

The Health Systems Research Unit, South African Medical Research Council in partnership with the Centre for Evidence-based Health Care at Stellenbosch University is involved in the Read-It project which is co-ordinated by the Liverpool School of Tropical Medicine.

READ-It focuses on two main areas:

• Reliable, up-to-date, scientifically defensible and relevant evidence in high-priority areas including HIV, nutrition, tuberculosis and malaria.

READ-It activities include:

• Preparing and updating Cochrane Reviews about the effects of health care relevant to low- and middle-income countries.

• Identifying approaches to ensure dissemination and use of the results of systematic reviews in decision making. 

READ-It (project number 300342-104) is funded by UK aid from the UK government.

PI: Catherine Mathews and Caroline Kuo

Overview

South Africa, a country with the largest HIV epidemic and some of the highest rates of IPV perpetration in the world. Few behavioral interventions integrate HIV-IPV prevention and are tailored for the unique age and developmental needs of adolescents. We utilized the insights of adolescent development theory in our school-based preventive intervention strategy by capitalizing on adolescents’ developmental propensities for maximum prevention gains. Adolescence presents an ideal age and developmental transition period for an integrated intervention targeting prevention of HIV behavioral risk reduction and perpetration of IPV including sexual violence. Developmental hallmarks of adolescence – including for example, the role of social norms in motivating behaviors, the importance of peers in shaping behavioral choices, and the desire for increased responsibility – were leveraged for prevention of sexual risk behavior driving acquisition of HIV infection and engagement in IPV. We used positive peer pressure and tapped into adolescents’ desire to be responsible future leaders to motivate adolescents to intervene as bystanders when their peers are involved in HIV risk behaviors or sexual assault and aggression.

Aims
This study investigates the acceptability and feasibility of Safe South Africa, an school-based, theory-driven, developmentally-tailored intervention to prevent adolescent behavioral risk for HIV and perpetration of intimate partner violence (IPV) among adolescent boys 15-17 years of age.

1. Development aim – to create Safe South Africa, a school-based male adolescent preventive intervention for HIV risk behavior and IPV perpetration;
2. Acceptability aim – to evaluate the school social ecology of HIV and IPV risk and test the acceptability of Safe South Africa through an open pilot trial in one high school
3. Feasibility aim – to conduct a randomized controlled pilot trial in one high school to assess the feasibility and acceptability for a future fully powered randomized controlled trial to evaluate efficacy of the intervention

Collaboration

Gender and Health Research Unit, SAMRC; Brown University, USA

Project status

Analysis and report-writing

Contact person

Catherine Mathews (catherine.mathews@mrc.ac.za)

PI: Dr Wanga Zembe

Co-Investigators: Lieve Vanleeuw; Yanga Zembe

A two-year mixed-methods research project that aims to assess (i) the levels of social support, economic empowerment and social protection available to adolescent girls and young women (AGYW), and (ii) the impact thereof on health and wellbeing of AGYW.

The main outcomes of the project are:

1. Synthesized evidence on best practice models regarding social protection, economic empowerment and social support interventions that can protect and improve the health and wellbeing of AGYW in LMIC settings.
2. Empirical evidence on the correlation between social protection, economic empowerment, and social support resources, interventions and programmes to proximal indicators associated with vulnerability, poor health and wellbeing among AGYW in South Africa.
3. Knowledge on gaps, opportunities and acceptability of expanded state-provided social protection and economic empowerment interventions to protect and promote health and wellbeing in AGYW in South Africa.
4. Recommendations for an integrated package of financial, economic and social support interventions to protect and promote the health and wellbeing of AGYW based on outcomes 1, 2 and 3.

Project status: The rapid review has been completed and a progress report for year 1 has been submitted to funders. The qualitative component of the project was carried out in 2019, as well as secondary analysis of data and engagement with stakeholders. Further analysis of data and writing up of reports and publications from the work have commenced.

Contact person

Wanga Zembe (wanga.zembe@mrc.ac.za)

The SA GRADE network contributes to capacity building and enhanced use of GRADE methodology within South Africa. SA GRADE is jointly led and managed by Centre for Evidence Based Health Care (CEBHC), Stellenbosch University and the Health Systems Research Unit, South African Medical Research Council.

The STAR project will run for a year in nine hospitals in the uMzinyathi and Zululand districts in KwaZulu-Natal. It will support health workers in their care of mothers and newborns. The project aims to help health workers (including midwives, nurses, enrolled nurses, ward or unit managers. doctors, M&E staff, social workers and data clerks) develop a shared focus on particular aspects of their work, and thus strengthen and support teamwork, respectful care, and learning together in hospitals.

The project uses a model of developing STAR champions and teams who work together on quality improvement projects.

With approval of the KwaZulu-Natal Department of Health, the STAR project is a partnership of the South African Medical Research Council (SAMRC), the Centre for Rural Health at the University of KwaZulu-Natal, and the London School of Hygiene and Tropical Medicine.

tanya.doherty@mrc.ac.za

PI: Deepa Rao; Inge Petersen
Co-investigators: Arvin Bhana, Lara Fairall, Crick Lund

Overview
In the context of the re‐engineered PHC system, including integrated chronic care in South Africa, the University of KwaZulu-Natal is collaborating with the University of Washington and I‐TECH South Africa to scale up the integration of mental health care into integrated chronic care at primary health care facilities in collaboration with the national and provincial DOH in North West, Mpumalanga and KwaZulu-Natal.

Aim
To scale up integrated mental health care into HIV and chronic care platforms at primary health care level

Collaboration
Department of Global Health, University of Washington, University of KwaZulu-Natal, I-TECH South Africa, University of Cape Town, Medical Research Council, Department of Health (National and Regional)

Project Status
While the project concluded in 2019, many of the learnings from this project have been taken up in a sister project (SMhINT). For example, the Brief Mental Health Screening (BMH) tool was validated for use in a primary care setting and has now been accepted as a standardized tool for screening all patients at a facility level for common mental health disorders.

Funder
United States Centres for Disease Control and Prevention

Contact person
Inge Petersen (peterseni@ukzn.ac.za)

PIs: Dr Catherine Mathews; Prof Seth Kalichman

Overview
Among the factors that impede retention in HIV care, ART adherence and HIV suppression is the social stigmatization of HIV infection. HIV stigmas and behaviors intended to avoid stigma have the adverse consequences of deterring people from seeking care, interfering with clinic attendance, and detracting from taking ART. Interventions to increase HIV care retention and ART adherence have not thus far focused on reducing the adverse effects of stigma in countries where HIV is most prevalent.  

Overall aim
This study will test a theory-based mobile-phone delivered counseling intervention designed to address HIV-stigma concerns in order to improve HIV treatment retention and adherence in South Africa. The intervention is grounded in Behavioral Self-Regulation Theory and the HIV Stigma Framework and was developed in partnership with South African public health agencies.

We will conduct a 3-arm randomised controlled trial in to compare: (a) Behavioral Self-Regulation + Stigma Management Counseling for HIV treatment retention and adherence, vs. (b) Behavioral Self-Regulation Counseling for HIV treatment retention and adherence, vs. (c) Uniform standard of care HIV patient education.

We will enrol 1250 men and women with unsuppressed HIV and receiving HIV treatment and follow them for 15-months post-intervention to assess effects on HIV care retention and HIV suppression (primary outcomes) and ART adherence (secondary outcome).

Collaboration
University of Connecticut

Project status
Data collection will start in October 2020.

Contact person
Dr. Catherine Mathews (catherine.mathews@mrc.ac.za); Ms Ellen Banas (ellen.banas@mrc.ac.za)