Actions of female sex workers who experience male condom failure during penetrative sexual encounters with clients in Cape Town: Implications for HIV prevention strategies

BACKGROUND: Condom failure has always been found to coexist with condom usage, especially among sex workers. OBJECTIVE: To describe the actions of female sex workers when they are faced with situations of condom failure. METHODS: Using the survey design, the participants were selected through the snowball sampling method. Their responses were obtained using a structured questionnaire. A total of 100 questionnaires were analysed. RESULTS: With respect to the immediate actions of sex workers after condom failure, 36% of the respondents continued with the sexual encounter after noticing that the condom was broken. Another 36% stopped immediately when they noticed that the condom had failed, but replaced the condom; 13% of the participants stopped the sexual encounter completely; 3% applied vaginal spermicidal foam; and 5% of the respondents stopped immediately and took a douche when they had the chance. For the actions within the next 24 hours of experiencing condom failure with a client, 53% of the participants did nothing; 4% sought counsel from a professional; 3% of the respondents took alcohol or drugs to forget the incident, 25% went to the clinic for assistance and 8% offered other responses. CONCLUSION: While continuing the sexual encounter without replacing the condom, taking alcohol and drugs or doing nothing could increase the risk of contracting HIV; however, actions like stopping the sexual encounter completely and visiting a clinic or a professional could make a difference between staying HIV negative or seroconverting. There is a need for targeted intervention to address issues of inappropriate behaviours after experiencing condom failure.ISIScieloScopu

A realist evaluation of the antiretroviral treatment adherence club programme in the metropolitan area of the Western Cape Province, South Africa

Philosophiae Doctor - PhD (School of Public Health)In South Africa, 7.1 million people living with HIV/AIDS (PLWHA) of whom about 56% were accessing antiretroviral therapy (ART) in 2016, accounted for approximately 20% of people on ART globally. The successful initiation of PLWHA on ART has engendered challenges of poor retention in care and suboptimal adherence to medication. While standard treatment and care schemes show the potential to retain patients in ART care, their success is challenged by congested health-care facilities, long waiting times and shortages of health-care providers. The antiretroviral adherence club intervention was rolled out in primary health-care facilities in the Western Cape Province of South Africa to relieve clinic congestion and improve retention in care, and treatment adherence in the face of growing patient loads. Evidence from the literature suggests that these models of ART service delivery are more effective than corresponding facility-based care. Nevertheless, there is little understanding of how these care models work to achieve their intended outcomes. To this end, a theory-driven approach to evaluate the adherence club intervention was proposed

Patients’ experiences of being nursed by student nurses at a teaching hospital

BACKGROUND: Teaching hospitals are medical institutes at which most nursing education institutions provide their students with practical nursing experience. Although the focus of care is the patient, attention is sometimes focused more on the nursing students rather than on the patients who are undergoing care at the hands of both the nursing professionals and students. However, proper nursing care should also take into account the experiences of patients during the care process in the health facility. OBJECTIVES: The study had three objectives: to describe the experiences of patients nursed by student nurses in a teaching hospital in the Western Cape; to identify patterns in the experiences of patients receiving patient care from student nurses; and to analyse aspects of the experiences that may need further attention for the training of student nurses. METHOD: A descriptive phenomenological approach was used to explore the experiences of patients nursed by student nurses. Participant selection took place purposively from different wards of the identified teaching hospital, and thematic saturation was achieved at 10 participants. The data were collected through in-depth interviews and analysed using thematic content analysis. RESULTS: Three main themes were discovered after data analysis: methods of identification of student nurses by patients; positive perceptions of student nurses by patients; and negative perceptions of student nurses by patients. CONCLUSION: The findings will inform the clinical supervisors and educational institutions of aspects of the nursing training of student nurses that need improvement and those that require enforcement.Department of HE and Training approved lis

Patients' experiences of being nursed by student nurses at a teaching hospital in the Western Cape

Magister Curationis - MCurPatients' experiences of being nursed by student nurses at a teaching hospital in the Western Cape. Results: Three main themes were discovered after the data analysis; methods of identification of student-nurses by patients; positive perceptions of student-nurses by patients and the negative perceptions of student-nurses by the patients. Conclusion: Patients’ experiences with student nurses in their roles during their practicum vary considerably. Some patients reported that the students were very good to them, friendly; making conversations with them that would lighten up their moods. They asserted also that they felt comfortable with the technique and execution of the nursing care process by the student nurses, confirming that they see nothing wrong with them. Conversely, other patients did not hold the student nurses in high esteem and said that they were not very good with discharging their nursing duties and were sometimes found wanting in the execution of certain nursing procedures. Consequently, their experiences were not so good ranging from boredom to extreme pain during the nursing care from students. Emanating from the bad experiences that these patients have had with student nurses, they have become sceptical when it comes to receiving nursing care from student nurses and would refuse should they have the opportunity to decide

Are asylum seekers, refugees and foreign migrants considered in the COVID-19 vaccine discourse?

There is a propitious belief that a potent vaccine against the SARS-COV-2 virus is a panacea for the COVID-19 pandemic. The need for a potent vaccine is heightened as many nations are finding it counterproductive to sustain national lockdowns and individuals are becoming complacent with their hygiene and social (physical) distancing practices. Currently, there are more than 100 COVID-19 vaccine candidates under development, with a number of these in the human trial phase. It is suggested that the introduction of a COVID-19 vaccine will prevent the loss of US$375 billion to the global economy every month.

Household-focused interventions to enhance the treatment and management of HIV in low- and middle-income countries: a scoping review

Background: HIV remains a major public health challenge in many low- and middle-income countries (LMICs). The initiation of a greater number of people living with HIV (PLHIV) onto antiretroviral therapy (ART) following the World Health Organization’s ‘universal test and treat’ recommendation has the potential to overstretch already challenged health systems in LMICs. While various mainstream and community-based care models have been implemented to improve the treatment outcomes of PLHIV, little effort has been made to harness the potential of the families or households of PLHIV to enhance their treatment outcomes. To this end, we sought to explore the characteristics and effectiveness of household-focused interventions in LMICs on the management of HIV as measured by levels of adherence, viral suppression and different dimensions of HIV competence. Additionally, we sought to explore the mechanisms of change to explain how the interventions achieved the expected outcomes. Methods: We systematically reviewed the literature published from 2003 to 2018, obtained from six electronic databases. We thematically analysed the 11 selected articles guided by the population, intervention, comparison and outcome (PICO) framework. Following the generative causality logic, whereby mechanisms are postulated to mediate an intervention and the outcomes, we applied a mechanism-based inferential reasoning, retroduction, to identify the mechanisms underlying the interventions to understand how these interventions are expected to work. Results: The identified HIV-related interventions with a household focus were multi-component and multidimensional, incorporating aspects of information sharing on HIV; improving communication; stimulating social support and promoting mental health. Most of the interventions sought to empower and stimulate self-efficacy while strengthening the perceived social support of the PLHIV. Studies reported a significant positive impact on improving various aspects of HIV competent household – positive effects on HIV knowledge, communication between household members, and improved mental health outcomes of youths living in HIV-affected households. Conclusion: By aiming to strengthen the perceived social support and self-efficacy of PLHIV, householdfocused HIV interventions can address various aspects of household HIV competency. Nevertheless, the role of the household as an enabling resource to improve the outcomes of PLHIV remains largely untapped by public HIV programmes; more research on improving household HIV competency is therefore required

Conceptualising the factors affecting retention in care of patients on antiretroviral treatment in Kabwe District, Zambia, using the ecological framework

BACKGROUND. HIV remains a major public health challenge in Zambia.The roll-out of antiretroviral treatment (ART) has engendered new challenges in retention in care. OBJECTIVE. To conceptualise the factors affecting retention in care of ART patients at three primary healthcare facilities using the ecological framework. METHOD. Qualitative data were collected through in-depth interviews with 45 ART patients and three focus group discussions with 20 healthcare providers from three primary healthcare facilities in Kabwe district, Zambia, and subjected to thematic content analysis. RESULTS. Individual level barriers to retention in care included side effects, gaining weight, belief in faith healing, and use of herbal remedies and alcohol. Interpersonal barriers such as stigma and nondisclosure of HIV status were reported. At the institutional level, inadequate space in the clinic, long waiting times, long travel distances, and shortage of third-line drugs presented barriers to retention in care. Food shortages and patient mobility were reported as community barriers to retention in care. CONCLUSION.The ecological framework conceptualises the complex and dynamic factors affecting retention inART care and highlights the need formultifaceted interventions that combine health education, disease management, and opportunities for income generation in a socially responsive and accountable environment.Scopu

Covid-19 vaccine hesitancy among Nigerians living with noncommunicable diseases: A qualitative study

The discovery and subsequent manufacture of various types of COVID-19 vaccines were considered a breakthrough in the fight against the COVID-19 pandemic. Initially, limited supplies of COVID-19 vaccines warranted vulnerable populations such as people living with chronic non-communicable diseases and the elderly to be prioritised for vaccination. Nevertheless, the uptake of the COVID-19 vaccines among these populations was suboptimal. In this study, we aimed to describe the drivers of COVID-19 vaccine hesitancy among people living with chronic non-communicable diseases in Ibadan, Nigeria

Leveraging the photovoice methodology for critical realist theorizing

Photovoice is a visual research methodology that integrates images and words to encourage the exploration of the experiences, perceptions, and meaning-making processes of individuals on various social phenomena. As a participatory qualitative methodology, Photovoice has been used within the interpretivist paradigm to explore various [public] health and social phenomena to enhance participants’ (co-investigators’) engagement and to lobby for policy. Despite its exponential growth and extensive application in the last two decades, its potential usefulness in critical realist-informed studies is unexplored. Herein, we highlight the epistemological and methodological alignment of the Photovoice methodology with the critical realist philosophy of science regarding the understanding of social phenomena through meaning-making. Drawing on the authors’ work on adolescents’ (non)adherence behavior on antiretroviral therapy, we illustrate the application of Photovoice methods in a critical realistinformed qualitative study. The emancipatory potential of the Photovoice methodology aligns with that of critical realist epistemology as they privilege participants’ (co-investigators’) knowledge generation and learning to better understand and take control of their situation - “integrated” knowledge translation. Methodologically, Photovoice provides a useful dialogue strategy for promoting discussions between the researcher and the co-investigators to obtain value-impregnated accounts to inform critical realist theorizing. The Photovoice methodology is appropriate for theorizing in critical realist research and especially suitable when engaging with suppressed or marginalized populations

Student nurse- educators’ construction of teacher identity from a self- evaluation perspective: A quantitative case study

The aim of this study was to explore the teacher identity formation dynamics of student nurse- educators about the subject matter, pedagogy and didactics. A case study using descriptive quantitative design was employed. Using a cross- sectional approach, data were collected in 2014 using a self- administered questionnaire. Participants were asked to self- evaluate their teaching competencies on the nursing subject matter, pedagogical expertise and didactical ex-pertise. Using descriptive analysis we determined the central tendencies of the constructs