An implementation science protocol of the Women’s Health CoOp in healthcare settings in Cape Town, South Africa: A stepped-wedge design

Abstract Background HIV persists as a public health emergency in South Africa, especially among women of childbearing age. In response to the HIV epidemic, the Joint United Nations Programme on HIV/AIDS has put forth the 90–90-90 global goals to achieve an AIDS-free generation by 2020. This goal aspires to have 90% of people living with HIV diagnosed; 90% of those who test positive on sustained antiretroviral therapy (ART); and 90% of those on ART be virally suppressed. Ensuring access to ART is an important first step in reducing HIV incidence, especially among vulnerable populations such as women who use substances and bear the burden of HIV in South Africa. Additionally, alcohol and other drug (AOD) use and exposure to gender-based violence are associated with increased risk of HIV infection and reduced adherence to ART. However, no research has estimated ART adherence rates for women who use substances in South Africa since the government approved the provision of ART to all people living with HIV. Methods The Women’s Health CoOp (WHC) is an evidence-based, woman-focused, behavioral intervention that addresses the intersecting risks of AODs, sex behaviors, and violence and victimization, with the primary goal of increasing skills and knowledge to reduce substance abuse and HIV risks and to improve ART adherence. The WHC has been packaged for further dissemination. This article describes the study protocol used to assess the feasibility and acceptability of implementing the WHC intervention into standard of care in Cape Town health clinics and substance abuse rehabilitation centers to reduce HIV risk behavior and increase ART adherence among women who use substances and are living with HIV. Discussion Because few of the interventions that demonstrate efficacy for HIV prevention and ART adherence in randomized trials are sustainable, studies to adapt and test intervention variations are needed to determine the best strategies for implementing them in real-world, high-risk settings. However, implementation in real-world settings presents challenges. Consequently, intervention developers should consider the strengths and limitations of their anticipated implementation setting by engaging with key stakeholders before, during, and after the adaptation and implementation process when developing and attempting to scale-up interventions. Trial registration NCT 02733003 and date approved 1/21/2016

The importance of the individual in PrEP uptake : multilevel correlates of PrEP uptake among adolescent girls and young women in Tshwane, South Africa

DATA AVAILABILITY : Data is available upon request from Dr. Wendee Wechsberg.Adolescent girls and young women (AGYW) account for 25% of new HIV infections in South Africa. Pre-exposure prophylaxis (PrEP) is approved by the South African Government, but the factors that promote PrEP uptake among AGYW are not well understood. This study examines multilevel factors associated with PrEP uptake among AGYW in six clinic catchment areas in Tshwane (Pretoria), South Africa. After consent/assent, PrEP-eligible AGYW (n = 448) completed a questionnaire assessing factors at the individual, network/interpersonal, and community levels and were prescribed PrEP in study clinics, if interested. A multivariable model, adjusting for clustering, assessed factors associated with PrEP uptake over a 9-month period. At the individual level, multiple partners in the past 3 months (OR = 0.47), perceived risk of HIV (OR = 0.71), and PrEP-related shame (OR = 0.63) were correlated with lower odds of PrEP uptake (ps ≤ 0.05). The findings highlight modifiable factors that should be addressed to support PrEP uptake efforts.The Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health.https://link.springer.com/journal/104612024-07-13hj2024Medical MicrobiologySDG-03:Good heatlh and well-bein

Gender and Context Matter: Behavioral and Structural Interventions for People Who Use Alcohol and Other Drugs in Africa

Heavy alcohol consumption and other drug use are prominent across Africa and increase the risk of exposure to violence, HIV acquisition, and other life-threatening injuries. This review synthesizes evidence on alcohol and other drug (AOD) interventions in Africa; evaluates the differences between interventions that do and do not specifically target populations that use AODs; and highlights the impact of comprehensive vs. brief interventions and those that address syndemic issues from a gender and contextualized lens. Literature searches were conducted to identify research outcomes of randomized interventions published between January 2010 and May 2022 that address AOD use in Africa. Thirty-five full-text articles were included in this review. Most of the identified research studies were concentrated in a few countries. Most studies were conducted in South Africa. Many of the studies comprised brief interventions. However, the most comprehensive interventions were the most effective for AOD outcomes. Several studies indicated the importance of addressing AOD use alongside gender-based violence, mental health needs, gender roles, and other social determinants that affect health outcomes. Intervening on AOD use and addressing social determinants from a gender and contextually relevant perspective is essential to ensuring the long-term health and well-being of people in Africa

Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa

Abstract Background Women in South Africa who use alcohol and other drugs face multiple barriers to HIV care. These barriers make it difficult for women to progress through each step in the HIV treatment cascade from diagnosis to treatment initiation and adherence. This paper examines correlates of HIV status, newly diagnosed HIV status, and use of antiretroviral therapy (ART). Methods Outreach workers recruited sexually active Black African women who used substances in Pretoria as part of a U.S. National Institutes of Health-funded geographically clustered randomized trial examining the effect of an intervention to reduce alcohol and drug use as well as sexual risk behaviors. To address the question of interest in the current investigation, cross-sectional baseline data were used. At study enrollment, all participants (N = 641) completed an interview, and underwent rapid HIV testing and biological drug screening. Those who tested positive for HIV and were eligible for ART were asked about their barriers to initiating or adhering to ART. Bivariate and multivariable logistic regression analyses were conducted to determine correlates of HIV status, newly diagnosed HIV, and ART use. Results At enrollment, 55% of participants tested positive for HIV, and 36% of these women were newly diagnosed. In multivariable analyses of the entire sample, women who had completed 10th grade were less likely to be living with HIV (OR 0.69; CI 0.48, 0.99) and those from the inner city were more likely to be living with HIV (OR 1.83; CI 1.26, 2.67). Among HIV-positive participants, women were less likely to be newly diagnosed if they had ever been in substance abuse treatment (OR 0.15; CI 0.03, 0.69) or used a condom at last sex (OR 0.58; CI 0.34, 0.98) and more likely to be newly diagnosed if they were physically assaulted in the past year (OR 1.97; CI 1.01, 3.84). Among women eligible for ART, fewer were likely to be on treatment (by self-report) if they had a positive urine test for opiates or cocaine (OR 0.27; CI 0.09, 0.80). Conclusions These results, although cross-sectional, provide some guidance for provincial authorities to address barriers to HIV care for sexually active, substance-using vulnerable women in Pretoria. Targeting the inner city with prevention campaigns, expanding and improving substance abuse treatment programs, linking clients with simultaneous HIV testing and treatment, and targeting women who have experienced sexual assault and violence may help the government achieve the UNAIDS 90-90-90 treatment target. Clinical Trials.gov NCT01497405 registered on December 1, 2011

The biobehavioral Women’s Health CoOp in Pretoria, South Africa: study protocol for a cluster-randomized design

Abstract Background South Africa has 6.4 million adults over the age of 15 living with HIV. Gender inequality issues continue to drive the HIV epidemic in South Africa, where Black African women bear the greatest HIV burden. Limited access to services; little capacity to negotiate sex and condom use; and other legal, social, and economic inequities make women highly vulnerable to HIV infection. Behavioral interventions have been shown to decrease risk behaviors, but they have been less successful in reducing HIV incidence. Conversely, biomedical prevention strategies have proven to be successful in reducing HIV incidence, but require behavioral interventions to increase uptake and adherence. Consequently, there is a need for integrated approaches that combine biomedical and behavioral interventions. Effective combination prevention efforts should comprise biomedical, behavioral, and structural programming proven in randomized trials that focuses on the driving forces and key populations at higher risk of HIV infection and transmission. Methods/Design This prospective, geographically clustered randomized field experiment is enrolling participants into two arms: a control arm that receives standard HIV testing and referral for treatment; and an intervention arm that receives an evidence-based, woman-focused behavioral intervention that emphasizes risk reduction and retention, the Women’s Health CoOp. We divided the city of Pretoria into 14 mutually exclusive geographic zones and randomized these zones into either the control arm or the intervention arm. Outreach workers are recruiting drug-using women from each zone. At baseline, eligible participants complete a questionnaire and biological testing for HIV, recent drug use, and pregnancy. Follow-up interviews are completed at 6 and 12 months. Discussion The biobehavioral intervention in this study merges an efficacious behavioral HIV prevention intervention for women with biomedical prevention through HIV treatment as prevention using a Seek, Test, Treat and Retain strategy. This combination biobehavioral intervention is designed to (1) improve the quality of life and reduce HIV infectiousness among women who are HIV positive, and (2) reduce HIV risk behaviors among women regardless of their HIV status. If efficacious, this intervention could help control the HIV epidemic in South Africa. Trial registration Trial registration no: NCT01497405

Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women : conflicting perspectives in South Africa

DATA AVAILABILITY : Data and materials are available on request from Dr. Wendee Wechsberg at [email protected] : Globally, an urgent need exists to expand access to HIV prevention among adolescent girls and young women (AGYW), but the need is particularly acute in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) offers an effective HIV prevention method. In many countries, however, accessing PrEP necessitates that AGYW visit their local health clinic, where they may face access challenges. Some countries have implemented youth-friendly services to reduce certain challenges in local health clinics, but barriers to access persist, including clinic stigma. However, evidence of clinic stigma toward AGYW, particularly with respect to PrEP service delivery, is still limited. This mixed methods study explores stigma toward AGYW seeking clinic services, in particular PrEP, from the perspective of both clinic staff (clinical and nonclinical) and AGYW who seek services at clinic sites in Tshwane province, South Africa. METHODS : Six focus group discussions were conducted with AGYW (43 total participants) and four with clinic staff (42 total participants) and triangulated with survey data with AGYW (n = 449) and clinic staff (n = 130). Thematic analysis was applied to the qualitative data and descriptive statistics were conducted with the survey data. RESULTS : Four common themes emerged across the qualitative and quantitative data and with both AGYW and clinic staff, although with varying degrees of resonance between these two groups. These themes included (1) clinic manifestations of stigma toward AGYW, (2) concerns about providing PrEP services for AGYW, (3) healthcare providers’ identity as mothers, and (4) privacy and breaches of confidentiality. An additional theme identified mainly in the AGYW data pertained to stigma and access to healthcare. CONCLUSION : Evidence is needed to inform strategies for addressing clinic stigma toward AGYW, with the goal of removing barriers to PrEP services for this group. While awareness has increased and progress has been achieved around the provision of comprehensive, youth-friendly sexual and reproductive health services, these programs need to be adapted for the specific concerns of young people seeking PrEP services. Our findings point to the four key areas noted above where programs seeking to address stigma toward AGYW in clinics can tailor their programming.The Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health.http://www.biomedcentral.com/bmcpublichealtham2023Medical Microbiolog

Influence of Transformational Leadership on Employee Performance: A Case Study of Local Non-Governmental Organizations in Kenya

A Research Project Report Submitted to the Chandaria School of Business in Partial Fulfilment of the Requirement for the Degree of Master of Science in Organizational Development (MOD)This study sought to determine the influence of transformational leadership on employee performance, the study focused on local Non-Governmental Organizations (NGOs) in Kenya. The study was directed by specific objectives that sought to determine: the influence of idealized influence on employee performance, the influence of inspirational motivation on employee performance, the influence of intellectual stimulation on employee performance, and the influence of individualized consideration on employee performance. To achieve this, the study adopted a quasi-experimental research design known as correlational research design. This design was deemed appropriate for the study because it enabled the researcher to measure the independent variable (transformational leadership) and the dependent variable (employee performance). The population of the study comprised a total of 79 employees from the five local NGOs. The sample frame for the study was the official list of employees as obtained from the head of each organization. Purposive sampling technique was used to select the targeted respondents from each organization. The researcher targeted at least 60% of respondents from each organization to give a sample size of 49 respondents. The study showed that the organizations utilized available resources efficiently and employees were provided with feedback on their performance. The organizations set goals to define what they needed to achieve, and take into consideration available employee competencies to enable achievement of these goals. The study revealed that the organizations supported innovative efforts from employees and embraced two-way communication. The leaders in these organizations provided followers with an inspiring mission and vision, and they involved employees in achieving it. Leaders in these organizations encouraged employees to become part of the overall organizational culture, and acted as role models towards attainment of organizational goals. The study found that leaders in these organizations permitted employees to "think outside the box", and encouraged them to try new ways of looking at a problem. The leaders also took into consideration the sentiments of employees - even if they did not conform to the views held by the leaders themselves. The leaders celebrated each employee’s contribution to the team, were sensitive to specific knowledge and capabilities that employees had when assigning them tasks, and were timely in resolving conflict. The study concludes that leaders in these organizations influence employee performance by applying the transformational leadership style. The leaders provide an inspiring vision, support innovation and match employee competencies with organization goals and objectives. The leaders act as role models towards attainment of organizational goals and encourage employees to “think outside the box”. The leaders eliminate chances of conflict by making employees feel they are part of the solution and ensure timely resolution of conflict when it occurs. The study recommends that the leaders of the local NGOs should continuously inspire their employees to enhance their performance and enable the organization achieve its goals and objectives. During times when organizations are going through organizational change, leaders should purpose to adopt a transformational leadership style to ensure that employee performance is not affected and employees stay motivated

Prevalence and Genotype Distribution of Human Papillomavirus in Women with Cervical Histopathology in Haiti

<p>The development of HPV vaccines has generated a great deal of hope that the burden of cervical cancer may be eliminated over the next several decades. However, this enthusiasm may be premature if the genotypes associated with high-grade cervical dysplasia and cancer in other countries does not match the select HPV genotypes that were targeted by current vaccines. The objective of this study was to document the profile of high-risk HPV genotypes that are associated with moderate and high-grade dysplasia in a subset of women living in Port-au-Prince and Leogane, Haiti. Preliminary data collected around the world and by Family Health Ministries in Haiti suggest that the high-grade disease seen in many communities may have a different spectrum than the US and Europe. The cross-sectional study was conducted in two medical clinics situated in the cities of Port-au-Prince and Leogane, Haiti. Genotype-specific distribution from cervical samples collected from 269 women was correlated with corresponding cytopathology results. Genotypes associated with HSIL or invasive cancer were HPV-16 (POR 6.8; 95% CI 2.62-17.86), HPV-18 (POR 4.3; 95% CI 1.46-12.40), HPV-35 (POR 4.3; 95% CI 1.63-11.33), and HPV-58 (POR 7.9; 95% CI 1.95-32.00). HPV-58 appeared to have a higher oncogenic potential than HPV-16 and HPV-18. There was a difference in the HPV genotypic profile found in cervical disease in this Haitian population compared to the United States and Europe. It may be less cost-effective to introduce existing HPV prophylactic vaccines to Haiti; resources may be better spent treating existing disease until more appropriate vaccines are developed.</p>Thesi

Antiretroviral Therapy (ART) Adherence and Prenatal Alcohol Use among Women Who Are Pregnant with HIV in South Africa

This brief report emphasizes the need to focus on women with HIV who are pregnant who use alcohol or other drugs. A recently completed implementation science study tested a gender-focused behavioral intervention, the Women’s Health CoOp (WHC), to improve antiretroviral therapy (ART) adherence and reduce alcohol use among women with HIV. The study identified 33 participants who had a positive pregnancy test result at the baseline assessment, of whom five participants remained pregnant during the 6-month duration of the study. Of the 33 pregnant participants at the baseline assessment, 55% reported past-month alcohol use, with 27% reporting a history of physical abuse and 12% reporting a history of sexual abuse. The five women who remained pregnant at 6 months showed improved ART adherence and reduced prenatal alcohol use. The gender-focused WHC intervention shows promise as a cost-effective, sustainable, behavioral intervention to address these intersecting syndemic issues. Future research should focus on identifying the needs of women with HIV who are pregnant who use alcohol or other drugs and developing tailored evidence-based behavioral interventions such as the WHC for preventing FASD in addition to improving ART adherence in this key population of women and reducing the economic burden on society

Seagrass restoration trials in tropical seagrass meadows of Kenya

The degradation of seagrasses is becoming prevalent in the Western Indian Ocean (WIO) region due to anchor damage, sea urchin herbivory, extreme events such as cyclones and floods and anthropogenic factors such as pollution and sediment inflows. Consequently, there have been numerous efforts to advance the restoration of degraded seagrass beds in several countries in the region. In Kenya, experimental restoration efforts were started in 2007 in response to seagrass habitat degradation due to sea urchin herbivory. Although the initial efforts experienced challenges, there were lessons learned which provided insights into subsequent restoration work using different techniques. In this paper, insights are provided into three types of restoration techniques; the sod technique, the seagrass mimic technique, and the Hessian bag technique. In the case of the sod technique, Thalassodendron ciliatum showed a decline from 20 ± 1.7 shoots sod-1 in the first three weeks to 7 ± 4.4 shoots sod-1 at the end of the experimental period of the study, while Thalassia hemprichii sods showed an increase from 28 ± 3.4 shoots sod-1 to 32 ± 2.7 shoots sod-1 over the same period. For the Hessian bag method, the expectation was that the pilot site would be filled with the transplanted seagrass species, Thalassia hemprichii, but the findings showed that different species including Halodule uninervis, Syringodium isoetifolium, Halophila stipulacea, Cymodocea rotundata, and Cymodocea serrulata colonized the area. This indicated that it was not possible to restore the area to its original status, but that the area could be rehabilitated. The costs of restoration have also been assessed as well as community participation in such initiatives. These findings provide insights for restoration efforts in Kenya and provide a baseline for future work