Project Masihambisane: a cluster randomised controlled trial with peer mentors to improve outcomes for pregnant mothers living with HIV

Abstract Background Pregnant women living with HIV (WLH) face daily challenges maintaining their own and their babies' health and mental health. Standard Prevention of Maternal to Child Transmission (PMTCT) programs are not designed to address these challenges. Methods/Design As part of a cluster randomized controlled trial, WLH are invited to attend four antenatal and four postnatal small group sessions led by a peer WLH (a Peer Mentor). The WLH and their babies are assessed during pregnancy and at one week, six months, and twelve months post-birth. Mobile phones are used to collect routine information, complete questionnaires and remain in contact with participants over time. Pregnant WLH (N = 1200) are randomly assigned by clinic (N = 8 clinics) to an intervention program, called Masihambisane (n = 4 clinics, n = 600 WLH) or a standard care PMTCT control condition (n = 4 clinics; n = 600 WLH). Discussion Data collection with cellular phones are innovative and effective in low-resource settings. Standard PMTCT programs are not designed to address the daily challenges faced by WLH; Peer Mentors may be useful in supporting WLH to cope with these challenges. Trial registration ClinicalTrials.gov registration # NCT0097269

If not now, when? Time for the European Union to define a global health strategy

Speakman, E. M., McKee, M., & Coker, R. (2017). If not now, when? Time for the European Union to define a global health strategy. Lancet Global Health, 5(4), e392-e393. https://doi.org/10.1016/S2214-109X%2817%2930085-

Louder than the frame:

Book abstract. Almost 30 years after the founding of the first curatorial studies program (at the École du Magasin, Grenoble), with the curator remaining a figure of curiosity and fascination in the contemporary art world, a new question has emerged: how do we educate curators? Great Expectations: Prospects for the Future of Curatorial Education explores this question, focusing in particular on the challenges, opportunities and subjects that motivate educators and students. How has curatorial education changed in the past 25 years, and what will the next 25 years bring?

South Africa’s domestic resource mobilization position: is it good or bad and why

This paper presents a case study on South Africa’s resource mobilisation. Domestic resource mobilisation is defined as the generation of savings from domestic resources and encouragement of investments from foreign investors to create a big domestic resource pull and the allocation of resources to economically and socially productive sectors. In South Africa, government fiscal policy and the monetary policy as well as the expenditure systems are well developed. The government lead institutions in the domestic resource mobilisation include, and not limited to, National Treasury, South African Receiver of Revenue (SARS), South African Reserve Bank (SARB), Fiscal and Financial Commission (FFS), and Statistics South Africa. The market oriented financial system of South Africa implies minimum state interventions as market mechanism is assumed to achieve the highest efficiency in terms of resource allocation. However, government acknowledge that market imperfections do occasionally arise and that intervention by way of regulation is sometimes justified. The government therefore promulgates legislation and creates regulatory authorities and authorise them to influence the economy according to government policy. South Africa has put in place strong administrative measures to ensure efficient tax collection process, however, the country still experiences large loses in the form of illicit financial flows. It is estimated that the country lost over US$ 24 billion in the last decade. South Africa’s domestic resource mobilisation status has been very good, however, recently a number of variables that are used to measure the healthy nature of this are going the opposite direction

Gender and poverty reduction: voice, dialogue and targeting

Commissioned by Department of Science and Technology's (DST) Unit on Technology for Social ImpactThis study examined the gendered dimensions of poverty in South Africa and their implications for poverty reduction interventions in South Africa. The study identifies and analyses national approaches to understanding and addressing poverty and their integration of gender. It also identifies and analyses approaches to understanding and addressing poverty and their integration of gender in three countries: Chile, Brazil and India. From these understandings, the study develops recommendations for developing integrated approaches to understanding poverty and its links to gender inequality and for developing and implementing ameliorative strategies. The research questions, in particular included: * What are the gendered dimensions of poverty and their implications for poverty reduction interventions in South Africa? * What poverty reduction policy and interventions exist to change the material realities of women and men's lives in South Africa? * How have other (selected) countries understood and addressed poverty, and how do their strategies aim to change the gendered lives of women and men

Facilitators and barriers to implementing provider-initiated HIV counselling and testing at the clinic-level in Ekurhuleni District, South Africa

BACKGROUND: HIV testing is the entry point into the HIV care continuum and critical for HIV epidemic control. Facility-based HIV testing services (HTS) reach individuals who are already seeking clinical care and engaging with the medical care system. For this reason, individuals diagnosed with HIV during facility-based HIV testing are more likely to continue into HIV care. To increase the number of PLHIV who are diagnosed and initiated on ART, in 2015, the South African Department of Health instituted Provider-Initiated Counselling and Testing (PICT) policy-encouraging healthcare providers to recommend HIV testing, but this strategy remains under-utilized. We aimed to identify key constraints to the normalization of PICT implementation in 10 Ekurhuleni District healthcare facilities in South Africa. METHODS: In-depth interviews were conducted with 40 healthcare workers (28 clinicians and 12 lay counsellors). Health care workers were purposefully selected to participate in the interviews, stratified by health facility and work category. Interviews were audio-recorded, transcribed, and translated for analysis. Thematic analysis was guided by the normalization process theory (NPT). NPT theory explains how practices are routinely embedded within organizational contexts. We used NVivo 10 software for qualitative data management. RESULTS: Both clinicians and lay counsellors exhibited a clear understanding of the PICT policy- acknowledging its purpose and value. The identified barrier to normalization of PICT among clinicians was offering HIV testing based on suspicion of HIV despite understanding that PICT involves offering testing to all clients. Additionally, clinicians perceived PICT as incongruent with their clinical roles and perceived it to be lay counsellors\u27 responsibility. The main facilitator was the participation of all healthcare workers, specifically the presence of lay counsellors, although they also faced barriers such as a lack of workspace and under-appreciation. CONCLUSIONS: Use of NPT helped identify barriers that prevent the normalization of PITC and its integration into routine patient care. These barriers can be modified by low-cost interventions that promote congruence of PICT to the roles of clinicians and integrate the role of lay counsellors within the patient flow in the facility

Project Masihambisane: a cluster randomised controlled trial with peer mentors to improve outcomes for pregnant mothers living with HIV

Pregnant women living with HIV (WLH) face daily challenges maintaining their own and their babies' health and mental health. Standard Prevention of Maternal to Child Transmission (PMTCT) programs are not designed to address these challenges. As part of a cluster randomized controlled trial, WLH are invited to attend four antenatal and four postnatal small group sessions led by a peer WLH (a Peer Mentor). The WLH and their babies are assessed during pregnancy and at one week, six months, and twelve months post-birth. Mobile phones are used to collect routine information, complete questionnaires and remain in contact with participants over time. Pregnant WLH (N = 1200) are randomly assigned by clinic (N = 8 clinics) to an intervention program, called Masihambisane (n = 4 clinics, n = 600 WLH) or a standard care PMTCT control condition (n = 4 clinics; n = 600 WLH). Data collection with cellular phones are innovative and effective in low-resource settings. Standard PMTCT programs are not designed to address the daily challenges faced by WLH; Peer Mentors may be useful in supporting WLH to cope with these challenges.