The treatment ambassador program: a highly acceptable and feasible community-based peer intervention for South Africans living with HIV who delay or discontinue antiretroviral therapy

We conducted a novel pilot randomized controlled trial of the Treatment Ambassador Program (TAP), an 8-session, peerbased, behavioral intervention for people with HIV (PWH) in South Africa not on antiretroviral therapy (ART). PWH (43 intervention, 41 controls) completed baseline, 3- and 6-month assessments. TAP was highly feasible (90% completion), with peer counselors demonstrating good intervention fdelity. Post-intervention interviews showed high acceptability of TAP and counselors, who supported autonomy, assisted with clinical navigation, and provided psychosocial support. Intentionto-treat analyses indicated increased ART initiation by 3 months in the intervention vs. control arm (12.2% [5/41] vs. 2.3% [1/43], Fisher exact p-value=0.105; Cohen’s h=0.41). Among those previously on ART (of for>6 months), 33.3% initiated ART by 3 months in the intervention vs. 14.3% in the control arm (Cohen’s h=0.45). Results suggest that TAP was highly acceptable and feasible among PWH not on ART

Nutritional knowledge amongst an adult South African sample of low socioeconomic status

The aim of this study was to determine the socioeconomic predictors of nutritional knowledge (NK) based on total household income, educational level and employment status. A secondary aim was to determine the relationship between NK and the body mass indexes (BMI) of children. Using a cross-sectional study, 39 participants enrolled in the Prospective Urban Rural Epidemiological (PURE) study were purposively sampled for data on their children’s age, gender, height and weight. A semi-structured researcher-generated questionnaire was used to collect sociodemographic information and assess NK. Pearson correlation assessed the relationship between the parent’s NK and their child’s BMI. Linear regression analysis was used to test predictive relationships. The Alpha level was set at p < 0.05. Regression analysis showed that 2.5% of the variance (R2 = 0.25) was based on NK and was significant (p < 0.05). Employment status was a significant predictor (p = -0.038) of NK, when controlling for total household income and education level. Parents of underweight children had the lowest NK. In conclusion, there was a positive correlation between the children’s BMI and their parents NK, but this was not significant. Employment status was a significant predictor of NK. Public health practitioners should develop interventions based on NK, which might benefit black parents, especially those of low socioeconomic status

An exploration of the concept of community and its impact on participatory governance policy and service delivery in poor areas of Cape Town, South Africa

The inclusion of citizen participation as a means to the equitable delivery of public services has distinguished South Africa’s democratic development trajectory over the last 20 years. While equitable resource allocation remains high on the agenda of more recently democratised states, most of which have highly diverse and unequally resourced populations. Influencing the design of more inclusive participation is the notion of a universal citizenship that applies the concept of the equality of individuals to the needs, identities and sense of agency of citizens both between and within states. The liberal democratic theoretical conceptualisation of the individual centres on the notion of universal citizen, who is the recipient and embodiment of democracy through the rights bestowed through the democratic model. This conceptualisation has been criticised for its inability to deal with the imprecision of individual and collective political identities, especially as these evolve in newly democratic contexts. The construction of a single identity citizen living in communities imbued with homogenous characteristics is carried forward into the policy construction of participatory governance. This article explores and challenges the notion of the single identity citizen that belongs to one homogenous community that can be identified and drawn into formally constructed government spaces. The paper explores the construction of political and socio-economic identities and how notions of community are constructed by citizens, on the one hand, and government policies, on the other.IS

The global pendulum swing towards community health workers in low- and middle-income countries: A scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014

BACKGROUND: There has been a substantial increase in publications and interest in community health workers (CHWs) in low- and middle-income countries (LMIC) over the last years. This paper examines the growth, geographical distribution and programmatic orientations of the indexed literature on CHWs in LMIC over a 10-year period. METHODS: A scoping review of publications on CHWs from 2005 to 2014 was conducted. Using an inclusive list of terms, we searched seven databases (including MEDLINE, CINAHL, Cochrane) for all English-language publications on CHWs in LMIC. Two authors independently screened titles/abstracts, downloading full-text publications meeting inclusion criteria. These were coded in an Excel spreadsheet by year, type of publication (e.g. review, empirical), country, region, programmatic orientation (e.g. maternal-child health, HIV/AIDS, comprehensive) and CHW roles (e.g. prevention, treatment) and further analysed in Stata14. Drawing principally on the subset of review articles, specific roles within programme areas were identified and grouped. FINDINGS: Six hundred seventy-eight publications from 46 countries on CHWs were inventoried over the 10-year period. There was a sevenfold increase in annual number of publications from 23 in 2005 to 156 in 2014. Half the publications were reporting on initiatives in Africa, a third from Asia and 11 % from the Americas (mostly Brazil). The largest single focus and driver of the growth in publications was on CHW roles in meeting the Millennium Development Goals of maternal, child and neonatal survival (35 % of total), followed by HIV/AIDS (16 %), reproductive health (6 %), non-communicable diseases (4 %) and mental health (4 %). Only 17 % of the publications approached CHW roles in an integrated fashion. There were also distinct regional (and sometimes country) profiles, reflecting different histories and programme traditions. CONCLUSIONS: The growth in literature on CHWs provides empirical evidence of ever-increasing expectations for addressing health burdens through community-based action. This literature has a strong disease- or programme-specific orientation, raising important questions for the design and sustainable delivery of integrated national programmes.Scopu

Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): A prospective cohort study

Some studies, mainly from high-income countries (HICs), report that women receive less care (investigations and treatments) for cardiovascular disease than do men and might have a higher risk of death. However, very few studies systematically report risk factors, use of primary or secondary prevention medications, incidence of cardiovascular disease, or death in populations drawn from the community. Given that most cardiovascular disease occurs in low-income and middle-income countries (LMICs), there is a need for comprehensive information comparing treatments and outcomes between women and men in HICs, middle-income countries, and low-income countries from community-based population studies. Methods: In the Prospective Urban Rural Epidemiological study (PURE), individuals aged 35–70 years from urban and rural communities in 27 countries were considered for inclusion

Integrating the prevention of mother-to-child transmission of HIV into primary healthcare services after AIDS denialism in South Africa: perspectives of experts and health care workers - a qualitative study

Integrating Prevention of Mother-to-Child Transmission (PMTCT) programmes into routine health services under complex socio-political and health system conditions is a priority and a challenge. The successful rollout of PMTCT in sub-Saharan Africa has decreased Human Immunodeficiency Virus (HIV), reduced child mortality and improved maternal health. In South Africa, PMTCT is now integrated into existing primary health care (PHC) services and this experience could serve as a relevant example for integrating other programmes into comprehensive primary care. This study explored the perspectives of both experts or key informants and frontline health workers (FHCWs) in South Africa on PMTCT integration into PHC in the context of post-AIDS denialism using a Complex Adaptive Systems framework. METHODS: A total of 20 in-depth semi-structured interviews were conducted; 10 with experts including national and international health systems and HIV/PMTCT policy makers and researchers, and 10 FHCWs including clinic managers, nurses and midwives. All interviews were conducted in person, audio-recorded and transcribed

Household, community, sub-national and country-level predictors of primary cooking fuel switching in nine countries from the PURE study

Introduction. Switchingfrom polluting (e.g. wood, crop waste, coal)to clean (e.g. gas, electricity) cooking fuels can reduce household air pollution exposures and climate-forcing emissions.While studies have evaluated specific interventions and assessed fuel-switching in repeated cross-sectional surveys, the role of different multilevel factors in household fuel switching, outside of interventions and across diverse community settings, is not well understood. Methods.We examined longitudinal survey data from 24 172 households in 177 rural communities across nine countries within the Prospective Urban and Rural Epidemiology study.We assessed household-level primary cooking fuel switching during a median of 10 years offollow up (∼2005–2015).We used hierarchical logistic regression models to examine the relative importance of household, community, sub-national and national-level factors contributing to primary fuel switching. Results. One-half of study households(12 369)reported changing their primary cookingfuels between baseline andfollow up surveys. Of these, 61% (7582) switchedfrom polluting (wood, dung, agricultural waste, charcoal, coal, kerosene)to clean (gas, electricity)fuels, 26% (3109)switched between different polluting fuels, 10% (1164)switched from clean to polluting fuels and 3% (522)switched between different clean fuels

Perceptions about body image and sizes among black African girls living in Cape Town

this study shows that opinions and beliefs about body image start in adolescence. It is therefore important to consider these perceptions when designing interventions for preventing obesity and other chronic non-communicable diseases during early childhood.

What do black South African adolescent girls think about their body size?

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