Factors influencing the use of voluntary counselling and testing by university students

The study explored the factors influencing the use of voluntary counselling and testing by university students. This was done by undertaking an exploratory and descriptive qualitative study. Focus group discussions and field notes were used to collect data from the participants. Outcomes from the study revealed various factors to the uptake of Voluntary Counselling and Testing (VCT) services by university students namely: the desire to know one‟s HIV status, illness, pregnancy, blood donation, to get a reward, the influence of significant others, the influence of media, awareness campaigns, compulsion, to get a job, curiosity, to be a positive role model and the positive attitude and professional conduct of the health care provider. The study also revealed various challenges to the uptake of VCT services by university students namely: the fear of being diagnosed HIV positive, HIV/AIDS-related stigma and discrimination, the low perception of risk to HIV infection, the lack of student friendly VCT services, the shortage of human and infrastructural resources, the inaccessibility of VCT services, the long waiting period for test results, negative perceptions about VCT, the problems with pre-test counselling and ignorance. Going by the participants‟ suggestions VCT services uptake by university students could be improved by increased resource allocation (incentives, human and infrastructural resources), increased awareness campaigns, and improved counselling and making VCT services more accessibleInformation ScienceM.A. (Public Health

Perceived influence of value systems on the uptake of voluntary medical male circumcision among men in Kweneng East, Botswana

© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Botswana is one of the countries in Eastern and Southern Africa significantly impacted by the Human Immunodeficiency Virus (HIV). To control the spread of HIV, the government in 2009 rolled out the voluntary medical male circumcision (VMMC) programme as an additional HIV prevention strategy with the goal of circumcising 80% of HIV negative men by 2016. However, the country failed to achieve this goal as less than 30% of the targeted men were circumcised by 2016. A study was therefore conducted to explore and describe the factors that are perceived by men in Botswana to influence the uptake of VMMC in order to inform future policymaking and programming on VMMC. An exploratory descriptive, qualitative design was utilised to investigate perceived factors influencing the uptake of VMMC among men. Data were collected from 38 men, aged 18–49 years in Kweneng East, Botswana using semi-structured individual interviews and focus group discussions (FGDs). Tesch\u27s method of qualitative data analysis was used to code and categorise transcribed data into meaningful themes. Upon analysis, three themes emerged as influencing the uptake of VMMC: (a) the influence of value systems associated with stakeholder consultation in the community; (b) the influence of value systems associated with cultural beliefs and (c) the influence of value systems associated with religious beliefs. The influence of value systems associated with stakeholder consultation in the community was found to manifest in the form of the lack of consultation with men at the inception of the VMMC; the lack of involvement of village elders during the service delivery process and the lack of involvement of women in VMMC. In addition, the influence of value systems associated with cultural beliefs was found to manifest in the form of the lack of openness between parents and children on sexual matters and the lack of traditional leadership support in VMMC. Lastly, the influence of value systems associated with religious beliefs was found to manifest in the form of religious views not in support of the VMMC and religious views in support of the VMMC. It is concluded that value systems associated with stakeholder consultation, cultural beliefs and religious beliefs were the factors influencing the uptake of VMMC among men in Kweneng East, Botswana, and these factors to a larger extent deterred men from using VMMC services. Based on these findings, it is therefore concluded that government and other providers of VMMC should consider the influence of value systems on the uptake of VMMC in order to provide culturally congruent VMMC services and boost of the uptake of VMMC among men in Kweneng East, Botswana

Preliminary efficacy, feasibility and safety of intra-umbilical oxytocin to reduce the time to placental delivery at caesarean section: An exploratory randomized trial

Background: Delayed placental separation either after vaginal birth or caesarean birth is an important cause of postpartum haemorrhage, among other causes such as uterine atony. Intra-umbilical oxytocin has been shown to reduce the time to placental delivery after vaginal birth. However, the efficacy of intra-umbilical oxytocin to reduce the time to placental delivery following caesarean section birth is not known. Objectives: To explore the preliminary efficacy, feasibility and safety of intra-umbilical oxytocin to reduce the time to placental delivery at caesarean section. Methods: A double-blind, placebo-controlled, exploratory randomized clinical trial was conducted at a tertiary hospital in the Eastern Cape Province, South Africa. A total of 66 women undergoing elective caesarean section were enrolled in the study and randomized into oxytocin group (n = 33) receiving an intra-umbilical infusion of 20 units of oxytocin in 30ml saline, and placebo group (n = 33) receiving an intra-umbilical infusion of 30ml saline. Data were analysed using Epi Info and RevMan software. Preliminary efficacy was assessed by examining the time elapsed from birth of the baby to complete delivery of the placenta; blood loss more than 500 ml; the need for manual removal of the placenta; and the completeness of the placenta. Feasibility was determined by observing the successful insertion of the catheter and injection of the solution. Safety was evaluated by investi-gating adverse effects of the procedure. Results: Four women (12%) in the placebo group had a delayed placental delivery compared to one (3%) in the oxytocin group. The mean time from birth to placental delivery was 159 (SD 61) seconds in the placebo group and 143 (SD 45) seconds in the oxytocin group. There was no statistically significant difference between the two groups. Feasibility of the procedure was con-firmed by successful insertion of the catheter and injection of the majority of the solution in all 66 cases. No adverse effects of the procedure were identified. Conclusion: Administration of intra-umbilical oxytocin is feasible, safe and has potential to reduce the time of placental delivery at caesarean section. Further studies involving larger sample sizes are justified

Barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide: A systematic review

Background: Interventions aimed at reducing risky sexual behavior are considered an important strategy for averting Human Immunodeficiency Virus (HIV) infection among youth (15-24 years) who continue to be at risk of the disease. Enhancing intervention success requires a comprehensive understanding of the barriers and facilitators to interventions targeting youth. However, there is lack of a systematic review of both quantitative and qualitative studies to comprehensively identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide. This review aimed to identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth globally based on original peer-reviewed studies published in the last decade. Methods: The Joanna Briggs Institute approach for mixed methods systematic reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to guide this review. Nine electronic databases, Joint United Nations Programme on HIV/AIDS and World Health Organization websites, and reference lists of included studies and systematic reviews on barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth were searched for eligible articles. Studies that met the inclusion criteria underwent quality appraisal and data extraction. Findings were analyzed using thematic synthesis and underpinned by Nilsen, 2015\u27s Determinant Framework. Results: Overall 13 studies comprising of eight qualitative studies, four quantitative studies and one mixed methods study were included in the review. Several barriers and facilitators across the five Determinant Framework domains were identified. Most of the barriers fell under the characteristics of the context domain (e.g., gender-biased norms). The next important group of barriers emerged within the characteristics of the end users domain (e.g., fear of relationship breakdown). In terms of facilitators, the majority fell under the characteristics of the strategy of facilitating implementation domain (e.g., implementation of intervention with fidelity) and characteristics of the end users domain (e.g., fear of pregnancy or sexually transmitted infections). The next common set of facilitators appeared within the characteristics of the context domain (e.g., family support). Conclusion: This review identified several multi-level barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth. Multi-level and combination approaches are needed to address these factors and enhance intervention success

Impact of You Only Live Once: A resilience-based HIV prevention intervention to reduce risky sexual behaviour among youth in South Africa

Purpose: Interventions focused on promoting resilience or protective factors of youth have been proposed as a strategy for reducing risky behaviours associated with HIV infection among youth; however few studies have explored their effectiveness. This study assessed the impact of a resilience-based HIV prevention intervention (You Only Live Once) on risky sexual behaviours, resilience and protective factors of youth. Methods: A one-group pretest-posttest design was used. One hundred and ninety-seven youth aged 15 – 24 years were conveniently recruited from a non-profit organisation in Maluti-a-Phofung Local Municipality, South Africa and participated in a 12-session, resilience-based HIV intervention delivered over a 1-week period by trained adult facilitators. Outcomes of interest were assessed at baseline and 3-month follow-up using validated risky sexual behaviour measures, and Child and Youth Resilience Measure. Mixed effect logistic and linear regression models were formulated to assess the impact of the intervention on risky sexual behaviours; resilience and protective factors respectively. Results: Compared to baseline, participants at 3-month follow-up were 68 % less likely to have unprotected sex, 22 % less likely to regret their decision to engage in sexual activity and 0.4 % less likely to be pregnant or made someone pregnant. Conversely, participants at the 3-month follow-up had a higher propensity to engage in multiple sexual partnerships, transactional sex and intergenerational sex than baseline. Participants at 3-month follow-up had significant improvements in their scores of resilience, individual capacities and contextual factors that facilitate a sense of belonging (p \u3c 0.05). Conclusion: You Only Live Once intervention appeared to have mitigated some risky sexual behaviours, and improved resilience and protective factors over a 3-month period. These findings suggest that the intervention has ability to reduce risky sexual behaviours associated with HIV, and improve resilience and protective factors among youth in South Africa. Further evaluation of the intervention with a rigorous study design, larger sample size and longer period for follow-up is warranted

Systematic review protocol of the effectiveness of HIV prevention interventions for reducing risky sexual behaviour among youth globally

INTRODUCTION: Human immunodeficiency virus (HIV) prevention interventions focused at reducing risky sexual behaviours are an important strategy for preventing HIV infection among youth (15-24 years) who continue to be vulnerable to the disease. This systematic review aims to synthesise current global evidence on the effectiveness of HIV prevention interventions for reducing risky sexual behaviour among youth in the last decade. METHODS AND ANALYSIS: MEDLINE/PubMed, EMBASE, PsychINFO, ProQuest Central, CINAHL and Web of Science databases, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform and reference lists of included studies and systematic reviews on effectiveness of HIV prevention interventions for reducing risky sexual behaviour among youth will be searched for articles published from August 2011 to August 2021. Eligible studies will be longitudinal studies including randomised controlled trials and quasi-experimental studies that examined the effectiveness of HIV prevention interventions among youth populations (15-24 years) with risky sexual behaviour as a primary or secondary outcome. Study selection and quality assessment will be undertaken independently by three reviewers and disagreements will be resolved through consensus. Data analysis will be undertaken using RevMan software V.5.3.3. A random effects meta-analysis will be conducted to report heterogeneous data where statistical pooling is achievable. We will use I2 statistics to test for heterogeneity. Where appropriate, a funnel plot will be generated to assess publication bias. Where statistical pooling is unachievable, the findings will be reported in a narrative form, together with tables and figures to assist in data presentation if required. Reporting of the systematic review will be informed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ETHICS AND DISSEMINATION: Ethical approval is not required. Findings of the systematic review will be published in a peer-reviewed journal. The findings will be of interest to researchers, healthcare practitioners and policymakers. PROSPERO REGISTRATION NUMBER: CRD42021271774

Evaluation of the you only live once: A resilience-based intervention for reducing risky sexual behaviours associated with HIV infection among youth in South Africa

Background: South African youth (aged 15–24 years) remain at high risk of contracting the human immunodeficiency virus [HIV], despite interventional efforts to prevent the disease. Interventions to strengthen resilience or protective factors may avert risky sexual behaviours linked to HIV transmission in youth, but little research has assessed the effectiveness of such interventions. This study referenced resilience theory in evaluating the impact of a resilience-based HIV prevention intervention, You Only Live Once [YOLO], for youth in South Africa. Perceptions and experiences of participants and intervention implementers were also explored. Methods: The study was done at a not-for-profit organisation that implemented the YOLO intervention in Maluti-a-Phofung Local Municipality, South Africa. Guided by pragmatism, an explanatory sequential mixed methods design was employed. In the first, quantitative phase, a one-group pretest-posttest design was used. Youth completed a self-administered questionnaire at baseline (n = 197) and three months after the intervention (n = 176). Validated risky sexual behaviour questions and the Child and Youth Resilience Measure [CYRM-28] were used to assess participants’ risky sexual behaviours, resilience and protective factors respectively. Data were analysed using R Statistical Software, Version 4.0.2. The impact of the intervention on risky sexual behaviours, and on resilience and protective factors was established using mixed effect logistic and linear regression models respectively. In the second, qualitative phase, 10 youth and four intervention implementers were interviewed to explore their perceptions and experiences of the intervention. An inductive thematic approach was applied to analyse the qualitative data. Findings from both phases were integrated narratively using a joint display. Results: Quantitative analyses suggest that the intervention positively impacted some risky sexual behaviours, and significantly improved resilience and some protective factors. At three months, participants were 68% less likely to have unprotected sex [odds ratio (OR) = 3.102; 95% confidence interval (CI) = 0.959 to 9.912], 22% less likely to regret their decision to engage in sexual activity [OR = 1.278; 95% CI = 0.430 to 3.797] and 0.4% less likely to be pregnant or have made someone pregnant [OR = 1.004; 95% CI = 0.149 to 6.776] than baseline. Also, participants had significant improvements in their scores of resilience [p = 0.013], individual capacities [p = 0.004] and contextual factors that facilitate a sense of belonging [p = 0.007]. However, the intervention did not positively impact multiple sexual partnerships, transactional sex and intergenerational sex. There was limited impact on relationship with primary caregiver. Qualitative analyses yielded three main themes: (1) Acceptability and impact of the intervention; (2) Factors influencing intervention implementation; and (3) Recommendations to improve intervention implementation. Integrated findings reveal that whereas the quantitative results demonstrate the impact of the intervention on youth, the qualitative data deepen the understanding of these results by indicating the impact of the intervention on youth, how youth accepted the intervention, factors that promoted and hindered implementation of the intervention, and how implementation of the intervention could be improved. Conclusion: The YOLO intervention has potential to reduce risk of HIV infection among youth in South Africa and similar contexts. However, there are barriers to the implementation of the programme that need to be eradicated to enhance intervention success. Further evaluation of the intervention with a rigorous study design, longer period for follow-up and larger sample is recommended

Facilitators for and Barriers to the Implementation of National Tuberculosis Management Guidelines

The South African government developed the National Tuberculosis Management Guidelines (NTBMGs) to provide guidance to professional healthcare workers on the management of people with TB and also those co-infected with HIV. However, little is known about primary healthcare (PHC) nurses’ perceptions of the implementation of the NTBMGs, despite their critical role in TB management. The purpose of this study was to explore PHC nurses’ perception of the implementation of the NTBMGs in order to identify factors influencing the implementation of the NTBMGs and to make recommendations to improve the implementation of the NTBMGs. The study was conducted in the Eastern Cape, South Africa. The Normalization Process Model (NPM) was used as a theoretical framework to understand the factors influencing the implementation of the NTBMGs. A qualitative, explorative, descriptive and contextual research design was utilised. Data were collected using individual semi-structured interviews on a purposive sample of 10 PHC nurses working in rural clinics. Data were analysed following a descriptive method of Tesch. The study revealed several facilitators for and barriers to the implementation of the NTBMGs based on the NPM. The facilitators included the PHC nurses’ satisfaction with the Directly Observed Treatment, Short Course (DOTS) strategy in rendering health services to TB patients, the PHC nurses’ perception of TB meetings as an appropriate platform for problem-solving, of the NTBMGs to be consistent with TB management, and of job satisfaction in relation to patient improvement. The barriers included poverty, inadequate training, shortage of staff, and a lack of material resources, a proper infection control policy, and space. There is a need for the provision of adequate human, material and infrastructural resources in order to eliminate the barriers to the implementation of the NTBMGs