Cohort profile: the Siyakhula cohort, rural South Africa

No abstract available

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

Public perceptions, beliefs and experiences of fostering and adoption: a national qualitative study in South Africa

In South Africa, rates of adoption remain low while the number of fostered children continually rises. Little is known about the public perceptions, beliefs and experiences that inform decisions to either foster or adopt in South Africa. This qualitative research explored these issues among a national sample of childless adults, biological parents, kin and non-kin fostering parents and prospective and successful adopters. Fostering is driven predominantly by access to subsidies but is also informed by socio-cultural beliefs. Low adoption rates are influenced by an absence of subsidies, poor access to quality adoptive services and a lack of information about adoption.

Living with HIV, disclosure patterns and partnerships a decade after the introduction of HIV programmes in rural South Africa

Prevention of mother-to-child Transmission and HIV Treatment programmes were scaled-up in resource-constrained settings over a decade ago, but there is still much to be understood about women's experiences of living with HIV and their HIV disclosure patterns. This qualitative study explored women's experiences of living with HIV, 6-10 years after being diagnosed during pregnancy. The area has high HIV prevalence, and an established HIV treatment programme. Participants were enrolled in a larger intervention, Amagugu, that supported women (n = 281) to disclose their HIV status to their children. Post-intervention we conducted individual in-depth interviews with 20 randomly selected women, stratified by clinic catchment area, from the total sample. Interviews were entered into ATLAS.ti computer software for coding. Most women were living with their current sexual partner and half were still in a relationship with the child's biological father. Household exposure to HIV was high with the majority of women knowing at least one other HIV-infected adult in their household. Eighteen women had disclosed their HIV status to another person; nine had disclosed to their current partner first. Two main themes were identified in the analyses: living with HIV and the normalisation of HIV treatment at a family level; and the complexity of love relationships, in particular in long-term partnerships. A decade on, most women were living positively with HIV, accessing care, and reported experiencing little stigma. However, as HIV became normalised new challenges arose including concerns about access to quality care, and the need for family-centred care. Women's sexual choices and relationships were intertwined with feelings of love, loyalty and trust and the important supportive role played by partners and families was acknowledged, however, some aspects of living with HIV presented challenges including continuing to practise safe sex several years after HIV diagnosis.

Adoption in South Africa: trends and patterns in social work practice

This paper reports findings from a research study on adoption in South Africa conducted in 2009. The research included secondary data analysis of the South African National Adoption Register to establish trends and patterns of adoption in South Africa between 2004 and 2009, and primary data collection through qualitative interviews with key informants in public and private social welfare services to explore attitudes, knowledge and experiences of social work practice related to adoption. The quantitative findings report the number of national and international adoptions along with trends and socio-demographic patterns of national adoptions. Qualitative findings report on social work practice, systemic barriers and social national adoptions. The paper highlights comparisons to adoption literature in the USA, a country with a similar legislative framework and cultural complexities, but significantly more resources for implementation. Recommendations are offered for social work practice, national data collection and policy implementation efforts to support efforts to increase adoption.

The future of the Euro as an international currency A transactions perspective

SIGLEAvailable from British Library Document Supply Centre-DSC:8368.310(LSE-FMG-SP--91) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Evaluation of a brief intervention to improve the nursing care of young children in a high HIV and AIDS setting

Caregivers and young children (107 pairs) and 17 nurses participated in an intervention to improve the care of young children in hospital in a high HIV and AIDS setting. The intervention addressed caregiver expectations about admission and treatment, responsive feeding, coping with infant pain and distress, assistance with medical procedures, and preparation for discharge and home care. Following a preparatory and piloting phase, measures of nurse burnout, caregiver physical and emotional wellbeing, and caregiver-child interaction were made before and after intervention. No changes were found between before and after intervention on assessments of caregiver wellbeing. However, mothers in the post intervention phase rated nurses as more supportive; mother-child interaction during feeding was more relaxed and engaged, and babies were less socially withdrawn. While the intervention proved useful in improving certain outcomes for children and their caregivers, it did not address challenging hospital and ward administration or support needed by caregivers at home following discharge. To address the latter need, the intervention has been extended into the community through home-based palliative care and support.

Intimate partner violence, HIV, and mental health: a triple epidemic of global proportions

Intimate partner violence (IPV) is a global health problem of epidemic proportions, affecting a third of women across the globe and as many as 60% in heavily affected regions of Africa. There is strong evidence that risk of IPV is heightened in HIV-infected women, and emerging evidence linking experiencing IPV and/or HIV to a higher likelihood of experiencing mental health problems. This triple burden makes women in Africa, living in the epicentre of HIV, all the more vulnerable. In this synthesis, this study reviewed literature pertaining to the overlap of IPV, HIV, and mental health problems. It presents a series of geographical maps illustrating the heavy burden of IPV and HIV globally, and how these coincide with a growing prevalence of mental health problems in Africa. Furthermore, it presents evidence on: the association between IPV and HIV, shared risk factors, and health consequences. This synthesis sheds light on the fact that 30% of women are affected by these three burdens concurrently, and the need for intervention is essential. Promising large scale interventions which have taken place in Africa are described, and evidence is presented in support of integrated versus targeted screening.

Maternal and child psychological outcomes of HIV disclosure to young children in rural South Africa: the Amagugu intervention

Increasingly, HIV-infected parents are surviving to nurture their children. Parental HIV disclosure is beneficial, but disclosure rates to younger children remain low. Previously, we demonstrated that the 'Amagugu' intervention increased disclosure to young children; however, effects on psychological outcomes have not been examined in detail. This study investigates the impact of the intervention on the maternal and child psychological outcomes. Method: This pre-post evaluation design enrolled 281 HIV-infected women and their HIV-uninfected children (6-10 years) at the Africa Centre for Health and Population Studies, in rural South Africa. The intervention included six home-based counselling sessions delivered by lay-counsellors. Psychological outcomes included maternal psychological functioning (General Health Questionnaire, GHQ12 using 0, 1, 2, 3 scoring); parenting stress (Parenting Stress Index, PSI36); and child emotional and behavioural functioning (Child Behaviour Checklist, CBCL). The proportions of mothers with psychological distress reduced after intervention: GHQ threshold at least 12 (from 41.3 to 24.9%, P<0.001) and GHQ threshold at least 20 (from 17.8 to 11.7%, P=0.040). Parenting stress scores also reduced (Pre M=79.8; Post M=76.2, P<0.001): two subscales, parental distress and parent-child relationship, showed significant improvement, while mothers 'perception' of 'child as difficult' was not significantly improved. Reductions in scores were not moderated by disclosure level (full/partial). There was a significant reduction in child emotional and behavioural problems (CBCL Pre M=56.1; Post M=48.9, P<0.001). Conclusion: Amagugu led to improvements in mothers' and children's mental health and parenting stress, irrespective of disclosure level, suggesting general nonspecific positive effects on family relationships. Findings require validation in a randomized control trial.

The Amagugu intervention for disclosure of maternal HIV to uninfected primary school-aged children in South Africa: a randomised controlled trial

Background As HIV preventive efforts improve, an increasing population of preadolescent HIV-exposed but uninfected children face significant developmental and health challenges, including disclosure of parental HIV. The aim of this research is to test the efficacy of the Amagugu intervention to increase maternal HIV-disclosure to HIV-uninfected children aged 6-10 years, leading to improvements in health care engagement and custody planning. Methods Individually randomised efficacy trial in rural KwaZulu-Natal, South Africa; follow-up to nine months. We used computer-generated simple random sampling with blinded assessment. The Amagugu intervention included six home-based counselling sessions; the enhanced standard of care included one clinic-based counselling session. The primary outcome was maternal HIV-disclosure (full, partial, none) measured at 9-months using an intention to treat analysis Findings We consecutively approached 634 women at four primary health care clinics (July 2013-December 2014). 464 mothers were randomised (Amagugu intervention n=235; enhanced standard of care n=229); 428 (92%) completed the 9-month assessment (September 2015). The Amagugu intervention led to an increase in any disclosure (204/235 vs. 128/229 aOR 9.88 [5.55-17.57] p Conclusions and Relevance This trial of a psychological intervention, the first from a low-resource setting, demonstrated positive outcomes. The counsellor-driven intervention changed maternal behaviours achieving high rates of mother-led HIV disclosure, enhanced health education and custody planning. Longer term follow-up and effectiveness research is required.</p