17 research outputs found
Community-based antiretroviral therapy versus standard clinic-based services for HIV in South Africa and Uganda (DO ART): a randomised trial
Background: Community-based delivery of antiretroviral therapy (ART) for HIV, including ART initiation, clinical and laboratory monitoring, and refills, could reduce barriers to treatment and improve viral suppression, reducing the gap in access to care for individuals who have detectable HIV viral load, including men who are less likely than women to be virally suppressed. We aimed to test the effect of community-based ART delivery on viral suppression among people living with HIV not on ART. / Methods: We did a household-randomised, unblinded trial (DO ART) of delivery of ART in the community compared with the clinic in rural and peri-urban settings in KwaZulu-Natal, South Africa and the Sheema District, Uganda. After community-based HIV testing, people living with HIV were randomly assigned (1:1:1) with mobile phone software to community-based ART initiation with quarterly monitoring and ART refills through mobile vans; ART initiation at the clinic followed by mobile van monitoring and refills (hybrid approach); or standard clinic ART initiation and refills. The primary outcome was HIV viral suppression at 12 months. If the difference in viral suppression was not superior between study groups, an a-priori test for non-inferiority was done to test for a relative risk (RR) of more than 0·95. The cost per person virally suppressed was a co-primary outcome of the study. This study is registered with ClinicalTrials.gov, NCT02929992. / Findings: Between May 26, 2016, and March 28, 2019, of 2479 assessed for eligibility, 1315 people living with HIV and not on ART with detectable viral load at baseline were randomly assigned; 666 (51%) were men. Retention at the month 12 visit was 95% (n=1253). At 12 months, community-based ART increased viral suppression compared with the clinic group (306 [74%] vs 269 [63%], RR 1·18, 95% CI 1·07–1·29; psuperiority=0·0005) and the hybrid approach was non-inferior (282 [68%] vs 269 [63%], RR 1·08, 0·98–1·19; pnon-inferiority=0·0049). Community-based ART increased viral suppression among men (73%, RR 1·34, 95% CI 1·16–1·55; psuperiority<0·0001) as did the hybrid approach (66%, RR 1·19, 1·02–1·40; psuperiority=0·026), compared with clinic-based ART (54%). Viral suppression was similar for men (n=156 [73%]) and women (n=150 [75%]) in the community-based ART group. With efficient scale-up, community-based ART could cost US$275–452 per person reaching viral suppression. Community-based ART was considered safe, with few adverse events. / Interpretation: In high and medium HIV prevalence settings in South Africa and Uganda, community-based delivery of ART significantly increased viral suppression compared with clinic-based ART, particularly among men, eliminating disparities in viral suppression by gender. Community-based ART should be implemented and evaluated in different contexts for people with detectable viral load. / Funding: The Bill & Melinda Gates Foundation; the University of Washington and Fred Hutch Center for AIDS Research; the Wellcome Trust; the University of Washington Royalty Research Fund; and the University of Washington King K Holmes Endowed Professorship in STDs and AIDS
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Voluntary associations and remittances among Nigerian migrants living in Central Durban*
In recent years there has been a surge in interest regarding the impact of migration and specifically remittances that migrants send home to help their families or for development in their communities of origin. This paper is based on research conducted among 50 Nigerian migrants in Durban. It produces insights into the highly heterogeneous impact of remittances on Nigerians families, communities and the role that voluntary associations play in the migrants' life both in Durban and in the migratory process. It also explores some of the means that migrants use to remit in the context of Hometown Associations (HTAs) and their specific ethnic backgrounds.
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Reviewing state-owned entities' governance landscape in South Africa
The current state-owned entities' (SOEs) governance landscape ranges from fragmented accountability frameworks and human factors to a convoluted array of SOEs typologies, i.e. parent entities and subsidiaries. The article reviews the SOEs' governance landscape to unravel underlying inconsistencies and contradictions and provides a compelling argument for opting to create an overarching SOEs governance and seamless legislative framework. The study perused primary and secondary data employing qualitative methods. As the proposed governance and seamless legal framework as not an absolute resolve of all SOEs challenges, the study tests whether the option could assist in arriving at a liberating praxis that would straddle and fulfil the corporate and developmental aspirations of the state.
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Theory of segmented assimilation: a comparative study of Nigerian migrants' integration in KwaZulu Natal province
This article applies the framework of segmented assimilation which analyzes different patterns of migrant integration to understand variations in transnational activities among Nigerian migrants in Durban. It examines the role of migrant integration in determining
the types of cross-border activities migrants pursue and their level of engagement in these activities. Given the monetary and legal resources needed to facilitate certain transnational activities, the article reveals that migrants with greater social and economic
mobility in the host country demonstrate a wider range and an increased frequency of transnational behaviours. For instance, Nigerian migrants having legal migration status and occupational mobility demonstrate greater transnational behaviours than those
illegally residing in South Africa and employed in low-wage menial jobs. It further, examines how South Africa's migration policies and the social context of reception affect the integration of migrants in their transnational activities.
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State of South African public service in the context of macro socio-economic environment
The Constitution of the Republic of South Africa 1996 requires the public service to embody certain enshrined democratic principles and values and be able to perform effectively and efficiently. The Constitution stipulates that the public service has to be professional, efficient in the use of resources, development-oriented, impartial in the provision of services, and responsive to the needs of the people. It should be accountable and transparent, perform effectively and efficiently in meeting all the tasks of government, and have the institutional capacity and organisational ethos to perform the tasks of government effectively. In each of
these areas the Public Service faces a number of challenges, determined by, among others, the macro-socio environment. It is on this bases that the authors provides an analyses of the macro-socio environment in which the public service operates and propose a professional single public service, subject to merit-based selection and promotion processes.
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Strengthening the capacity of civil society to enhance social accountability
HSRC and NDA Policy Brief, AprilThis policy brief firstly outlines the importance of enhancing active citizenry and elaborates on the urgency for South Africa to seek innovative approaches to enhancing citizen engagement. It then provides a brief synopsis of what social auditing entails and substantiates this through a case study of an effective social auditing intervention implemented in South Africa identified through recent research conducted by HSRC. It concludes with recommendations for the NDA in respect of how it can contribute to enhancing active citizenry through its mandate to enhance the capacity of civil society organisations (CSO's) in South Africa.
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The national liberation heritage route
Paper presented at the 2013 HSRC Social Sciences Research Conference, Birchwood Conference Centre, Boksburg, 26-27 Septembe
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Documenting the legacy of the South African liberation struggle: The national liberation heritage route: unsung heroes and heroines of the liberaton struggle project
Paper presented at the HSRC Seminar Series, 9 Octobe
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Evaluation of the implementation of the Jo'burg City Safety Strategy (JCSS)
Commissioned by the Jo'burg City Safety Programme Office, MayThis evaluation has sought to take into account the complex and challenging environment in which all new strategies have to be implemented in the South African context in its assessment of the implementation of the Jo'burg City Safety Strategy (JCSS). The study has therefore adopted a qualitative approach to assessment which combines interviews with key stakeholders, focus groups with implementing agents, documentary evidence provided by the JCSP Office and a literature review. The HSRC conducted a total of 15 interviews with a range of stakeholders involved in the implementation of the JCSS who were identified by the Jo'burg City Safety programme office. In addition two focus groups were held with Strategy implementers in specific geographical focus areas (GFAs), namely Norwood/Orange Grove and Moroka in Soweto, in order to understand the implementation of the strategy at a local level. These focus groups provided useful insights that were integrated into a broader analysis of the approach and methodology used in the GFAs, as specified in the terms of reference. In addition, the focus groups as well as interviews contributed to the section of the report on cross-cutting themes. Every effort was made to systematically incorporate a range of stakeholders who might be able to shed light on the implementation of the Strategy . The HSRC also studied the background documentary material and records provided by the Jo'burg City programme office in order to inform and complement the qualitative interviews
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Evaluation of the implementation of the Jo'burg City Safety Strategy (JCSS)
Executive summary brochure of the full report for the 6th National Learning Group MeetingThe JCSS advocated an integrated approach to crime prevention and safety using a multi-disciplinary and multi-agency approach. In line with the NCPS the JCSS emphasised the key role of local government in crime prevention and foresaw that City leadership would play a critical role in realising a localised approach to crime prevention. This was in line with international 'best practice' where city driven initiatives have led to significant reductions in crime and violence in cities with similar socio-economic challenges and high levels of violence as Johannesburg, such as Sao Paulo in Brazil and the Colombian cities of Medellin and Bogota