“I’m suffering for food” : Food insecurity and access to social protection for TB patients and their households in Cape Town, South Africa

Background Tuberculosis (TB) is a major health concern and the number one cause of death in South Africa. Social protection programmes can strengthen the resilience of TB patients, their families and households. This study aimed to get a better understanding of the role of social protection and other forms of support in relation to the burden of TB on patients and their households in South Africa. Methods This is a cross-sectional exploratory qualitative study using a phenomenological approach to focus on the lived experiences and perceptions of TB patients and healthcare workers. We interviewed 16 patients and six healthcare workers and analysed data thematically. Results The challenges faced by participants were closely related to household challenges. Participants reported a heavy physical burden, aggravated by a lack of nutritious food and that households could not provide the food they needed. Some needed to resort to charity. At the same time, households were significantly affected by the burden of caring for the patient—and remained the main source of financial, emotional and physical support. Participants reported challenges and costs associated with the application process and high levels of discretion by the assessing doctor allowing doctors’ opinions and beliefs to influence their assessment. Conclusion Access to adequate nutritious food was a key issue for many patients and this need strained already stretched households and budgets. Few participants reported obtaining state social protection support during their illness, but many reported challenges and high costs of trying to access it. Further research should be conducted on support mechanisms and interventions for TB patients, but also their households, including food support, social protection and contact tracing. In deciding eligibility for grants, the situation of the household should be considered in addition to the individual patient.publishedVersionPeer reviewe

Falling through the cracks : Increased vulnerability and limited social assistance for TB patients and their households during COVID-19 in Cape Town, South Africa

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From Survival to Glamour: Motivations for Engaging in Transactional Sex and Relationships Among Adolescent Girls and Young Women in South Africa

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“As a Young Pregnant Girl… The Challenges You Face” : Exploring the Intersection Between Mental Health and Sexual and Reproductive Health Amongst Adolescent Girls and Young Women in South Africa

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“In this place we have found sisterhood” : perceptions of how participating in a peer-group club intervention benefited South African adolescent girls and young women

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Sex work and young women : a cross sectional study to understand the overlap of age and sex work as a central tenet to epidemic control in South Africa

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Addressing the tensions and complexities involved in commissioning and undertaking implementation research in low- and middle-income countries

Rapid scale-up of new policies and guidelines, in the context of weak health systems in low/middle-income countries (LMIC), has led to greater interest and funding for implementation research. Implementation research in LMICs is often commissioned by institutions from high-income countries but increasingly undertaken by LMIC-based research institutions. Commissioned implementation research to evaluate large-scale, donor-funded health interventions in LMICs may hold tensions with respect to the interests of the researchers, the commissioning agency, implementers and the country government. We propose key questions that could help researchers navigate and minimise the potential conflicts of commissioned implementation research in an LMIC setting

Provider perspectives of the introduction and implementation of care for drug-resistant tuberculosis patients in district-level facilities in South Africa: A qualitative study

ObjectivesDrug-resistant tuberculosis (DR-TB) is a growing concern in many low-income and middle-income countries. Facing rising numbers of DR-TB patients, South Africa (SA) introduced a decentralised model of care for DR-TB in 2011. We aimed to document the introduction and implementation of the new models of care for patients with DR-TB in four provinces (Northern Cape, KwaZulu-Natal, Eastern Cape and Gauteng) in 2015 using mixed methods, including interviews, register reviews and clinical audits. This paper reports on the qualitative component of the study.DesignThis is a qualitative interview study.SettingData were collected in 22 decentralised DR-TB sites, primary healthcare facilities and district hospitals and one provincial central DR-TB hospital.Participants58 healthcare workers (HCWs), facility staff and provincial and district TB coordinators were included in qualitative interviews.ResultsHCWs felt that the introduction of DR-TB care in their facility came with little warning or engagement, creating fear and anxiety. They expressed a need for support from the district and province to guide them through the changes but this support was often lacking. In addition, many respondents expressed feeling isolated and not supported by other healthcare providers which they feel impacts on the quality of the care they provide.ConclusionIntroduction of a new service such as DR-TB care can be difficult and does not always result in the intended outcomes. Improved engagement with front-line providers and addressing the fear and anxiety that may be raised by changes in daily practices should be addressed to ensure successful implementation and prevent negative consequences that can hamper quality of care for patients. Attention should be paid to how the decentralised DR-TB unit can be supported by district management and other healthcare providers