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Reducing Hiv Risk Among Young Women And Their Partners: Highlights From The Dreams Implementation Science Research Portfolio, Population Council

HIV and AIDS

The Population Council, with funding from the Bill & Melinda Gates Foundation and the U.S. Agency for International Development through Project SOAR, led a set of implementation science studies to capture multiple perspectives that reflect the innovative aspects of DREAMS. These mixed-method studies conducted across seven countries (Eswatini, Kenya, Malawi, South Africa, Tanzania, Uganda, and Zambia) provide critical evidence that fill knowledge gaps on how to reduce HIV risk among AGYW and their male partners. This brief presents key findings grouped around four areas of inquiry: 1) HIV vulnerability and risk; 2) social drivers of HIV risk; 3) effects of …

Impacts Of Rift Valley Fever Virus: A One Health Approach To Assess Burden And Inform Prevention And Control Options, Catherine Machalaba

Dissertations and Theses

Background: Rift Valley Fever (RVF) is a climate-sensitive emerging zoonotic disease associated with large-scale livestock production losses and human disease burden in Sub-Saharan Africa and the Middle East. While recognized as a key One Health issue based on its transmission dynamics involving human, animal and environmental determinants, there has been poor coordination between sectors to reduce the risk and impact of RVF. Efforts to counter the disease remain largely reactive, presenting an ongoing threat to local and global health security. The intent of this dissertation was to improve understanding of the burden of RVF across society and to identify entry …

Implementing And Scaling-Up Stepping Stones In Kwazulu-Natal, South Africa: Lessons From Working In Informal Settlements, Cecilia Milford, M. Mtshali, Mags Beksinska, Julie Pulerwitz

HIV and AIDS

KwaZulu-Natal (KZN), a major epicenter of the South African HIV epidemic, has large informal settlements where thousands of people live. The settlements are often underserved by municipal services and lack accessible health care. Given high rates of HIV, there is a critical need to assess the successes and challenges of implementing HIV prevention and treatment in this context. Stepping Stones is a widely used life-skills training intervention focused on curbing gender-based violence and reducing HIV risk. The program addresses issues such as communication about HIV, relationship skills, and assertiveness. The manual-based curriculum encourages participants to engage in critical reflection through …

Mobile Hiv Units In South Africa: A Systematic Review, Meaghan Doherty

Senior Honors Projects, 2010-2019

Abstract

Objective: To examine existing literature on mobile HIV testing units to determine if they have the potential to increase access to testing, treatment, and HIV education to decrease rates of HIV in South Africa.

Participants: Ten research articles evaluating the HIV intervention method of mobile HIV units in South Africa, including outcome measures.

Analysis: Systematic search of 87 articles from 2000 to 2018 and review of the 10 articles that met inclusion criteria.

Results: Several studies (n=5) showed that mobile testing units are effective at attracting hard to reach populations, such as men and young adults. Studies (n=3) also …

Male Partners Of Adolescent Girls And Young Women: Relationship Characteristics And Hiv Risk—Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

Adolescent girls and young women (AGYW) in South Africa, as in many countries, are particularly vulnerable to HIV for a variety of reasons, including economic disadvantage and unequal power dynamics in sexual relationships with their male partners—many of whom are older and engage in high-risk behaviors. In an effort to learn more about men’s relationships with AGYW and how HIV services can better engage them, the Population Council is conducting implementation science research in KwaZulu-Natal Province. This brief reports findings from a 2017 baseline survey with nearly 1,000 men. An endline survey is planned for mid-late 2018, and will focus …

Understanding The Dynamics Of Hiv Testing Services In South African Primary Care Facilities, Tonderai Mabuto, Bhakti Hansoti, Salome Charalambous, Christopher Hoffmann

HIV and AIDS

Facility-based HIV testing services remains underutilized in many settings, including South Africa—even in the context of opt-out testing. Additionally, linkages to care are often not made in a timely manner after an HIV diagnosis, limiting access to ART and the possibility of viral suppression. This brief summarizes findings from formative research conducted by Project SOAR and The Aurum Institute to understand the dynamics of HIV testing services and the key constraints to its optimal delivery.

Strengthening Capacity In Hiv Operations Research: Reflections On A Project Soar Workshop In Johannesburg, South Africa, Project Soar

HIV and AIDS

Capacity strengthening (CS) to support rigorous scientific research is a globally recognized need and central to Project SOAR. Over a four-day period, SOAR conducted a CS workshop to strengthen individual and institutional capacity in HIV operations research, with a particular emphasis on the research utilization process. This brief summarizes the CS activities conducted, insights from the workshop’s organization, and participants’ views of the workshop.

Evaluation Of The Pepfar/Usaid Asibonisane Community Responses Program In Kwazulu-Natal, South Africa, Project Soar

HIV and AIDS

Few programs intended to improve HIV outcomes or modulate gender norms have been rigorously evaluated in South Africa’s informal settlements where nearly 400,000 people live in KwaZulu Natal province alone. There is limited evidence on how to implement large-scale HIV-prevention programming in these contexts. Project SOAR and partners are addressing these knowledge gaps by conducting an evaluation of the PEPFAR/USAID-funded Asibonisane Community Responses Program in South Africa. Specifically, the study will assess the effectiveness of this community-based HIV-prevention program in informal settlements throughout KwaZulu-Natal—one of four provinces where the program is being carried out. This study aims to influence the …

A Systems Approach To Improving Delivery And Update Of Facility-Based Hiv Testing And Linkage To Care In South Africa, Project Soar

HIV and AIDS

Project SOAR is examining the current delivery of HIV testing (HTS) and linkages to care (LTC) services—including barriers, facilitators, and infrastructure—in Ekurhuleni District, South Africa which has the second-highest district-level HIV prevalence in the country. Based on these formative findings, the project will develop and test tailored approaches to increase patients’ uptake of HTS and subsequent LTC, if positive. The project expects to find evidence of HTS coverage outside of antenatal care; document key systems-level barriers to HTS and LTC; assess potentially generalizable clinic-level strategies to increase HTS delivery and assess LTC needs; and identify the added value for implementation …

Are We Meeting The Hiv Service Needs Of People Living In Informal Settlements In Kwazulu-Natal, South Africa?, Project Soar

HIV and AIDS

This brief summarizes the characteristics and circumstances of approximately 1,500 men and women living in 18 informal settlements in KwaZulu-Natal, South Africa. The data come from a baseline survey conducted in mid-2017 as part of an evaluation of the PEPFAR/USAID-funded Asibonisane Community Responses program. Project SOAR/Population Council conducted the evaluation in partnership with the MatCH Research Unit at the University of Witwatersrand. The findings presented here highlight the need for HIV treatment services to be more responsive to residents living with HIV in informal settlements. Furthermore, continued efforts are needed to reduce HIV risk and intimate partner violence among young …

Effective Engagement Of Male Partners Of Adolescent Girls And Young Women In South Africa, Population Council

HIV and AIDS

The Population Council is conducting implementation research in South Africa, in collaboration with local partner organizations, to learn more about men’s relationships with adolescent girls and young women (AGYW) and how HIV services can better engage them—two neglected areas of research. Similar studies are being conducted in Uganda, Swaziland, and Malawi. Learnings from these studies will be valuable for informing ongoing programming in South Africa and the region, as well as HIV prevention, care, and treatment efforts for AGYW and their male partners globally, particularly in this era of test and start.

Optimizing Community Services For An Improved Continuum Of Hiv Care, Project Soar

HIV and AIDS

Project SOAR, together with Aurum Institute, is conducting research in Ekurhuleni District and Bojanala District in South Africa to improve the availability of effective care continuum services to meet the communities’ HIV treatment needs. The two districts have a combined population of 3.6 million inhabitants and approximately 350 public clinics and hospitals. Through improved information on community HIV care services and their relationship to care continuum outcomes, the study will provide valuable new knowledge about service gaps and approaches to planning and delivering services that best achieve HIV treatment goals.

Private Sector Costing Of Voluntary Medical Male Circumcision In South Africa, Michel Tchuenche, Steven Forsythe

HIV and AIDS

In 2010, after voluntary medical male circumcision (VMMC) had been shown to be one of the most cost-effective strategies for preventing HIV infections, South Africa initiated a VMMC program with an ambitious target of performing 4.3 million circumcisions by 2016. However, because of a gap in knowledge concerning the overall cost of scaling up services, the South African National Department of Health requested that Project SOAR—Supporting Operational AIDS Research—conduct a private-sector costing of providing VMMC services in South Africa. The findings presented in this report provide a detailed investigation, through a comprehensive bottom-up approach, of the costs to private providers …

Preventing Pediatric Tuberculosis: A Randomized Trial Of Symptom-Based Screening Of South African Children Exposed To Tuberculosis, Population Council

HIV and AIDS

In South Africa, a country with one of the highest levels of HIV prevalence, HIV-positive adults are the source case for a large proportion of pediatric tuberculosis (TB) cases. Unfortunately, TB index cases are not consistently asked about their child contacts, not all child contacts present to the clinic for TB screening, and it remains unknown what proportion of child contacts receive isoniazid preventive therapy (IPT)—a highly effective treatment for preventing TB in these children, long recommended by the World Health Organization. Project SOAR is assessing whether a symptom-based screening approach by TB nurses in community health clinics is more …

Estimating The Costs Of Providing Voluntary Medical Male Circumcision In South Africa, Project Soar

HIV and AIDS

The South African government introduced voluntary medical male circumcision (VMMC) as an HIV-prevention intervention in 2010, based on the compelling evidence that VMMC reduces men’s risk of becoming HIV infected by approximately 60 percent. To inform strategic planning for continued scale-up of its VMMC program and better understand cost drivers and cost variances across provinces, the South African National Department of Health in 2014 requested estimates of the unit cost of VMMC and the level of current spending for VMMC demand creation. The results of this study provide a comprehensive analysis of the unit cost of providing VMMC in South …

Does Shifting Gender Norms On The Community Level Lead To Increased Hiv Services Uptake?, Project Soar

HIV and AIDS

Project SOAR and partners are building on an ongoing National Institute of Mental Health–funded randomized controlled trial being conducted in South Africa—Community Mobilization for Treatment as Prevention. Specifically, the study aims to strengthen and expand the gender content of the intervention to engage both women and men in critically examining gender norms and power inequalities. This brief presents the particularly timely study that will address a key question in the field as to how gender norms may operate to affect HIV service utilization. Building the evidence base in this area is vital for improving care outcomes as well as creating …

The Africa Regional Sgbv Network Learning Brief Series: Learning Updates From South Africa (Brief #1), Population Council

Reproductive Health

The Thohoyandou Victim Empowerment Programme (TVEP) is one of the largest community-based organizations in Southern Africa with projects that focus on preventing and responding to sexual and gender-based violence and HIV. From 2011–12, 40 percent of all sexual offences in South Africa involved children as victims, according to crime statistics. Over half of the rape cases reported to TVEP in rural Vhembe are children below the age of 18. TVEP is adapting its “Zero Tolerance Village Alliance” (ZTVA) model for children and schools. The ZTVA model is designed to inspire men and women in communities to commit themselves to taking …

Changes In Malaria Prevention And Incidence Due To Political Restructuring Of Mozambique And South Africa, Nirmala K. Shivakumar

Undergraduate Research Posters

The UN’s current Millennium Development Goal puts pressure on many countries to decrease malaria incidence by 2015, including Mozambique and South Africa. While Mozambique and South Africa have continually worked to decrease malaria incidence for the last five decades, neither country can claim elimination of disease by UN standards. This study analyzes the changes in political structure and the simultaneous changes in the malaria prevention programs of Mozambique and South Africa after the end of their respective civil wars in 1992 and 1994. This study analyzed public health, historical, and social science journal articles. This study examined political power distribution, …

Learning From Women About Hiv Risk, Hiv Testing Behaviors, And Prevention Practices In Mpumalanga, South Africa: A Descriptive Study To Inform Microbicides Introduction, Martha Brady, Saiqa Mullick, Barbara Friedland, Marlena Gehret Plagianos, Linda Du Plessis, Thabiso Mango

HIV and AIDS

The provision of any new prevention product in clinical trial settings is often vastly different from implementation in “real life” public sector settings. In addition, use of antiretrovirals (ARV), such as tenofovir gel, for pre-exposure prophylaxis requires regular HIV testing to ensure users are uninfected before initiating and continuing product use. Therefore, before any ARV-based prevention product can be introduced to women, information is needed on HIV testing practices, how best to integrate products into existing primary health care systems, and women’s risk perception and health-seeking behaviors. The Population Council, in partnership with Solutions IPPT, conducted a study to learn …

Hiv/Aids Vulnerabilities, Discrimination, And Service Accessibility Among Africa's Youth: Insights From A Multi-Country Study, Babatunde A.O. Ahonsi, Nahla G. Abdel-Tawab, Scott Geibel, Sam Kalibala, Jerry Okal, Babacar Mane, Nathi Sohaba, Julialynne Walker, Eric P. Green

HIV and AIDS

This report contains information from a study implemented between August 2011 and July 2012 that sought to provide a comprehensive, evidence-based picture of the HIV-related issues facing young people across Africa, and the prevailing legal, policy, and programmatic responses. The study was designed to establish a basis for a sharper focus on youth within the response to HIV on the continent. Researchers conducted country-specific analytical reviews of the relevant literature on factors associated with HIV risk-taking and health-seeking behaviors among young people aged 15–24 in six countries across Africa—Egypt, Kenya, Nigeria, Senegal, South Africa, and Uganda. In addition, qualitative and …

The Case Of South African And Chilean Health Systems: Comparison Of Financial, Economic And Health Indicators, Alberto Coustasse, Peter Hilsenrath, Patricio Silva Rojas

Alberto Coustasse, DrPH, MD, MBA, MPH

The purpose of this study is to identify similarities and differences between healthcare systems of South Africa and Chile. The World Health Report 2000, the Human Development Index, and financial indicators were used for comparison. Chile showed better performance than South Africa in most of the measures used. Significant progress has been made in South Africa, bringing better education, healthcare and housing to the deprived black majority. However, the HIV/AIDS epidemic, weighs heavily on health indicators. Chile decentralized its health services and implemented economic reforms during the 1980's and has had steady improvement in its healthcare indicators. Finally, these counties …

The Contracting World Of Girls At Puberty: Violence And Gender-Divergent Access To The Public Sphere Among Adolescents In South Africa, Kelly Hallman, Nora Kenworthy, Judith A. Diers, Nick Swan, Bashi Devnarain

Poverty, Gender, and Youth

This Population Council working paper describes a participatory mapping project undertaken with single-sex groups of grade 5 and grade 8–9 children in urban and rural KwaZulu-Natal, South Africa. At grade 5, female self-defined community areas were equal to or larger in size than those of males in both sites. However, wide gender divergence in access to the public sphere was found among grade 8–9 children. Although curtailed spatial access, especially in urban areas, is intended to protect post-pubescent girls, grade 8–9 girls reported most spaces in their small navigable areas unsafe. Reducing girls’ access to the public sphere does not …

The Africa Regional Sexual And Gender-Based Violence Network Annual Partners Meeting: June 26-27 2012, Mombasa, Kenya—Meeting Report, Population Council

Reproductive Health

The Population Council convened an annual partners meeting of its Africa Regional Sexual and Gender-Based Violence (SGBV) Network. Over 30 participants attended the meeting whose objectives were: 1) to facilitate South-South technical exchange and information-sharing on the changing landscape of violence among partners, donors, and other experts; and 2) to reflect on the ways in which research is translating into policy and practice. This report highlights the myriad ways in which activities conducted under this Network have influenced policy, practice, and funding considerations in the region, while detailing the progress of Network partners on their projects, built around several key …

The Cost Of Reaching The Most Disadvantaged Girls: Programmatic Evidence From Egypt, Ethiopia, Guatemala, Kenya, South Africa, And Uganda, Jessica Sewall-Menon, Judith Bruce, Karen Austrian, Raven Brown, Jennifer Catino, Alejandra Colom, Angel Del Valle, Habtamu Demele, Annabel Erulkar, Kelly Hallman, Eva Roca, Nadia Zibani

Poverty, Gender, and Youth

The most disadvantaged adolescent girls are the poorest girls from the poorest communities. They suffer from human rights abuses, lack education and economic opportunity, are affected by HIV/AIDS, and have poor reproductive and maternal health outcomes. To effectively reach these girls so that they can receive critical services such as gathering spaces, life skills, financial literacy, savings accounts, and reproductive health knowledge, they must be targeted as a distinct segment. It is important to invest in building the capacities of local partners and governments to deliver and scale-up low-cost, well-targeted programs. This technical report is intended to assist programmatic officers, …

Les Coûts Du Mariage—Les Transactions Matrimoniales Dans Le Monde En Développement, Sajeda Amin, Ashish Bajracharya

Poverty, Gender, and Youth

Au cours des deux dernières décennies, le Population Council a receuilli une multitude d'informations sur les causes et les corrélats du mariage des enfants et documenté ses effets néfastes sur le bien-être des femmes et des filles. Dans de nombreuses régions du monde en développement, la compréhension du mariage des enfants est au coeur de la conception de programmes qui favorisent des transitions saines vers l'âge adulte. Les travaux de recherche du Population Council soulignent également l'importance des rituels et des pratiques d'échange matrimoniales dans le monde et éclairent les différences considérables entre ces pratiques. Promouvoir des transitions vers l'âge …

Costos Del Matrimonio—Negociaciones Maritales En Países En Vías De Desarrollo, Sajeda Amin, Ashish Bajracharya

Poverty, Gender, and Youth

Durante las dos últimas décadas, el Population Council ha acumulado una cantidad de información sobre las causas y correlaciones del matrimonio infantil y documentó sus efectos adversos sobre el bienestar de las mujeres y niñas. En muchas partes de los países en vías de desarrollo, el hecho de comprender el matrimonio infantil es central a la hora de diseñar programas que promuevan transiciones saludables para la edad adulta. La investigación del Council subraya la importancia de los rituales y las prácticas de intercambio matrimonial en todo el mundo y documenta la variación considerable en estas prácticas. Promoción de transiciones a …

Siyakha Nentsha: Building Economic, Health, And Social Capabilities Among Highly Vulnerable Adolescents In Kwazulu-Natal, South Africa, Kelly Hallman, Eva Roca

Poverty, Gender, and Youth

Young people growing up in South Africa face many challenges. HIV, orphanhood, early pregnancy, and limited employment prospects are some of the major obstacles to a healthy and productive adulthood. In KwaZulu-Natal (KZN), the province with the highest HIV prevalence rates, the impact of HIV and AIDS is felt especially strongly, and already-disadvantaged adolescents face the prospect of falling even further behind socially and economically because of the disruption of key relationships in their lives. The Isihlangu Health and Development Agency and the Population Council developed and piloted a life-orientation program, Siyakha Nentsha, to improve the lifelong skills and well-being …

Costs Of Marriage—Marriage Transactions In The Developing World, Sajeda Amin, Ashish Bajracharya

Poverty, Gender, and Youth

Over the past two decades the Population Council has amassed a wealth of information on the causes and correlates of child marriage and documented its adverse effects on the well-being of women and girls. In many parts of the developing world, understanding child marriage is central to designing programs that promote healthy transitions to adulthood. Council research also underscores the importance of rituals and practices of marriage exchange around the globe and documents the considerable variation in these practices. Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief No. 35 synthesizes some broad themes that have emerged from research on …

Proceedings And Presentations From The Free State Child Abuse Indaba, Population Council

Reproductive Health

The Free State Department of Health and its partners held a “first-of-its kind” Child Sexual Assault Indaba (conference) in South Africa to streamline relationships between services for effective prevention and management of child abuse. This report details the presentations delivered at the conference, which was a resounding success, with participation from a wide range of stakeholders. The recurring theme of all the presentations was the urgent need to unite and fight against child sexual assault. The most appropriate strategy was unanimous—information—and clarity in terms of the role of each stakeholder. The Free State Department of Health will coordinate the development …

The Role Of Traditional Leaders In Preventing And Addressing Sexual And Gender-Based Violence: Findings From Kwazulu-Natal, Northwest And Limpopo Provinces In South Africa, Mantshi Teffo-Menziwa, Saiqa Mullick, Prince Cedza Dlamini

Reproductive Health

The Population Council, in partnership with the Ubuntu Institute, embarked on a program to engage traditional Leaders in three South African provinces (North West, KwaZulu-Natal and Limpopo) to address sexual and gender-based violence (SGBV) in rural communities. The overarching goals of the program were to strengthen linkages between the Population Council and traditional communities, generate and share strategic information on SGBV, strengthen prevention and response to child sexual assault, engage new partners to address prevention of and access to SGBV services, and expand access to comprehensive post-rape services by working with traditional leadership structures. Some of the key findings reflect …