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Introduction Diabetes mellitus (DM) is a significant global public health challenge, with effective management relying heavily on patient adherence to treatment protocols. In South Africa, particularly in low-resource settings like the Soweto area in the Johannesburg Health District, treatment nonadherence among diabetic patients is a pressing concern, contributing to poor health outcomes and increased healthcare costs. Purpose This study aimed to identify and analyze factors associated with treatment nonadherence among patients diagnosed with diabetes mellitus attending primary healthcare facilities in Soweto, Johannesburg Health District, South Africa. Methods This was a cross-sectional quantitative study conducted among 490 diabetic patients attending primary healthcare facilities in Soweto using structured anonymous questionnaires. The chi-squared test was used to assess associations between treatment nonadherence and various factors. SPSS version 27 was used to analyze the data. Results The average age of the patients was 59 years, and 66% were female. The nonadherence rate among the patients was 31%, with 80% having occasionally missed a dose of their medication. Gender, marital status, monthly household income, number of years living with diabetes, and adherence to diet were significantly associated with nonadherence to diabetes treatment (p < 0.05). Conclusion The study highlights the multifaceted nature of treatment nonadherence among diabetic patients in Soweto. Addressing these factors requires a comprehensive approach, including improving patient education, enhancing social support, and addressing socioeconomic barriers.

In rural areas, a dearth of health care support services, lack of legal protection, and widespread stigma can lead to increased cases of violence and exploitation, making it increasingly difficult for female sex workers to seek help or escape situations of abuse. The aim of this study was to investigate the prevalence of gender-based violence (GBV) among female sex workers (FSWs) in the Westrand District area of Mogale, South Africa. This was a descriptive, quantitative study conducted among 383 FSWs who were selected using a systematic random sampling technique. Data were collected using self-administered questionnaires. About half of the FSWs (45%) were between the ages of 25 and 35. Most of the FSWs were single (91%), and half of them (54%) had completed only secondary education. Results showed that two-thirds of the FSWs (67%) experienced GBV. More than two-thirds (70%) had been belittled, 60% reported being insulted, 43% of FSWs had experienced forced vaginal sex, and another 40% had experienced forced anal or oral sex. Among those who did not report the violence, 18% indicated financial reasons, followed by personal choice. GBV is pervasive among FSWs in Mogale City and hinders HIV prevention efforts as well as access to justice and treatment. An integrated, multi-sectoral GBV strategy that addresses structural risks is required to improve safety and promote access to care and justice.

Background: HIV-positive and pregnancy diagnosis is a traumatic, shocking, and distressing experience for women. Adoption of routine HIV counselling and testing in the antenatal programme aimed to increase the uptake and the early diagnosis of HIV among pregnant women to prevent maternal HIV transmission to unborn babies and neonates. Objectives: The study aimed to explore the psychological reaction of women coincidentally discovering their HIV-positive status and pregnancy while seeking medical care in primary healthcare facilities in the Tshwane district. Method: Descriptive phenomenology involving a semi-structured in-depth interview was used to collect data. The sample was purposively selected. Twenty-eight women participated in the research project. Face-to-face in-depth audio recorded interviews were used to gain a full understanding of the experiences and feelings of the participants. Results: Reason for the uptake of pregnancy and HIV testing, reactions upon discovering HIV and pregnancy-positive status, emotions arising from the pregnancy and HIV-positive diagnosis, understanding HIV infection in pregnancy, and transitions to acceptance and coping with the HIV-positive diagnosis were themes that emerged from this study. Conclusion: It is crucial that responsible healthcare workers consider this psychological imbalance during their offering of antenatal and postnatal care services so that the pregnant women living with HIV can accept and cope with the situation. Contribution: This study accounts to support other studies that offer intense counselling for women coincidentally discovering their positive HIV status and pregnancy. It is important to remedy the acceptance of the situation and to promote HIV prevention and family planning for women of childbearing age.

Background The prevalence of non-adherence to ART medication is on the rise and resulting in high mortality and morbidity among older adolescents with perinatal acquired HIV. Furthermore, their engagement in health risk behaviours such as smoking, alcohol and other drug abuse, sexual risk behaviour’s resulting in unplanned pregnancy. Their health risk behaviours are associated with poor or non-adherence to medication resulting in viral replication. Purpose The purpose of the study is to determine the relationship between risky sexual behaviours and adherence to ART among adolescents with perinatal acquired HIV at Mbombela sub-district in Mpumalanga province, South Africa. Methodology A quantitative descriptive cross-sectional study design was used to obtain data on adherence and risky behaviours among adolescents with perinatal acquired HIV. The study population consists of adolescents with perinatal acquired HIV who are on ART for more than 12 months and came for their follow up visit. Results The prevalence of adherence to ART was found to be 73.3%. Younger adolescent (

IntroductionYoung women from the low-middle-income country of Lesotho in southern Africa frequently report limited knowledge regarding sexual and reproductive health issues and engage in risky sexual behaviors. The purpose of this study is to describe the adaptation of an evidence-based conversational agent system for implementation in Lesotho and provide qualitative data pertaining to the success of the said adaptation.MethodsAn embodied conversational agent system used to provide preconception health advice in the United States was clinically and culturally adapted for use in the rural country of Lesotho in southern Africa. Inputs from potential end users, health leaders, and district nurses guided the adaptations. Focus group discussions with young women aged 18–28 years who had used the newly adapted system renamed “Nthabi” for 3–4 weeks and key informant interviews with Ministry of Health leadership were conducted to explore their views of the acceptability of the said adaptation. Data were analyzed using NVivo software, and a thematic content analysis approach was employed in the study.ResultsA total of 33 women aged 18–28 years used Nthabi for 3–4 weeks; eight (24.2%) of them were able to download and use the app on their mobile phones and 25 (75.8%) of them used the app on a tablet provided to them. Focus group participants (n = 33) reported that adaptations were culturally appropriate and provided relevant clinical information. The participants emphasized that the physical characteristics, personal and non-verbal behaviors, utilization of Sesotho words and idioms, and sensitively delivered clinical content were culturally appropriate for Lesotho. The key informants from the Ministry leadership (n = 10) agreed that the adaptation was successful, and that the system holds great potential to improve the delivery of health education in Lesotho. Both groups suggested modifications, such as using the local language and adapting Nthabi for use by boys and young men.ConclusionsClinically tailored, culturally sensitive, and trustworthy content provided by Nthabi has the potential to improve accessibility of sexual and reproductive health information to young women in the low-middle-income country of Lesotho.

The increase in sexually transmitted infections (STIs) in young people is a public health concern. Among those in university and out of school, different contextual factors contribute to their risky sexual behavior and increased susceptibility to STIs and HIV. There are limited comparative studies examining risky sexual behavior and partner notification (PN) between these two groups, particularly in South Africa. We investigated sexual behaviors, self-reported STI diagnosis, health seeking behavior, and preferred PN methods of university students and out of school youth. A descriptive cross-sectional survey was used using convenient sampling to select 917 students across five health sciences universities and through periodic sampling 699 out of school youth were selected from two main local shopping centers in South Africa. Descriptive statistics, bivariate and multivariable logistic analysis were performed using Stata IC version 14. More university students (71.7%) than out of school youth were in casual relationships (28.3%), with half of out of school youth being in steady relations (50.2%). Moreover, university students (65.7%) used a condom in the past 6 months compared to their counterparts (34.3%). Of the 124 youth who were diagnosed with STI in the past 12 months, majority (n = 106, 85%) were out of school youth. The probability of notifying a partner about a STI infection was 82% among university students compared to their counterparts (p = >0.05). The odds of notifying a partner was 1.79 times more for those having multiple sexual partners than those who had only one partner. Both groups preferred a face-to-face STI disclosure with partner; however, more university students (67%) preferred SMS notification than PN referral slips as compared to out of school youth (42%). Both the university students and the out of school youth engaged in risky sexual behaviors. Both groups preferred face-to-face and clinic SMS partner notifications, even though university students were in the majority. There is a need for developing health promotion scripts on disclosing STIs to sexual partners to empower the majority of the youth who prefer face-to-face PN over the prescribed methods.

INTRODUCTION: Patient delay in seeking TB (tuberculosis) care is reported as one of the major hurdles undermining the efforts of controlling TB by many TB control programmes of the world. The main aim of this study was to determine the prevalence of this phenomenon and to profile the TB patients that delayed seeking TB care in a rural area of KwaZulu Natal province of South Africa. METHODS: this was a cross-sectional study, conducted among 200 TB patients attending primary health care facilities in Ugu District. Patient data were collected by a self-administered questionnaire, entered into an Excel file and imported into the EpiInfo 7 statistical software for analysis. Frequency tables were used to display the data and the p value was used for statistical significance. RESULTS: about 40% of the participants delayed seeking TB care in this study, and these were mostly individuals who were married, the employed and those who walked to the clinic. Delay was also prevalent among those that self-medicated, bought medication from the pharmacy and sought TB care from a private doctor. The reasons included the great distances, long queues waiting at the facilities, and not feeling ill. CONCLUSION: the 4 weeks cut-off in seeking TB care in this study far exceeds the recommended 2 weeks. This study recommends periodic active TB case finding and active engagement between the public and the private health sectors.

INTRODUCTION: Fermented indigenous foods are known to confer health and nutritional benefits to young children. However, perception and usage of these foods is not well understood. This study aimed to determine the perceptions and usage of fermented foods, by child caregivers, for child feeding in Gauteng Province, South Africa. METHODS: a standard questionnaire was used to cater data from child caregivers on the perceptions and usage of fermented foods to feed young children in Tshwane metro. RESULTS: a total of 1248 child caregivers completed the questionnaires. Their age ranged from 15-65 years, 71.7% being single, with majority (74%) having attained secondary school education and unemployed (65%). Over 60% of children were fed sour milk (maas), sour porridge and yoghurt (at least 1-3 times a week), with the feeding starting at the age of 6-12 months. Majority (59-74%) had positive perceptions on benefits of feeding children with fermented foods. CONCLUSION: there is a high acceptability of fermented foods for feeding children in this community. Further promotion of these foods may improve the frequency of their usage.

BACKGROUND:The emergence of a large population of orphaned youth in sub-Saharan Africa is due to the natural maturity of orphaned children. Research indicates that orphaned youth face more negative psychosocial challenges than their younger counterparts do. Furthermore, these challenges are intensified for early school leavers. This paper describes how experiencing maternal death affects the psychosocial wellbeing of orphaned youth who left school before completing high school. METHODS:An exploratory qualitative study was undertaken among purposively sampled orphaned youth using in-depth interviews with open-ended questions. Fifty participants were recruited through social workers, community based organisations, and tribal authorities in a rural local municipality of Mpumalanga Province, South Africa. All data analyses were performed using NVivo10, following an inductive thematic approach. RESULTS:The narratives with the participants revealed that they live in a socially depressed environment and are subjected to extreme poverty characterised by frequent hunger. Furthermore, they do not enjoy family support and when they live with their extended families, they experience ill treatment and unsympathetic gestures. The death of their mothers has made a negative psychological impact on their psychosocial wellbeing, resulting in the development of internalising depressive symptoms. They suffer from emotional distress and prolonged bereavement characterised by perpetual yearning for the mother and, they resort to silence as a coping strategy. The study established that they were forced to leave school early for a variety of reasons. However, leaving school early became a major stressor and contributed to their negative psychosocial wellbeing. CONCLUSION:Maternal death has a negative impact on the psychosocial wellbeing of the participants even after they have crossed the 18 years threshold of orphan hood. Yearning for their mothers negatively affected their ability to develop coping strategies, which led to isolation, sadness, hopelessness, lack of peace, and fear of an uncertain future. The lack of routine screening for mental health in schools and other settings in South Africa increases their vulnerability to undiagnosed depression. The school health services should develop interventions for mental health screening in schools. For early school leavers, relevant policies should consider the continuation of support through NGOs and community networks.

Background: The majority of HIV-infected children in resource-limited countries are not aware of their HIV status because of the various reasons responsible for the delay in seeking HIV testing for children. The aim of the study was to determine the prevalence and barriers to testing and disclosing the HIV status of children aged between 5 and 18 years. Methods: This was a cross-sectional survey involving 405 caregivers of HIV perinatally infected children receiving anti-retroviral treatment (ART) in primary health care facilities in a rural district of Mpumalanga province in South Africa. Results: The prevalence of disclosure was 27%, and disclosure was done to promote adherence (26%) or because it was the child’s right to know his/her status (43%). Children’s age was significantly associated with disclosure (AOR = 2.81, p < 0.000, CI 1.64–4.81). Concerns that children were too young and would not understand the implications of HIV diagnosis (74.5%) or would not keep the diagnosis secret (7%) were reasons for non-disclosure. Over half of the caregivers intended to disclose status when the child was aged between 12 and 15 years. In response to children’s questions about medication, caregivers substituted HIV with other less stigmatising conditions (32%). Conclusion: The prevalence of disclosure was low and delayed till the child was above 10 years of age. The main barrier to disclosure was fear of stigma, or fears of the child telling others about their HIV status with consequences of stigma. The need for guidelines to provide caregivers with disclosure skills, to overcome the barriers that prevent disclosure, is crucial. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1329489

Background. A formative assessment of the implementation of HIV testing and counseling (HTC) at school showed high acceptability and willingness to test among learners. However, the success of the proposed HTC depends on the support and acceptability of key stakeholders, including the parents. The aim of the study was to assess the opinions and acceptability of the implementation of HTC at school among parents of adolescents in high school. Methods. This was a cross-sectional household survey conducted with parents of adolescents attending high schools in educational districts in North West and Gauteng provinces, South Africa. Results. A total of 804 parents participated, and 548 (68.3%) were biological mothers, 85 (10.6%) were fathers, and the remaining were other relatives including grandmothers. Almost all (n=742, 92.9%) parents were in support of implementation and provision of HTC at school, 701 (87.7%) would allow their children to be tested at school, 365 (46%) felt that parental consent was not needed to test at school, and 39.4% preferred to receive the HIV test results with their children. Conclusion. Parents accept the roll-out of an HTC program at school and have a role to play in supporting children who test positive for HIV.

Background. There is limited research on the disclosure experiences of adolescents with perinatal acquired HIV (PAH). The study explores how adolescents with PAH experience living with HIV and examined their perceptions and experiences regarding disclosure and onward self-disclosure to friends and sexual partners. Methods. Thematic analysis was used to analyze in-depth interviews conducted with 37 adolescents. Findings. Adolescents received disclosure about their status at mean age of 12 years. They perceived disclosure as necessary and appreciated the truthful communication they received. Adolescents have learned to accept and live with HIV, and they desired to be healthy and normal like other people. After receiving disclosure, they found their treatment meaningful, and they adhered to medication. However, they also expressed a strong message that their HIV status was truly their secret and that self-disclosure to others will take the feeling of being normal away from them because they will be treated differently. Conclusion. Adolescents maintained secrecy in order to be accepted by their peers but also to protect themselves from stigma and isolation. Given that adolescents want to be informed of their HIV status but desire controlling self-disclosure of their HIV status, these should form the basis for development of disclosure interventions.

The perspectives and practices of health care workers (HCWs) regarding disclosure to HIV-infected children have not been adequately investigated ten years after the roll-out of pediatrics antiretroviral therapy (ART). The aim of the study was to examine the opinions of HCWs about disclosure to HIV-infected children and determine their role in disclosure to children accessing ART in health centers in South Africa. This was a cross-sectional survey using a semi-structured questionnaire among HCWs in ART centers at three hospitals and 48 primary health facilities in two provinces in South Africa. Of the 206 HCWs, 140 (68.2%) were nurses, 44 (21.5%) were lay counsellors, and 4 (2%) were doctors. The majority (n = 183, 89.3%) felt that disclosure benefits children and they should be told about their HIV status. Over half (n = 93, 51.4%) recommended 11–18 years as the appropriate age to disclose. Half (n = 99, 48.5%) said that caregivers should take the lead to disclose, 87 (42.7%) said that disclosure is a shared responsibility of caregivers and HCWs, and 18 (8.8%) said HCWs should lead disclosure. HCWs perceived their role as that of preparing the caregiver for disclosure and the child to understand the disease. However, the lack of guidelines and training on disclosure counselling for children affects their ability to fully participate in disclosure to children. There is a need to adopt the World Health Organizations’ disclosure guidelines for children and adapt them to the local cultural and community contexts and train HCWs to guide, support, and assist caregivers in their disclosure to HIV-infected children.