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Background: Achieving universal health coverage (UHC) in the context of limited resources will require prioritising the most vulnerable and ensuring health policies and services are responsive to their needs. One way of addressing this is through the engagement of marginalised voices in the priority setting process. Public engagement approaches that enable group level deliberation as well as individual level preference capturing might be valuable in this regard, but there are limited examples of their practical application, and gaps in understanding their outcomes, especially with rural populations. Objective: To address this gap, we implemented a modified priority setting tool (Choosing All Together—CHAT) that enables individuals and groups to make trade‐offs to demonstrate the type of health services packages that may be acceptable to a rural population. The paper presents the findings from the individual choices as compared to the group choices, as well as the differences among the individual choices using this tool. Methods: Participants worked in groups and as individuals to allocate stickers representing the available budget to different health topics and interventions using the CHAT tool. The allocations were recorded at each stage of the study. We calculated the median and interquartile range across study participants for the topic totals. To examine differences in individual choices, we performed Wilcoxon rank sum tests. Results: The results show that individual interests were mostly aligned with societal ones, and there were no statistically significant differences between the individual and group choices. However, there were some statistically significant differences between individual priorities based on demographic characteristics like age. Discussion: The study demonstrates that giving individuals greater control and agency in designing health services packages can increase their participation in the priority setting process, align individual and community priorities, and potentially enhance the legitimacy and acceptability of priority setting. Methods that enable group level deliberation and individual level priority setting may be necessary to reconcile plurality. The paper also highlights the importance of capturing the details of public engagement processes and transparently reporting on these details to ensure valuable outcomes. Public Contribution: The facilitator of the CHAT groups was a member from the community and underwent training from the research team. The fieldworkers were also from the community and were trained and paid to capture the data. The participants were all members of the rural community‐ the study represents their priorities. [ABSTRACT FROM AUTHOR]

Migration to South Africa is motivated by the pursuit of employment, safety, and improved living conditions. However, immigrants encounter significant challenges, such as restricted access to essential services, which were exacerbated by the COVID-19 pandemic. This paper investigates the impact of the COVID-19 pandemic on Malawian immigrants in South Africa, addressing the lack of attention given to this immigrant population by highlighting their vulnerabilities. Using a qualitative exploratory and descriptive approach, in-depth interviews were conducted with 24 Malawi immigrants who were over 18 years old and had established residency in South Africa before the onset of the COVID-19 pandemic. Five key stakeholders were also interviewed for additional perspectives and to ensure triangulation and improve data reliability. The interviews were transcribed verbatim and analyzed using thematic analysis strategies and coding with Nvivo12 software. The study highlighted the exacerbated struggles of Malawian immigrants in South Africa amid the COVID-19 pandemic, uncovering systemic discrimination in healthcare, marked by longer wait times and reluctance from health workers to treat undocumented immigrants. The study also revealed a dire security situation, with immigrants living in high-crime areas and feeling particularly targeted due to their foreign status, a situation worsened by the pandemic's economic effects. Additionally, the economic downturn induced by COVID-19 significantly impacted employment opportunities, with many immigrants facing prolonged unemployment and job losses, especially in sectors where they traditionally found work. The detailed accounts of participants highlight not only the multifaceted challenges imposed by the pandemic but also the critical need for inclusive policies and support systems that ensure healthcare access, safety, and economic resilience for immigrants, particularly during global health emergencies. Future research should focus on effective interventions for socioeconomic integration and well-being, particularly for immigrants from other African countries. [ABSTRACT FROM AUTHOR]

Aims: To identify the influence of teamwork, communication skills, and structural empowerment on providing patient‐centered care among nurses in Eswatini. Design: A quantitative, cross‐sectional survey was used. Methods: This survey conducted in Eswatini selected registered nurses working as full‐time nurses with more than 3 months of working experience using convenience sampling. Different measures were adopted and used to collect data among 130 eligible nurses from February to March 2022. Data were analyzed using Statistical Program for Social Sciences version 26.0. Results: A total of 123 nurses responded in the study and the mean age was 31.05 years with a standard deviation of 5.49. The overall response rate was 94.6% in this study. Hierarchical multiple regression analysis revealed that teamwork (β = 0.236, p < 0.05) and communication skills (β = 0.328, p < 0.05) were significant predictors of the provision of patient‐centered care among nurses. Conclusion: Team‐building exercises and management interventions to empower nurses should be established to improve the provision of patient‐centered care among nurses. Nurses should be empowered to provide patient‐centered care in health facilities by encouraging them to provide their input in management procedures and planning programs. Impact: Clinical practice requires nurses to use effective communication skills and work as a team. Nursing care established on teamwork, respect, empathy, and communication skills allows patients to express their concerns and views in health facilities as they feel involved in care. Patient or public contribution: No patient or public contribution in this paper. This study only involved registered nurses as health professionals. Summary Statement: What is already known? : Patient‐centered care gives patients the chance to participate actively in discussions and consultations.Patient‐centered care requires nurses to work as a team, use effective communication skills, and feel empowered during the execution of their work.Nurses who are empowered are less likely to make medical errors, and collaborative nurses provide better patient‐centered care. What does this paper add? : Highlights that teamwork and communication skills influence nurses' ability to provide patient‐centered care.Add to the growing evidence‐based support that there is a need for teamwork and communication education programs for registered nurses in the workplace.Empowering nurses to participate in management processes and program planning will enable them to deliver patient‐centered care in healthcare facilities. Implications for practice/policy : Education programs focusing on teamwork and communication skills should be provided to nurses working in the clinical setting to enhance the quality of patient care and improve collaboration.All hospitals should adopt a tailored intervention designed to enhance the delivery of patient‐centered care to raise the standard of care.It is imperative that nurses prioritize the development of their teamwork, respect, empathy, and communication skills. [ABSTRACT FROM AUTHOR]

Background: South Africa has the highest reported prevalence of fetal alcohol spectrum disorders (FASD) globally. The most recent study reported a weighted, estimated FASD prevalence of 310 per 1000 in a community in the Western Cape Province. Because there is as yet no reliable estimate of the national burden of FASD in South Africa, further epidemiological studies are needed in diverse settings. This paper reports on a multiyear, multisite FASD epidemiological study that took place from 2015 to 2022 at eight study sites in four provinces. Methods: The cross‐sectional epidemiological study used an active case‐ascertainment method, specifically in primary schools. All children were recruited when they were enrolled in Grade 1 at a participating school. All consented participants progressed through a tiered‐screening recruitment and diagnostic process. Results: Overall, 3033 children were included in the study. A total of 3001 children were screened for FASD in the first tier, with 1086 progressing to the second and 495 to the third tier. Of the 495 children referred, 475 were discussed during the final case conference. A total of 309 participants were diagnosed with FAS across the eight study sites. The highest reported prevalence was in the Northern Cape Province, with a rate of 199.3/1000 (95% CI, 147.6–251) using all eligible participants as the denominator. The lowest prevalence was in the Eastern Cape Province, with a rate of 57.4/1000 (95% CI, 36.5–78.3). The pooled FAS prevalence for the eight study sites was 80.2/1000 (95% CI, 70.4–89.9). Conclusions: As with previous studies, we found a concerningly high prevalence of FASD in South Africa. Given the scope of the problem it should be a high priority for health and welfare services to address. [ABSTRACT FROM AUTHOR]

Background: Professional nurses are trained to provide quality care. Despite the professional nurses' acquired skill and professionalism attributes, the neonate, infant, and under-5-child mortality rates are high in sub-Saharan Africa. This health care report indicates that sub-Saharan Africa countries face a challenge in reaching the Sustainable Development Goal number 3 by the year 2030 (that is, ensuring healthy lives and reducing the mortality rates of children under 5). It has been reported that professionalism in nursing can improve the quality of care and positively change the health outcomes. Methods: This study employed a qualitative exploratory, descriptive design to explore and describe professional nurses' own professionalism attributes to provide quality care to neonates, infants, and under-5 children in the North West province in South Africa. Eight naïve sketches of an all-inclusive sample of invited professional nurses (N = 25; n = 8) were received. The naïve sketch questions were based on the Registered Nurses' Association of Ontario's professionalism attributes. Tesch's eight steps of data-analysis were used, with an independent coder's assistance. Results: The categories included (1) knowledge, (2) spirit of inquiry, (3) accountability, (4) autonomy, (5) advocacy, (6) collegiality and collaboration, (7) ethics and values, and (8) professional reputation, and each category generated sub-themes. Conclusion: Professional nurses are aware of their own professionalism attributes in quality of care of neonates, infants and under-5 children; the 'innovation and visionary' attribute did not emerge, which should receive more attention to strengthen quality care. However, a new attribute, 'professional reputation', reflecting a South African culture-orientated attribute, emerged from the data collected. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether the same health state results in the same distribution of responses on the EQ-5D youth and adult descriptive systems. Methods: Adolescents aged 13–18 years with a range of health conditions and from the general school going population were recruited in South Africa (ZA) and Ethiopia (ET). In ZA participants completed the English EQ-5D-3L, EQ-5D-Y-3L and EQ-5D-5L in parallel. Whereas in ET participants completed the Amharic EQ-5D-5L and EQ-5D-Y-5L in parallel. Analysis aimed to describe the transition between youth and adult instruments and not differences between countries. Results: Data from 592 adolescents completing the EQ-5D-3L, EQ-5D-Y-3L and EQ-5D-5L (ZA) and 693 completing the EQ-5D-5L and EQ-5D-Y-5L (ET) were analysed. Adolescents reported more problems on the youth versions compared to the adult version for the dimension of mental health. 13% and 4% of adolescents who reported no problems on the EQ-5D-3L and EQ-5D-5L reported some problems on the EQ-5D-Y-3L respectively. This was less notable with transition between the five level versions with 4% of adolescents reporting more problems on the EQ-5D-Y-5L than the EQ-5D-5L. Very few adolescents reported severe problems (level 3 on the EQ-5D-3L or EQ-5D-Y-3L and level 4 and level 5 on the EQ-5D-5L or EQ-5D-5L) thus there was little variation between responses between the versions. In ZA, discriminatory power, measured on the Shannon's Index, was higher for Y-3L compared to 3L for pain/discomfort (ΔH′=0.11) and anxiety/depression (ΔH′=0.04) and across all dimensions for Y-3L compared to 5L. Similarly, in ET discriminatory power was higher for Y-5L than 5L (ΔH′ range 0.05–0.09). Gwet's AC showed good to very good agreement across all paired (ZA) 3L and (ET) 5L dimensions. The summary score of all EQ-5D versions were able to differentiate between known disease groups. Conclusion: Despite the overall high levels of agreement between EQ-5D instruments for youth and for adults, they do not provide identical results in terms of health state, from the same respondent. The differences were most notable for anxiety/depression. These differences in the way individuals respond to the various descriptive systems need to be taken into consideration for descriptive analysis, when transitioning between instruments, and when comparing preference-weighted scores. [ABSTRACT FROM AUTHOR]

Children's participation and inclusion in violence research, particularly in low- and middle-income country (LMIC) contexts, is scant and not well understood. To assess how young children can be engaged in violence research, 4- to 7-year-old children were recruited into our pilot study in a rural area of South Africa. Six interviewers, recruited from the community, were trained to complete cognitive interviews (n = 24), interviewer-administered questionnaires (n = 21), and qualitative interviews (n = 18) with young children. Three focus group discussions (FGDs) were conducted with interviewers. Findings from FGDs and assessment of interview performance highlighted that young children could feasibly and meaningfully appraise violence they experience and articulate their view in a research context. Art- and play-based approaches offered participants an easier and developmentally appropriate platform for communication, expression, and engagement, and asking directly about violence was acceptable. The ease with which children participated was determined both by their level of development and the sensitivity of the interviewers; thus, intensive training and mentorship were required over time to assist interviewers in understanding child development and mental health and increase recognition of these issues and their presentation. Interviewers critically engaged with personal values regarding children's rights and voice in research, reflecting that some of the stories were difficult to listen to. They were able to use and value novel methods to facilitate the ethical involvement of young children to yield rich data. Without young children's involvement and dynamic participation in violence research, the field will not have the evidence to build best practices, respond appropriately to the needs of this vulnerable population, and interrupt the intergenerational transmission of violence that develops in these formative years. Our study adds to the burgeoning evidence that young participants are vital to the research process and are valuable active contributors to understanding violence in LMICs. [ABSTRACT FROM AUTHOR]

Introduction: South African women bear an intersecting burden of HIV, sexually transmitted infections (STIs) and unintended pregnancy. Multipurpose prevention technologies (MPTs) are a class of products that address multiple needs and have the potential to improve uptake and use of prevention products. Methods: Analysing survey data from 703 HIV-negative women 18--40 years in three provinces in South Africa, collected between July and November 2022, this study explores their preferences for prevention methods and factors influencing choice of hypothetical prevention methods, including MPTs. Descriptive statistics and multinomial regression analyses were conducted to determine prevention method preferences and factors associated with choosing a pill, injectable or MPT-implant type prevention method. Results: Most women wanted to prevent HIV, STIs and pregnancy. The most important factors when choosing a prevention product were whether it provided dual and long-term protection and if side effects were manageable. If choosing only one method, half of women would choose any MPT-implant and a quarter each would choose a pill or an injectable method, with method choices differing by population group. Discussion: Prevention method choices were influenced by sexual-behavioural factors and current and prior contraceptive method use. Providing a choice of prevention methods and a population specific approach to new method development and introduction with access to accurate information could enhance their ability to fill a gap in prevention needs. [ABSTRACT FROM AUTHOR]

Poor iron status is detrimental to physical and cognitive performance in adolescents. Due to the limited studies investigating the association between iron status and physical fitness components in adolescents from low- and middle-income countries, we aimed to determine the association of iron status with selected physical fitness components in South African adolescents. A cross-sectional study design, including 178 adolescents (102 girls and 76 boys) from the Physical Activity and Health Longitudinal Study (PAHLS), was followed. Height and weight were measured to calculate the body mass index (BMI). Subsequently, WHO BMI-for-age-specific categorised body fatness. Cardiorespiratory fitness was determined with a 20-m shuttle run test ( V ˙ O 2 max ), and lower-body explosive power by the standing broad jump (SBJ). Fasting haemoglobin (Hb) and ferritin were analysed from blood samples. Correlation analyses determine the association between iron status, explosive power and cardiorespiratory fitness. Of the 178 participants, 18.5% (n = 33) had low Hb, and 14% (n = 25) iron deficiency without anaemia. Significant positive correlations were found between the selected physical fitness components, ferritin, and Hb. In boys, a positive association was found between Hb and SBJ (r = 0.30, p = 0.006), whilst in girls, positive associations were found between ferritin (r = 0.25, p = 0.04) and SBJ, and Hb with both SBJ (r = 0.21, p = 0.03) and V ˙ O 2 max (r = 0.32, p = 0.001). Hb concentration remained associated with V ˙ O 2 max and SBJ in girls after adjustment for age, whilst in boys, Hb concentration was associated with SBJ. Higher iron status in South African adolescents is associated with higher lower-limb explosive power and cardiorespiratory fitness. We suggest monitoring of haematological parameters, and interventions to improve the iron status of South African adolescents. [ABSTRACT FROM AUTHOR]

There are ongoing debates and controversies about whether genderqueer individuals have specific sexual-reproductive healthcare services and needs (SRHSNs). This study intended to identify and explore queer-specific SRHSNs among healthcare providers (HCPs) in Gauteng Province, South Africa. This was an exploratory sequential mixed-methods study, and this article focuses on the qualitative findings of that investigation. Thirty-three HCPs were purposively sampled, and semi-structured one-on-one interviews were used to collect data between September and November 2023. The data were analyzed using thematic content analysis (TCA). The results of this study revealed nine main themes: a crucial need for inclusive healthcare facilities; a need for psychological, counseling, and therapeutic support in sexual and reproductive healthcare; access to sexual-reproductive education and integrating support; suggested reproductive health services for queer sexual wellness; improved accessibility and particular queer reproductive healthcare; optimizing services related to human immunodeficiency virus (HIV), pre-exposure prophylaxis (PrEP) access, and sexually transmitted illness (STI) treatment; genderqueer persons' parenthood aspirations and empowerment; the safe availability of intimacy tools; and navigation transitions. A holistic and inclusive healthcare approach that fits psychological support, comprehensive sexual-reproductive education, and specialized services to accommodate the unique needs of queer individuals should be implemented and made easily accessible. [ABSTRACT FROM AUTHOR]

Improving the practice environment, quality of care and patient safety are global health priorities. In South Africa, quality of care and patient safety are among the top goals of the National Department of Health; nevertheless, empirical data regarding the condition of the nursing practice environment, quality of care and patient safety in public hospitals is lacking. Aim This study examined nurses' perceptions of the practice environment, quality of care and patient safety across four hospital levels (central, tertiary, provincial and district) within the public health sector of South Africa. Methods This was a cross-sectional survey design. We used multi-phase sampling to recruit all categories of nursing staff from central (n = 408), tertiary (n = 254), provincial (n = 401) and district (n = 244 [large n = 81; medium n = 83 and small n = 80]) public hospitals in all nine provinces of South Africa. After ethical approval, a self-reported questionnaire with subscales on the practice environment, quality of care and patient safety was administered. Data was collected from April 2021 to June 2022, with a response rate of 43.1%. ANOVA type Hierarchical Linear Modelling (HLM) was used to present the differences in nurses' perceptions across four hospital levels. Results Nurses rated the overall practice environment as poor (M = 2.46; SD = 0.65), especially with regard to the subscales of nurse participation in hospital affairs (M = 2.22; SD = 0.76), staffing and resource adequacy (M = 2.23; SD = 0.80), and nurse leadership, management, and support of nurses (M = 2.39; SD = 0.81). One-fifth (19.59%; n = 248) of nurses rated the overall grade of patient safety in their units as poor or failing, and more than one third (38.45%; n = 486) reported that the quality of care delivered to patient was fair or poor. Statistical and practical significant results indicated that central hospitals most often presented more positive perceptions of the practice environment, quality of care and patient safety, while small district hospitals often presented the most negative. The practice environment was most highly correlated with quality of care and patient safety outcomes. Conclusion There is a need to strengthen compliance with existing policies that enhance quality of care and patient safety. This includes the need to create positive practice environments in all public hospitals, but with an increased focus on smaller hospital settings. [ABSTRACT FROM AUTHOR]

Background: Evidence-Based Practice (EBP) is a model utilised by the majority of healthcare professionals and is a clinical framework that assists with decision-making related to patient care, to improve outcomes and patient satisfaction. The study aimed to analyse the attitudes, skills, and utilization of evidence-based practice (EBP) among South African chiropractors, focusing on perceived skill levels, training, use and identifying facilitators and barriers to EBP application. Methods: A descriptive cross-sectional quantitative secondary analysis was conducted by inviting registered chiropractors in South Africa (n = 920) to participate in an anonymous online questionnaire using the Evidence-Based Practice Attitude and Utilisation Survey (EBASE). Results: A total of 132 chiropractors completed the survey, yielding a response rate of 14.4%. Of the respondents, 59.9% were female, 52.3% were between 26 and 35 years old, and 63.3% had graduated from the University of Johannesburg. A third of respondents stated they have poor clinical research skills. Over half of the respondents (56.8%) indicated that EBP constituted a significant part of their education except for completing systematic reviews or meta-analyses. Published clinical evidence was ranked 6th as a source of information for clinical decisions. The obstacles indicated were time constraints and a lack of clinical research in complementary and alternative medicine. Access to the internet, databases and research tools were facilitators that were deemed to be "very useful" in promoting EBP. Conclusion: The majority of South African chiropractors are generally favourable towards EBP, and this practice therefore appears to be utilised and embraced, with the requisite skills. [ABSTRACT FROM AUTHOR]

Purpose: Developmental stuttering is a complex and multifaceted neurodevelopmental disorder that may cause pervasive negative consequences for adults who stutter (AWS). Historically, intervention for AWS has primarily addressed speech fluency, with less focus on the covert psychosocial aspects of the disorder. The purpose of this article is to report on a feasibility trial evaluating a novel integrated intervention that combines traditional stuttering management techniques with Acceptance and Commitment Therapy (ACT) for AWS. Method: Twenty-nine AWS participated in the feasibility trial. All participants successfully completed a combined fluency and ACT intervention, titled the fluency and Acceptance and Commitment Therapy for Stuttering (fACTS) Program. As this was a feasibility study, no control group was included. Intervention was administered by two certified practicing speech-language pathologists, over eight 60- to 90-min sessions. Results: Generalized linear mixed modeling was used to determine change from pre- to post-intervention and follow-up. Significant pre- and post-intervention improvements in self-efficacy, psychosocial functioning, and psychological flexibility were observed, along with significant reductions in observable stuttering behaviors (i.e., stuttered speech frequency). Intervention gains for all variables of interest were maintained 3 and 6 months post-intervention. Conclusions: The fACTS Program was created to be a holistic and flexible intervention to promote self-efficacy beliefs and address stuttering-related psychosocial impacts and speech fluency goals of AWS. Preliminary results indicated positive improvement in all psychosocial outcomes (i.e., self-efficacy, psychosocial impact, and psychological flexibility) and observable speech fluency following completion of the program. Future clinical trials of the fACTS Program with an included control group will further investigate the mechanisms of change for the positive effects observed. [ABSTRACT FROM AUTHOR]

Background: Completion of a research assignment is a requirement for specialist training in South Africa. Difficulty with completion delays graduation and the supply of family physicians. The aim of this study was to explore the experience of registrars with their research in postgraduate family medicine training programmes. Methods: An explorative descriptive qualitative study. Extreme case purposive sampling selected registrars who had and had not completed their research on time, from all nine training programmes. Saturation was achieved after 12 semi-structured interviews. The framework method was used for data analysis, assisted by ATLAS.ti software. Results: The assumption of prior learning by teachers and supervisors contributed to a sense of being overwhelmed and stressed. Teaching modules should be more standardised and focussed on the practical tasks and skills, rather than didactic theory. Lengthy provincial and ethics processes, and lack of institutional support, such as scholarly services and financial support, caused delays. The expertise of the supervisor was important, and the registrar-supervisor relationship should be constructive, collaborative and responsive. The individual research experience was dependent on choosing a feasible project and having dedicated time. The balancing of personal, professional and academic responsibilities was challenging. Conclusion: Training programmes should revise the teaching of research and improve institutional processes. Supervisors need to become more responsive, with adequate expertise. Provincial support is needed for streamlined approval and dedicated research time. Contribution: The study highlights ways in which teaching, and completion of research can be improved, to increase the supply of family physicians to the country. [ABSTRACT FROM AUTHOR]

Aim: Human immunodeficiency virus (HIV) nursing has become more prominent with the increase in chronic HIV infections. This study examined articles related to HIV nursing to determine how the profession has developed and its future direction. Design: A bibliometric analysis was conducted. Methods: HIV nursing‐related articles published in the Web of Science core collection between 1999 and 2022 were searched. VOSviewer was used to identify the contributions of countries, institutions and authors in HIV‐related care. Collaborative maps, hot topics and keywords trends were analysed using VOSviewer and CiteSpace. Results: A total of 1513 publications were extracted. An increase in articles published between 1999 and 2012 was observed. After 2012, the increase in the number of publications was relatively stable. Since 2016, a downward trend in the number of publications has occurred. The USA, South Africa and the UK were the leading contributors to publications related to HIV nursing. The focus of the HIV nursing research has gradually shifted from "HIV infection", "risk factors", and "transmission routes" to "social support", "depression", and "public health". The result shows that increased collaboration among countries/regions can improve the development of HIV nursing and effectively reduce the global HIV infection rate. The mental health of patients has become a research centre in the field of HIV nursing. This study provides direction in clinical practice and future research areas in this field. [ABSTRACT FROM AUTHOR]

The use of donated expressed breast milk (DBM) is encouraged in South Africa, with donor milk banks and legislated policies and programmes available in hospitals serving populations with a high HIV prevalence. Concerns over poor attitudes amongst mothers towards DBM seem to persist. A cross-sectional mixed-methods approach was used in a cohort of mothers of neonates in a regional hospital. Between April 2021 and January 2022, survey data on knowledge, awareness and attitudes towards DBM was collected. Qualitative data from open-ended questions were thematically analysed. Comparative analysis using independent sample t-tests and logistic regression to determine differences in variables and to understand associations related to knowledge was conducted. A total of 163 mothers with a mean (SD) age of 27.1 ± 6.3 years were included; 49.7% of mothers had post-high-school qualifications, 82.8% were unemployed and 87.0% received social security. Some 64.4% had inadequate knowledge of DBM. Awareness of DBM had the strongest association with better knowledge concerning DBM and AdjOR (25.25 95% CI 10.60–68.40; p < 0.001). Negative attitudes towards DBM were largely driven by a lack of knowledge regarding human immunodeficiency virus (HIV) screening of donor mothers and fears of HIV transmission when using DBM. Lack of awareness concerning DBM was associated with poor knowledge of DBM, which may drive poor uptake of this critical nutritional source for at-risk neonates. Implementing targeted awareness programmes on DBM, which begin in the antenatal period and specifically address HIV screening of donor mothers, could address the poor uptake of DBM. [ABSTRACT FROM AUTHOR]

Adolescents living with HIV (ALHIVs) are considered a priority population in the fight against HIV, requiring dedicated services. The COVID-19 pandemic and subsequent disruptions deprived ALHIVs on antiretroviral therapy (ART) of the care and social support essential for treatment adherence and positive treatment outcomes. This study describes health managers' and healthcare workers' responses to the impact of COVID-19 on service delivery to ALHIVs in HIV treatment in the Cape Town Metropole. A descriptive qualitative design was employed, where semi-structured individual interviews (n = 13) were conducted with senior and programme managers as well as healthcare workers between April and October 2023. Inductive thematic analysis was performed using Atlas.ti version 23. Two main themes emerged from these interviews: "HIV service delivery to adolescents during the COVID-19 pandemic" and "Lessons learnt—the way forward". The de-escalation of health services at primary health facilities and the disruption of HIV services resulted in disengagement from care by ALHIVs, increasing mental health and treatment challenges. This warrants the restoration of psychosocial support services and the re-engagement of ALHIVs. The findings from this study can function as a guide for health systems and healthcare providers to navigate future pandemics to ensure that vulnerable populations such as ALHIVs continue to receive care and treatment. [ABSTRACT FROM AUTHOR]

Background: HIV partner disclosure rates remain low among pregnant women living with HIV in many African countries despite potential benefits for women and their families. Partner disclosure can trigger negative responses like blame, violence, and separation. Women diagnosed with HIV late in pregnancy have limited time to prepare for partner disclosure. We sought to understand challenges around partner disclosure and non-disclosure faced by women diagnosed with HIV late in pregnancy in South Africa and Uganda and to explore pathways to safe partner disclosure. Methods: We conducted in-depth interviews and focus group discussions with pregnant women and lactating mothers living with HIV (n = 109), disaggregated by antenatal care (ANC) initiation before and after 20 weeks of gestation, male partners (n = 87), and health workers (n = 53). All participants were recruited from DolPHIN2 trial sites in Kampala (Uganda) and Gugulethu (South Africa). Topic guides explored barriers to partner disclosure, effects of non-disclosure, strategies for safe disclosure. Using the framework analysis approach, we coded and summarised data based on a socio-ecological model, topic guides, and emerging issues from the data. Data was analysed in NVivo software. Results: Our findings illustrate pregnant women who initiate ANC late experience many difficulties which are compounded by the late HIV diagnosis. Various individual, interpersonal, community, and health system factors complicate partner disclosure among these women. They postpone or decide against partner disclosure mainly for own and baby's safety. Women experience stress and poor mental health because of non-disclosure while demonstrating agency and resilience. We found many similarities and some differences around preferred approaches to safe partner disclosure among female and male participants across countries. Women and male partners preferred healthcare workers to assist with disclosure by identifying the 'right' time to disclose, mentoring women to enhance their confidence and communication skills, and providing professional mediation for partner disclosure and couple testing. Increasing the number of counsellors and training them on safe partner disclosure was deemed necessary for strengthening local health services to improve safe partner disclosure. Conclusion: HIV diagnosis late in pregnancy amplifies existing difficulties among pregnant women. Late ANC initiation is an indicator for the likelihood that a pregnant woman is highly vulnerable and needs safeguarding. Respective health programmes should be prepared to offer women initiating ANC late in pregnancy additional support and referral to complementary programmes to achieve safe partner disclosure and good health. [ABSTRACT FROM AUTHOR]

Background: Registered nurses working in the mobile health clinics (MHCs) play an important role in enabling HIV care access to populations in remote areas through Nurse Initiated Antiretroviral Therapy program (NIMART). Aim: To explore and describe the nurses' experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics (MHCs) of eThekwini Municipality in KwaZulu Natal. Methods: Qualitative Exploratory Descriptive (QED) method was used after permission was granted from North-West University Human Research Ethics Committee provincial and local health authorities. Data saturation informed sample size of thirteen MHCs nurses were purposefully sampled to participate. Audio-recorded, semi-structured, online, one-on-one interviews guided by open-ended questions were done for data collection, and including demographic profile. The interview transcripts were analysed using Atlas-TI and SPSS descriptive statistics was used for demographics. Results: Eleven subthemes emerged under patient-related, nurse-related, and organisational-related themes which influence the operational factors in the MHCs, namely: patient defaulting treatment, lack of privacy, unavailability of phones, stressful and demotivating MHCs, nurses feel unsafe, lack of support from management, lack of budget, unavailability of computers, shortage of medical equipment, shortage of nursing staff and absence of data capturers. Conclusion: Structured contextual coaching and support program for nurses is imperative to ensure effective and strengthened operations in MHCs, further supported by improvement in human resource for health allocation for MHCs in light of expanding health care programs Contributions: Evaluation of health care programmes, and human resource for health quality improvement needs in the clinical practice of HIV care of MHCs nurses which advocate for specific policy formulations. [ABSTRACT FROM AUTHOR]

Background: Dementia care in South Africa faces challenges including a paucity of published research, a prevalent medical model in healthcare, and inadequate caregiver training. Music is a meaningful psychosocial intervention in dementia care, yet its application is not always safe and effective. A training protocol was codesigned to enhance caregivers' delivery of person‐centred care through attuned, live singing. Objectives: This study explored the acceptability and caregivers' experiences of a person‐centred caregiver singing (PCCS) protocol in South Africa. Methods: A PCCS workshop was applied at seven aged care homes in Cape Town, South Africa. Forty‐one formal caregivers adhered to inclusion criteria and consented to attend one workshop on PCCS. Mixed methods data collection was obtained from questionnaires containing a Likert scale and written reflections. Quantitative data were analysed through nonparametric tests and narrative descriptions, and qualitative data through thematic content analysis. Findings were integrated deductively using seven components of acceptability. Results: Findings converged to show caregivers' positive experiences, highlighting observed improvements in residents' wellbeing, caregivers' capabilities, empathic connection, and person‐centred care beyond the one‐on‐one. Caregivers' limited song repertoire and residents' unpredictability hindered implementation, however, the skills acquired appeared useful and applicable. Conclusions: Integration of findings suggests the acceptability of PCCS as caregivers experienced PCCS as a helpful, easy‐to‐implement intervention that contributes to their delivery of person‐centred care. Further research focused on caregiver self‐efficacy, empathy, and caregivers' own personhood is needed as well as determining the most effective strategies to ensure maximum uptake and sustainability in the sector. Patient or Public Contribution: Formal caregivers participated in this study, both attending the training and implementing the singing protocol with residents in their care at their respective care homes. The people living with dementia residing at the care home were recipients of the singing protocol but not included as participants in the research. [ABSTRACT FROM AUTHOR]

Background: Palliative care (PC) has been integrated to a limited extent in the South African healthcare system. Contextual factors may be a pivotal influence in this integration. Objectives: This study aims to explore contextual factors that are possibly influencing the integration or lack thereof in an academic teaching hospital (ATH). Design: A mixed-method study was conducted in a large ATH in South Africa. Methods: The mixed methods were conducted in parallel and then merged. Findings were integrated to describe the contextual factors influencing PC integration, to develop a timeline of implementation and assess the probable influence of context on the integration process. The mixed-methods phases included a narrative review of published literature related to health systems, integration of health interventions and PC in teaching hospital settings; followed by interviews, documentary and routine data analyses. Semi-structured interviews with purposively sampled participants provided the qualitative data. Primary national, provincial and organizational documents expanded the contextual phenomena and corroborated findings. Routine hospital admission and mortality data was statistically analysed to expand further and corroborate findings. All qualitative data was thematically analysed using deductive coding, drawing from the aspects of the contextual dimensions of integration. Results: Enabling contextual factors for local PC integration were global and local advocacy, demonstrated need, PC being a human right, as well as the personal experiences of hospital staff. Impeding factors were numerous misconceptions, PC not valued as a healthcare priority, as well as limitations in functional elements necessary for PC integration: national and regional political support, leadership at all levels and sustainable financing. Conclusion: The normative and functional contextual aspects interplay at macro, meso and micro levels positively and negatively. How stakeholders understand and value PC directly and indirectly impacts on PC integration. Strategic interventions such as mandatory education are required to ensure PC integration. The health system is dynamic, and understanding the context in which the health system functions is core to the integration of PC. This may assist in developing integration strategies to address PC integration and the transferability of these strategies. Plain language summary: How the context influences a new palliative care intervention Palliative care is being integrated in a big hospital in South Africa. However, there are many contextual factors that influence this integration. These factors are both structural aspects like policies, but also how role players' values and understand of palliative care. It is important to know what these factors are and how these factors influence integration. This study describes the factors and how they influence palliative care integration. [ABSTRACT FROM AUTHOR]