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BACKGROUND: Index contact testing is an HIV case-finding approach that elicits sexual or needle-sharing partners, as well as biological children, of people living with HIV (PLHIV) and offers them HIV testing services. OBJECTIVES: We aim to describe the results of an innovative project in Sedibeng District that expanded index testing by retesting previously negative contacts and incorporating status-neutral testing. METHOD: We used registers to identify people who previously tested HIV-negative through index testing from March 2019 to September 2021. The individuals were telephonically traced and offered HIV retesting. Data were collected on a weekly basis using REDCap®. We monitored the number of individuals called, those who came back for retest, and their HIV results. RESULTS: Fifteen counsellors contacted 968 people over 12 months. Forty-eight percent (462 out of 968) of those called returned for testing. Of those, 121 (26%) tested positive. Overall, 66 out of 276 (24%) men with HIV and 55 out of 186 (30%) women with HIV were identified and linked to antiretroviral treatment (ART). Fifty-seven percent (194 out of 341) of clients who tested HIV-negative were offered, and 124 out of 194 (64%) initiated, pre-exposure prophylaxis (PrEP). All individuals who retested HIV-positive had a new diagnosis; none reported having had another positive test result between the original negative and the positive retest. CONCLUSION: Revisiting index clients with a previous negative HIV test result is worthwhile, creating an opportunity to identify undiagnosed PLHIV and high-risk people for PrEP. The high positivity rate highlights the importance of providing a sero-neutral approach to HIV testing, including integrating prevention messaging and linkage to PrEP services.

BackgroundThe postnatal period is a critical period for the health of both mother and infant. Studies show that postnatal care reduces neonatal mortality and other adverse mother and child health outcomes. While the World Health Organization recommends four postnatal care contacts, South African guidelines only specify three, excluding a 7-14-day post-birth contact. This study aimed to assess whether a telephonic contact at 7-14 days following delivery had any effect on use of additional postnatal services.MethodsA randomized controlled trial design was used to address the study objectives. Two groups of new mothers were randomly allocated to either receive the 7-14-day telephonic contact or not from a research nurse. Data for this study was collected at Maphutha L Malatjie Hospital (MLMH). Descriptive analysis was performed first, then a multivariable logistic regression analysis was conducted to assess the factors associated with access to other health care services.ResultsA total of 882 mothers were recruited, 854 (97%) were classified as high risk, 28 (3%) were classified as low risk. 417 (49%) of the high risk received the 7-14-day call (intervention group) whilst the remainder of 437 (51%) from the high risk plus all mothers classified as low risk (28) did not receive the call (control group). 686 (78%) of all mothers received the 3 month follow up call. The call showed that 17 mothers from the control group and 10 mothers from the intervention group accessed other healthcare services. We find that hypertension (3.28; 1.06 −10.10), mental health risk (2.82; 1.25 −6.38), PV bleeding during pregnancy (18.33; 1.79–187.61), problem during labor (4.40; 1.280–15.13) were positively associated with access to other health services, with statistically significant associations (p-value < 0.05). We found statistically insignificant associations between receiving the 7-14-day call and accessing other health care services.ConclusionThe 7-14-day call had no statistically significant impact on access to other health services, however, high levels of satisfaction with the call may point to an unmet need for care at this time. It is important to investigate other innovative solutions to postnatal care improvement in South Africa.

Additional file 1. Supplementary Material for: Postnatal clubs for integrated postnatal care in Johannesburg, South Africa: a qualitative assessment of implementation. Interview Guide.

Background: Despite a high burden of disease, in many health districts in the Wes tern Cape, South Africa, intimate partner violence is known to be poorly recognised and managed. To address this gap in service an innovative intersectoral model for the delivery of comprehensive intimate partner violence (IPV) care was piloted in the Witzenberg, a rural, agricultural sub - district known to have a high incidence of IPV. It was not known whether the initiative was a success from the perspective of the women using the service, from the service providers or from the managers. Methods: A qualitative evaluation was conducted. Ten service users were interviewed to explore their experience of the intervention. Two focus groups were conducted amongst health care workers, and one focus group and six interviews were conducted with the intersectoral implementation team, to understand their experience of implementing the intervention. Documents relating to the pilot were also analysed. A contextualized thematic content analysis approach was used, triangulating the various sources of data, and utilising inductive as well as deductive approaches. Results: Over the pilot period 75 women received the intervention. Study participants described their experience of it as overwhelmingly positive, with some experiencing improvements in their home lives. Significant access barriers included unaffordable indirect costs, fear of loss of confidentiality, and fear of children being removed from the home. For health care workers, barriers to inquiry about intimate partner violence included its normalisation in this community, poor understanding of the complexities of living with violence and frustration in managing a difficult emotional problem. Health system constraints impacted on the pilot, affecting continuity of care, privacy and integration of the intervention into routine functioning, and the process of intersectoral action was hindered by the formation of alliances. Contextual factors, for example high levels of alcohol misuse and socioeconomic disempowerment highlighted the need for a multifaceted approach to addressing intimate partner violence. Conclusion: The results of this qualitative evaluation draw attention to the need to take a health systems approach and focus on contextual factors when implementing complex interventions. They will be used to inform decisions about instituting appropriate intimate partner violence care in the rest of the province. Additionally, there is a pressing need for clear policies and guidelines framing intimate partner violence as a health issue.

BACKGROUND: Intimate partner violence (IPV) is a common and serious public health concern, particularly in South Africa, but it is not well managed in primary care. AIM: This review aims to summarise the current state of knowledge regarding health sector-based interventions for IPV, their integration into health systems and services and the perspectives of service users and healthcare workers on IPV care, focusing on the South African context. METHOD: PubMed, CINAHL, PsycINFO and Google Scholar were searched between January 2012 and May 2014. All types of study design were included, critically appraised and summarised. RESULTS: Exposure to IPV leads to wide-ranging and serious health effects. There is sufficient evidence that intervening in IPV in primary care can improve outcomes. Women who have experienced IPV have described an appropriate response by healthcare providers to be non-judgmental, understanding and empathetic. IPV interventions that are complex, comprehensive and utilise systems-wide approaches have been most effective, but system- and society-level barriers hamper implementation. Gender inequities should not be overlooked when responding to IPV CONCLUSION: Further evaluations of health sector responses to IPV are needed, in order to assist health services to determine the most appropriate models of care, how these can be integrated into current systems and how they can be supported in managing IPV. The need for this research should not prevent health services and healthcare providers from implementing IPV care, but rather should guide the development of rigorous contextually-appropriate evaluations. CONTEXTE: La violence conjugale (IPV) est une grave préoccupation commune de santé publique, particulièrement en Afrique du Sud, mais n'est pas bien gérée au niveau des soins primaires. OBJECTIF: Ce rapport vise à résumer l'état actuel des connaissances en ce qui concerne les interventions sanitaires contre l'IVP, leur intégration dans le système et les services de santé, et les perspectives des utilisateurs des services et des professionnels de la santé sur les soins pour l'IPV, en mettant l'accent sur le contexte sud-africain. MÉTHODE: On a fait des recherches en 2012 et 2013 sur PubMed, CINAHL, PsycINFO et Google Scholar. On a inclus tous les types d'études qu'on a évalués et résumés. RÉSULTATS: L'exposition à l'IPV entraine toute une série de graves problèmes de santé. Il y a suffisamment de preuves que l'intervention dans le contexte des soins de santé primaires peut améliorer les résultats. Les femmes ayant été victimes d'IPV ont déclaré qu'une réponse appropriée par les prestataires de soins ne portait pas de jugement et était complète et compréhensive. Les interventions d'IPV qui sont complexes, complètes et utilisent des démarches à l'échelle des systèmes ont été très efficaces, mais les barrières au niveau du système et de la société entravent leur mise en luvre. Il ne faut pas négliger les injustices liées au genre quand on réagit à l'IPV. CONCLUSION: D'autres évaluations de la réaction du secteur de la santé à l'IPV seront nécessaires, pour permettre aux services de santé de déterminer les modes de soins les plus appropriés, comment les intégrer dans les systèmes actuels, et comment on peut les aider à gérer l'IPV. La nécessité de mener cette étude ne doit pas empêcher les services de santé et les prestataires de soins de mettre en œuvre les soins pour l'IPV, mais devrait plutôt guider l'élaboration d'évaluations rigoureuses et appropriées dans ce contexte.