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Fear of stigma and discrimination among health care workers (HCWs) in South African hospitals is thought to be a major factor in the high rates of HIV and tuberculosis infection experienced in the health care workforce. The aim of the current study is to inform the development of a stigma reduction intervention in the context of a large multicomponent trial. We analysed relevant results of four feasibility studies conducted in the lead up to the trial. Our findings suggest that a stigma reduction campaign must address community and structural level drivers of stigma, in addition to individual level concerns, through a participatory and iterative approach. Importantly, stigma reduction must not only be embedded in the institutional management of HCWs but also be attentive to the localised needs of HCWs themselves. [ABSTRACT FROM PUBLISHER]

High rates of residential separation of fathers and children in South Africa demand reliable methods of collecting data on the parenting practices of nonresident fathers. Using questionnaire data from matched mother-father pairs, we assessed the reliability of mother's reports of father's involvement in infant care as a proxy for father's own reports. Agreement between parental reports was reasonable for father's financial provisioning and time spent with the infant, but poor for father's engagement in direct caregiving, decision-making responsibility, and assistance with household chores. Across a range of activities, fathers reported higher levels of involvement than were acknowledged by mothers. Disagreement over definitions of the underlying parenting practices being assessed and definitions of the response categories on the questionnaire appeared to contribute to low levels of overall agreement. Mother and father reports should not be treated interchangeably in research on father involvement. Ideally, future research will incorporate data from multiple observers. [ABSTRACT FROM AUTHOR]

Background: Community-based cluster-randomized controlled trials (RCTs) are increasingly being conducted to address pressing global health concerns. Preparations for clinical trials are well-described, as are the steps for multi-component health service trials. However, guidance is lacking for addressing the ethical and logistic challenges in (cluster) RCTs of population health interventions in low- and middle-income countries., Objective: We aimed to identify the factors that population health researchers must explicitly consider when planning RCTs within North-South partnerships., Design: We reviewed our experiences and identified key ethical and logistic issues encountered during the pre-trial phase of a recently implemented RCT. This trial aimed to improve tuberculosis (TB) and Human Immunodeficiency Virus (HIV) prevention and care for health workers by enhancing workplace assessment capability, addressing concerns about confidentiality and stigma, and providing onsite counseling, testing, and treatment. An iterative framework was used to synthesize this analysis with lessons taken from other studies., Results: The checklist of critical factors was grouped into eight categories: 1) Building trust and shared ownership; 2) Conducting feasibility studies throughout the process; 3) Building capacity; 4) Creating an appropriate information system; 5) Conducting pilot studies; 6) Securing stakeholder support, with a view to scale-up; 7) Continuously refining methodological rigor; and 8) Explicitly addressing all ethical issues both at the start and continuously as they arise., Conclusion: Researchers should allow for the significant investment of time and resources required for successful implementation of population health RCTs within North-South collaborations, recognize the iterative nature of the process, and be prepared to revise protocols as challenges emerge.