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Intimate partners play an important role in chronic diseases. Despite the chronic disease burden in sub- Saharan Africa, very few culturally relevant quantitative measures of intimate relationship functioning are available. We conducted an empirical investigation evaluating the psychometric properties of the South African Relationship Functioning Assessment (SARFA) assessing healthy relationship functioning in N = 150 community members (50% women; M age = 27.2 years) living in the Vulindlela area of KwaZulu-Natal, South Africa. Item development was based on prior qualitative research from two South African communities. All assessments were conducted in isiZulu, participants' primary language. An exploratory factor analysis was conducted on the initial 39-item measure. The best-fitting model consisted of one factor with 22 items. The SARFA's internal consistency was a = .94. Convergent validity was observed via significant positive associations (all rs = .38, p < .001) between the SARFA's total score and measures of trust, emotional intimacy, constructive communication, sexual satisfaction, and relationship control (women only). Divergent validity was observed for women only. Encouraging initial psychometric properties of a culturally relevant measure of relationship functioning in KwaZulu-Natal may have relevance to other communities and potential to be used in research involving couples and health in chronic disease-burdened communities. [ABSTRACT FROM AUTHOR]

IntroductionIn South Africa where HIV prevalence is high, mentor mother programmes have been used to promote the health and wellbeing of women enrolled in government programmes preventing vertical transmission. The Masihambisane Project trained mentors to be educators and facilitators as "expert patients" in self-help groups. While this and other similar interventions demonstrate positive outcomes for mothers and their children, the long-term repercussions for mentors delivering the intervention are seldom considered. This article explores the personal impact of being a mentor, the potentially traumatizing effects of repeatedly sharing their experiences of living with HIV and the coping strategies they adopt.ResultsTowards the end of the Masihambisane intervention, 10 semi-structured qualitative interviews were conducted with locally recruited mentors living with HIV and were thematically analysed. Mentors found the repeated telling of their stories a painful reminder of adverse personal experiences. In some cases, retelling caused a physical reaction. Mentors relied on coping strategies like taking breaks, writing their experiences down and debriefing sessions. Despite the difficulties associated with their role, some mentors found being advisors and the group sessions therapeutic and empowering.ConclusionsThese findings indicate that the inclusion of peer mentors comes with certain responsibilities. While the mentors were resilient and some found the experience therapeutic and empowering found creative ways to cope with secondary trauma, the negative implications cannot be ignored. To effectively deliver a mentor-driven intervention to mothers enrolled in a programme to prevent vertical transmission, the possibilities of secondary trauma should be considered and mentors provided with ongoing counselling, training on coping skills and regular debriefing sessions.

Abstract Background Pregnant women living with HIV (WLH) face daily challenges maintaining their own and their babies' health and mental health. Standard Prevention of Maternal to Child Transmission (PMTCT) programs are not designed to address these challenges. Methods/Design As part of a cluster randomized controlled trial, WLH are invited to attend four antenatal and four postnatal small group sessions led by a peer WLH (a Peer Mentor). The WLH and their babies are assessed during pregnancy and at one week, six months, and twelve months post-birth. Mobile phones are used to collect routine information, complete questionnaires and remain in contact with participants over time. Pregnant WLH (N = 1200) are randomly assigned by clinic (N = 8 clinics) to an intervention program, called Masihambisane (n = 4 clinics, n = 600 WLH) or a standard care PMTCT control condition (n = 4 clinics; n = 600 WLH). Discussion Data collection with cellular phones are innovative and effective in low-resource settings. Standard PMTCT programs are not designed to address the daily challenges faced by WLH; Peer Mentors may be useful in supporting WLH to cope with these challenges. Trial registration ClinicalTrials.gov registration # NCT00972699

Children exposed to alcohol in utero may suffer from cognitive and physical sequelae. The most impactful damage in terms of daily functioning is to higher order cognitive functions involved in planning and goal-directed behaviour, referred to as executive functions. Cognitive training interventions are used as a remedial tool for executive function deficits but require implementation by professionals. For the South African context, where resources are limited, a tablet computer-based cognitive training game was developed. This study aimed to establish the feasibility of implementing and evaluating this intervention in South Africa for children exposed to alcohol prenatally. This was a three-arm feasibility randomised control trial comparing an alcohol exposed intervention arm, to an alcohol exposed control arm, and a non-exposed normative arm. Arm allocation was based on self-reported maternal alcohol use during a structured interview. To assess feasibility, we evaluated participant recruitment and barriers to implementation. Executive functions were measured at baseline and following intervention to evaluate the preliminary impact of the intervention. No significant differences were found between the three arms on the post-intervention assessments. The retention rate was acceptable for a randomised control trial; however, there was significant variance in the length of time spent playing the game overall. The majority of participants learned to play the game quickly and progressed through the difficulty levels. In conclusion, a full randomised control trial using the recruitment, randomisation and implementation method would be suitable in the South African context. The statistical outcomes of this trial do not support a full-scale randomised control trial of this intervention. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB) is the leading cause of HIV-associated mortality in Africa. As HIV testing, linkage to care and antiretroviral treatment initiation intensify to meet UNAIDS targets, it is not known what effect these efforts will have on TB detection and prevention. We aimed to characterize the TB care cascade of screening, diagnostic testing, treatment and provision of isoniazid preventive therapy (IPT) in a study of community-based HIV screening and linkage to care and determine whether symptom screening results affected progress along the cascade. Methods: Between June 2013 and March 2015, HIV-infected adults enrolled in the Linkages study, a multi-site, community-based, randomized HIV screening and linkage-to-care study in South Africa and Uganda. All participants were screened for TB symptoms at entry after testing positive for HIV and referred to local clinics for care. During the 9 month follow-up, participants were periodically surveyed about clinic linkage and initiation of HIV care as well as subsequent TB testing, treatment, or IPT. We compared outcomes between persons with and without a positive symptom screen at baseline using descriptive statistics and Poisson regression to calculate relative risks of outcomes along the care cascade. Results and discussion: Of the 1,325 HIV-infected adults enrolled, 26% reported at least one TB symptom at the time of HIV diagnosis. Loss of appetite and fever were the most commonly reported symptoms on a TB symptom screen. Despite 92% HIV linkage success, corresponding TB linkage was incomplete. Baseline TB symptoms were associated with an increased risk of a TB diagnosis (relative risk 3.23, 95% CI 1.51 to 6.91), but only 34% of symptomatic persons had sputum TB testing. Fifty-five percent of participants diagnosed with TB started TB treatment. In South Africa, only 18% of asymptomatic participants initiated IPT after linkage to HIV care, and presence of symptoms was not associated with IPT initiation (relative risk 0.86 95% CI 0.6 to 1.23). Conclusions: HIV linkage to care interventions provide an opportunity to improve completion of the TB care cascade, but will require additional support to realize full benefits. Keywords: tuberculosis; HIV; linkage; isoniazid preventive therapy, 1 | INTRODUCTION Tuberculosis (TB) is a leading cause of mortality among persons with HIV/AIDS worldwide, causing nearly a third of HIV-associated deaths [1]. Early diagnosis and treatment of active [...]

Continuous monitoring of glucose (CGM) via subcutaneous patch is an accurate self-monitoring tool of blood glucose, but also introduces a range of additional benefits such as real-time feedback. While its value among pregnant women with gestational diabetes mellitus (GDM) is established in high-income countries, little is known about the feasibility and acceptability among pregnant women without GDM in low-resource settings in low- and middle-income countries. This study aims to assess the feasibility and acceptability of CGM with pregnant mothers in South Africa and to explore the value of a collected data set for GDM prevention. Ten women between 12 and 18 weeks pregnant were recruited from the antenatal clinic at Chris Hani Baragwanath Academic Hospital into a prospective mixed-methods pilot study. Demographic and anthropometric data, HbA1c and a lipid panel were collected. Women then wore two consecutive Freestyle Libre 2 patches for a total of 28 days. In-depth interviews were undertaken with all 10 women on study exit to explore themes of acceptability and the use of technology during pregnancy. Thematic analysis was performed on the qualitative data while exploratory data-analysis techniques were applied to the CGM data. Pregnant women (n = 10) had a mean (SD) age of 29.81 years (4.39), with most being unemployed (8), unmarried (8) and without a tertiary degree (7). Analysis suggests that fear of use was greater than the actual discomfort experienced during use of the CGM patch. The main barrier to use was the patch falling off and women being uncomfortable to reapply it. This was borne out by all 10 women wearing the first patch for at least 12 of the 14 days, but only 4 managing the same with patch two – primarily applied by themselves at home. Women expressed support for the use of technology during pregnancy, especially as it related to feeling that their pregnancy was being monitored and that they were being supported. In this pilot study, women overwhelmingly found the wearing of a CGM patch during pregnancy to be acceptable. Feasibility was reasonable with most data being successfully retrieved from the devices over a two-week period. Longer use was found to have additional challenges. The use of CGM patches appear to be a possible candidate for inclusion in GDM prevention or behavioural interventions during pregnancy in South Africa. [ABSTRACT FROM AUTHOR]

Background: In 2018, South Africa developed 24-hour movement behavior guidelines for children from birth to 5 years. This study reports on the stakeholder consultation as part of this development process. Methods: An online survey was completed by 197 participants; 9 focus groups (with parents/caregivers, early childhood development practitioners, and community health workers, total n = 70) were conducted, and a meeting with stakeholders from government and nongovernment organizations (n = 15) was held. Results: In the online survey, stakeholders overwhelmingly agreed with the guidelines (97.0%) and recognized the benefit of putting the guidelines into practice (88.8%). Most online survey respondents (88.3%) reported that the guidelines would benefit all South African children equally. Responses to open-ended questions in the online survey and focus group discussions revealed issues including safety and nutrition of children, perceived parental barriers to using the guidelines, and education. Training and provision of educational materials were identified from all stakeholders as key in the dissemination and implementation of the guidelines. Conclusions: The findings informed the development of the South African 24-hour movement behavior guidelines and revealed several important factors to address in the dissemination and implementation of the guidelines to ensure that they are applicable and equitable in South Africa. [ABSTRACT FROM AUTHOR]