Regina Mlobeli - Academia.edu (original) (raw)

Papers by Regina Mlobeli

Background: Emergency contraception (EC) is widely available free of charge at public sector clin... more Background: Emergency contraception (EC) is widely available free of charge at public sector clinics in South Africa. At the same time, rates of teenage and unintended pregnancy in South Africa remain high, and there are few data on knowledge of EC in the general population in South Africa, as in other resource-limited settings. Methods: We conducted a cross-sectional, interviewer-administered survey among 831 sexually active women at 26 randomly selected public sector clinics in the Western Cape province. Results: Overall, 30 % of the women had ever heard of EC when asked directly, after the method was described to them. Only 15 % mentioned EC by name or description spontaneously. Knowledge of EC was independently associated with higher education, being married, and living in an urban setting. Four percent of women had ever used EC. Discussion: These data suggest that knowledge of EC in this setting is more common among women of higher socioeconomic status living in urban areas. Fo...

BMC Women's Health, Sep 12, 2007

Background: Emergency contraception (EC) is widely available free of charge at public sector clin... more Background: Emergency contraception (EC) is widely available free of charge at public sector clinics in South Africa. At the same time, rates of teenage and unintended pregnancy in South Africa remain high, and there are few data on knowledge of EC in the general population in South Africa, as in other resource-limited settings. Methods: We conducted a cross-sectional, interviewer-administered survey among 831 sexually active women at 26 randomly selected public sector clinics in the Western Cape province. Results: Overall, 30% of the women had ever heard of EC when asked directly, after the method was described to them. Only 15% mentioned EC by name or description spontaneously. Knowledge of EC was independently associated with higher education, being married, and living in an urban setting. Four percent of women had ever used EC. Discussion: These data suggest that knowledge of EC in this setting is more common among women of higher socioeconomic status living in urban areas. For EC to play a role in decreasing unintended pregnancy in South Africa, specific interventions are necessary to increase knowledge of the method, where to get it, and the appropriate time interval for its use before the need for EC arises. Future health promotion campaigns should target rural and low socioeconomic status communities.

eClinicalMedicine, 2022

HIV-TB treatment integration reduces mortality. Operational implementation of integrated services... more HIV-TB treatment integration reduces mortality. Operational implementation of integrated services is challenging. This study assessed the impact of quality improvement (QI) for HIV-TB integration on mortality within primary healthcare (PHC) clinics in South Africa. An open-label cluster randomized controlled study was conducted between 2016 and 2018 in 40 rural clinics in South Africa. The study statistician randomized PHC nurse-supervisors 1:1 into 16 clusters (eight nurse-supervisors supporting 20 clinics per arm) to receive QI, supported HIV-TB integration intervention or standard of care (control). Nurse supervisors and clinics under their supervision, based in the study health districts were eligible for inclusion in this study. Nurse supervisors were excluded if their clinics were managed by municipal health (different resource allocation), did not offer co-located antiretroviral therapy (ART) and TB services, services were performed by a single nurse, did not receive non-governmental organisation (NGO) support, patient data was not available for > 50% of attendees. The analysis population consists of all patients newly diagnosed with (i) both TB and HIV (ii) HIV only (among patients previously treated for TB or those who never had TB before) and (iii) TB only (among patients already diagnosed with HIV or those who were never diagnosed with HIV) after QI implementation in the intervention arm, or enrolment in the control arm. Mortality rates was assessed 12 months post enrolment, using unpaired t-tests and cox-proportional hazards model. (Clinicaltrials.gov, NCT02654613, registered 01 June 2015, trial closed). Overall, 21 379 participants were enrolled between December 2016 and December 2018 in intervention and control arm clinics: 1329 and 841 HIV-TB co-infected (10·2%); 10 799 and 6 611 people living with Human Immunodeficiency Virus (HIV)/ acquired immunodeficiency syndrome (AIDS) (PLWHA) only (81·4%); 1 131 and 668 patients with TB only (8·4%), respectively. Average cluster sizes were 1657 (range 170-5782) and 1015 (range 33-2027) in intervention and control arms. By 12 months, 6529 (68·7%) and 4074 (70·4%) were alive and in care, 568 (6·0%) and 321 (5·6%) had completed TB treatment, 1078 (11·3%) and 694 (12·0%) were lost to follow-up, with 245 and 156 deaths occurring in intervention and control arms, respectively. Mortality rates overall [95% confidence interval (CI)] was 4·5 (3·4-5·9) in intervention arm, and 3·8 (2·6-5·4) per 100 person-years in control arm clusters [mortality rate ratio (MRR): 1·19 (95% CI 0·79-1·80)]. Mortality rates among HIV-TB co-infected patients was 10·1 (6·7-15·3) and 9·8 (5·0-18·9) per 100 person-years, [MRR: 1·04 (95% CI 0·51-2·10)], in intervention and control arm clusters, respectively. HIV-TB integration supported by a QI intervention did not reduce mortality in HIV-TB co-infected patients. Demonstrating mortality benefit from health systems process improvements in real-world operational settings remains challenging. Despite the study being potentially underpowered to demonstrate the effect size, integration interventions were implemented using existing facility staff and infrastructure reflecting the real-world context where most patients in similar settings access care, thereby improving generalizability and scalability of study findings. Research reported in this publication was supported by South African Medical Research Council (SAMRC), and UK Government's Newton Fund through United Kingdom Medical Research Council (UKMRC).

People's attitudes towards people living with HIV/AIDS remain a major community challenge. There ... more People's attitudes towards people living with HIV/AIDS remain a major community challenge. There is a need to generate a climate of understanding, compassion and dignity in which people living with HIV/AIDS (PLWHA) will be able to voluntarily disclose their status and receive the support and respect all people deserve. However, many people experience discrimination because they have HIV/AIDS. In a certain area in Khayelitsha, a township in Cape Town, a young woman was killed after disclosing the HIV status after being raped by five men. This has become a barrier to testing, treatment, on quality of life and social responses to HIV/AIDS. While many previous studies have focused on the external stigma in the general population, there is a dearth of studies on stigma among PLWHA themselves and hence the aim of the present study was to investigate stigma attached to HIV/AIDS from the perspective of PLWHA. The focus group research method was used to collect the data. Six focus groups consisting of 8-10 people in each group were held in Khayelitsha drawn from organizations working with PLWHA and Treatment Action Campaign (TAC). Data was analyzed using discourse analysis and the PEN-3 Model was used to explain the themes that emerged from the data. Results showed that PLWHA are affected by both enacted and internal stigma related to HIV/AIDS. It was found that the experiences of discrimination and stigma often originate from the fear and perceptions of PLWHA as immoral or living dead. They suffer rejection at home, work, school and in the health care centres. Results also showed that PLWHA felt shame, guilt, hopelessness and useless. This internalized stigma leads to withdrawal, depression, not to disclose the HIV status and prevent people for testing for HIV and also affect health-seeking behaviour. However, participants who were well informed and those who were members of the support groups reported that they are coping with the illness and they are open about their HIV-status. This suggests that education efforts have been remarkably successful in changing attitudes. It is recommended that stigma reduction programmes should involve PLWHA, community leaders and the community members to be part of the planning and implementation. It is also important to look at the successful programmes already existing in the area and adapt them and also to evaluate the effectiveness. Prof. Leickness Simbayi for your support, encouragement and being patient with me until the end of this process. The Penn-State University and Human Science Research Council for providing me fellowship and the facilities which made it possible for me to finish my thesis. Chelsea Morroni for support, friendship, motivation and containment which kept me going. My husband, children and family for the inspiration, encouragement and providing me space to finish this thesis. PLWHA who participated in this study for sharing your experiences with me. Thank you for trusting me with your sensitive life stories, without you this project was not going to be possible.

Global Health: Science and Practice

Setting The research took place in two separate regions in South Africa: an urban setting in Cape... more Setting The research took place in two separate regions in South Africa: an urban setting in Cape Town, Western Cape and a rural setting near Umtata (Mthatha) in the former Transkei region of the Eastern Cape. This allowed exploration of the key research questions in two very different health care systems, each facing unique challenges: the extremely busy, urban township clinics of Khayelitsha in Cape Town, and the less developed, rural clinics outside of Umtata. In each region, two facilities were selected to participate in research. Each facility provides a range of primary care services. For this research, participants were recruited from HIV care services, family planning services, and STI services only. In Cape Town, the sites were local authority clinics and in Umtata, the sites were Community Health Centers operated by the local authority. Facilities were selected in consultation with provincial / local health care officials based on the following criteria: (a) the degree to which they are typical of primary care clinics in the area, (b) the preference of provincial officials to avoid over-researched facilities, and (c) adequate patient volumes to ensure efficient data collection. Research collaboration In addition to providing insights from different urban and rural settings, the two-province design of the research built on existing collaborations between the School of Public Health at the University of Cape Town and the Department of Obstetrics and Gynaecology at the University of the Transkei (now Walter Sisulu University). This partnership provided a unique opportunity to examine the issues related to DP practices and promotion in two very distinct settings.

Studies in Family Planning, 2012

Arriving late for scheduled contraceptive reinjections is common in many countries and contribute... more Arriving late for scheduled contraceptive reinjections is common in many countries and contributes to discontinuation when providers are unsure how to manage such clients. A clinic-randomized cohort and cross-sectional study with more than 5,000 clients using injectable contraceptives was conducted in the Eastern Cape province of South Africa to test the effectiveness of a provider job aid for managing late-returning clients and promoting continued use of the method. A marginally significant difference in reinjection rates between intervention and control groups was found for those up to two weeks late, and reanalysis excluding one clinic that experienced stockout issues revealed a significant difference. The difference in reinjection rates for those 2-12 weeks late was also found to be significant. The one-reinjection cycle continuation rate for the intervention group was higher than that for the control group, but the difference was not statistically significant. Appropriate management of late-returning clients is critical, and this study illustrates that reinjection rates can be significantly increased with a low-resource provider job aid.

Journal of Behavioral Medicine, 2011

International Family Planning Perspectives, 2007

Research examining hormonal injectable contraceptive continuation has focused on clients' intenti... more Research examining hormonal injectable contraceptive continuation has focused on clients' intentional discontinuation. Little attention, however, has been paid to unintentional discontinuation due to providers' management of clients who would like to continue use but arrive late for their scheduled reinjections. METHODS: A cross-sectional survey of 1,042 continuing injectable clients at 10 public clinics was conducted in South Africa's Western and Eastern Cape provinces. Bivariate logistic regression analyses were used to identify associations between specific variables and the likelihood of receiving a reinjection, among clients who returned to clinics late but within the two-week grace period for reinjection. RESULTS: Of 626 continuing clients in the Western Cape, 29% were up to two weeks late and 25% were 2-12 weeks late for their scheduled reinjection; these proportions among 416 continuing clients in the Eastern Cape were 42% and 16%, respectively. Only 1% of continuing clients in the Western Cape who arrived during the two-week grace period did not receive a reinjection; however, 36% of similar clients in the Eastern Cape did not receive a reinjection. Among late clients in the Eastern Cape who did not receive a reinjection, 64% did not receive any other method. Few variables were significant in bivariate analyses; however, certain characteristics were associated with receiving reinjections among late clients in the Eastern Cape. CONCLUSIONS: It is common for clients to arrive late for reinjections in this setting. Providers should adhere to protocols for the reinjection grace period and have a contraceptive coverage plan for clients arriving past the grace period to reduce clients' risk of unintentional discontinuation and unintended pregnancy.

Health Education Research, 2011

Communicating about sex is a vital component of human immunodeficiency virus (HIV) prevention and... more Communicating about sex is a vital component of human immunodeficiency virus (HIV) prevention and influences how HIV educators convey messages to communities and how couples negotiate safer sex practices. However, sexual communication inevitably confronts culturally based behavioral guidelines and linguistic taboos unique to diverse social contexts. The HIV interventionist needs to identify the appropriate language for sexual communication given the participants and the message. Ethnographic research can help facilitate the exploration of how sex terminology is chosen. A theoretical framework, developed to guide HIV interventionists, suggests that an individual's language choice for sexual communication is influenced by gender roles and power differentials. Indepth interviews, free listing and triadic comparisons were conducted with Xhosa men and women in Cape Town, South Africa, to determine the terms for male genitalia, female genitalia and sexual intercourse that are most appropriate for sexual communication. Results showed that sexual terms express cultural norms and role expectations where men should be powerful and resilient and women should be passive and virginal. For HIV prevention education, non-mother tongue (English and Zulu) terms were recommended as most appropriate because they are descriptive, but allow the speaker to communicate outside the restrictive limits of their mother tongue by reducing emotive cultural connotations.

People's attitudes towards people living with HIV/AIDS remain a major community challenge. There ... more People's attitudes towards people living with HIV/AIDS remain a major community challenge. There is a need to generate a climate of understanding, compassion and dignity in which people living with HIV/AIDS (PLWHA) will be able to voluntarily disclose their status and receive the support and respect all people deserve. However, many people experience discrimination because they have HIV/AIDS. In a certain area in Khayelitsha, a township in Cape Town, a young woman was killed after disclosing the HIV status after being raped by five men. This has become a barrier to testing, treatment, on quality of life and social responses to HIV/AIDS. While many previous studies have focused on the external stigma in the general population, there is a dearth of studies on stigma among PLWHA themselves and hence the aim of the present study was to investigate stigma attached to HIV/AIDS from the perspective of PLWHA. The focus group research method was used to collect the data. Six focus groups consisting of 8-10 people in each group were held in Khayelitsha drawn from organizations working with PLWHA and Treatment Action Campaign (TAC). Data was analyzed using discourse analysis and the PEN-3 Model was used to explain the themes that emerged from the data. Results showed that PLWHA are affected by both enacted and internal stigma related to HIV/AIDS. It was found that the experiences of discrimination and stigma often originate from the fear and perceptions of PLWHA as immoral or living dead. They suffer rejection at home, work, school and in the health care centres. Results also showed that PLWHA felt shame, guilt, hopelessness and useless. This internalized stigma leads to withdrawal, depression, not to disclose the HIV status and prevent people for testing for HIV and also affect health-seeking behaviour. However, participants who were well informed and those who were members of the support groups reported that they are coping with the illness and they are open about their HIV-status. This suggests that education efforts have been remarkably successful in changing attitudes. It is recommended that stigma reduction programmes should involve PLWHA, community leaders and the community members to be part of the planning and implementation. It is also important to look at the successful programmes already existing in the area and adapt them and also to evaluate the effectiveness. Prof. Leickness Simbayi for your support, encouragement and being patient with me until the end of this process. The Penn-State University and Human Science Research Council for providing me fellowship and the facilities which made it possible for me to finish my thesis. Chelsea Morroni for support, friendship, motivation and containment which kept me going. My husband, children and family for the inspiration, encouragement and providing me space to finish this thesis. PLWHA who participated in this study for sharing your experiences with me. Thank you for trusting me with your sensitive life stories, without you this project was not going to be possible.

BMC Women's Health, 2007

Background: Emergency contraception (EC) is widely available free of charge at public sector clin... more Background: Emergency contraception (EC) is widely available free of charge at public sector clinics in South Africa. At the same time, rates of teenage and unintended pregnancy in South Africa remain high, and there are few data on knowledge of EC in the general population in South Africa, as in other resource-limited settings. Methods: We conducted a cross-sectional, interviewer-administered survey among 831 sexually active women at 26 randomly selected public sector clinics in the Western Cape province. Results: Overall, 30% of the women had ever heard of EC when asked directly, after the method was described to them. Only 15% mentioned EC by name or description spontaneously. Knowledge of EC was independently associated with higher education, being married, and living in an urban setting. Four percent of women had ever used EC. Discussion: These data suggest that knowledge of EC in this setting is more common among women of higher socioeconomic status living in urban areas. For EC to play a role in decreasing unintended pregnancy in South Africa, specific interventions are necessary to increase knowledge of the method, where to get it, and the appropriate time interval for its use before the need for EC arises. Future health promotion campaigns should target rural and low socioeconomic status communities.

Background: Emergency contraception (EC) is widely available free of charge at public sector clin... more Background: Emergency contraception (EC) is widely available free of charge at public sector clinics in South Africa. At the same time, rates of teenage and unintended pregnancy in South Africa remain high, and there are few data on knowledge of EC in the general population in South Africa, as in other resource-limited settings. Methods: We conducted a cross-sectional, interviewer-administered survey among 831 sexually active women at 26 randomly selected public sector clinics in the Western Cape province. Results: Overall, 30 % of the women had ever heard of EC when asked directly, after the method was described to them. Only 15 % mentioned EC by name or description spontaneously. Knowledge of EC was independently associated with higher education, being married, and living in an urban setting. Four percent of women had ever used EC. Discussion: These data suggest that knowledge of EC in this setting is more common among women of higher socioeconomic status living in urban areas. Fo...

BMC Women's Health, Sep 12, 2007

Background: Emergency contraception (EC) is widely available free of charge at public sector clin... more Background: Emergency contraception (EC) is widely available free of charge at public sector clinics in South Africa. At the same time, rates of teenage and unintended pregnancy in South Africa remain high, and there are few data on knowledge of EC in the general population in South Africa, as in other resource-limited settings. Methods: We conducted a cross-sectional, interviewer-administered survey among 831 sexually active women at 26 randomly selected public sector clinics in the Western Cape province. Results: Overall, 30% of the women had ever heard of EC when asked directly, after the method was described to them. Only 15% mentioned EC by name or description spontaneously. Knowledge of EC was independently associated with higher education, being married, and living in an urban setting. Four percent of women had ever used EC. Discussion: These data suggest that knowledge of EC in this setting is more common among women of higher socioeconomic status living in urban areas. For EC to play a role in decreasing unintended pregnancy in South Africa, specific interventions are necessary to increase knowledge of the method, where to get it, and the appropriate time interval for its use before the need for EC arises. Future health promotion campaigns should target rural and low socioeconomic status communities.

eClinicalMedicine, 2022

HIV-TB treatment integration reduces mortality. Operational implementation of integrated services... more HIV-TB treatment integration reduces mortality. Operational implementation of integrated services is challenging. This study assessed the impact of quality improvement (QI) for HIV-TB integration on mortality within primary healthcare (PHC) clinics in South Africa. An open-label cluster randomized controlled study was conducted between 2016 and 2018 in 40 rural clinics in South Africa. The study statistician randomized PHC nurse-supervisors 1:1 into 16 clusters (eight nurse-supervisors supporting 20 clinics per arm) to receive QI, supported HIV-TB integration intervention or standard of care (control). Nurse supervisors and clinics under their supervision, based in the study health districts were eligible for inclusion in this study. Nurse supervisors were excluded if their clinics were managed by municipal health (different resource allocation), did not offer co-located antiretroviral therapy (ART) and TB services, services were performed by a single nurse, did not receive non-governmental organisation (NGO) support, patient data was not available for > 50% of attendees. The analysis population consists of all patients newly diagnosed with (i) both TB and HIV (ii) HIV only (among patients previously treated for TB or those who never had TB before) and (iii) TB only (among patients already diagnosed with HIV or those who were never diagnosed with HIV) after QI implementation in the intervention arm, or enrolment in the control arm. Mortality rates was assessed 12 months post enrolment, using unpaired t-tests and cox-proportional hazards model. (Clinicaltrials.gov, NCT02654613, registered 01 June 2015, trial closed). Overall, 21 379 participants were enrolled between December 2016 and December 2018 in intervention and control arm clinics: 1329 and 841 HIV-TB co-infected (10·2%); 10 799 and 6 611 people living with Human Immunodeficiency Virus (HIV)/ acquired immunodeficiency syndrome (AIDS) (PLWHA) only (81·4%); 1 131 and 668 patients with TB only (8·4%), respectively. Average cluster sizes were 1657 (range 170-5782) and 1015 (range 33-2027) in intervention and control arms. By 12 months, 6529 (68·7%) and 4074 (70·4%) were alive and in care, 568 (6·0%) and 321 (5·6%) had completed TB treatment, 1078 (11·3%) and 694 (12·0%) were lost to follow-up, with 245 and 156 deaths occurring in intervention and control arms, respectively. Mortality rates overall [95% confidence interval (CI)] was 4·5 (3·4-5·9) in intervention arm, and 3·8 (2·6-5·4) per 100 person-years in control arm clusters [mortality rate ratio (MRR): 1·19 (95% CI 0·79-1·80)]. Mortality rates among HIV-TB co-infected patients was 10·1 (6·7-15·3) and 9·8 (5·0-18·9) per 100 person-years, [MRR: 1·04 (95% CI 0·51-2·10)], in intervention and control arm clusters, respectively. HIV-TB integration supported by a QI intervention did not reduce mortality in HIV-TB co-infected patients. Demonstrating mortality benefit from health systems process improvements in real-world operational settings remains challenging. Despite the study being potentially underpowered to demonstrate the effect size, integration interventions were implemented using existing facility staff and infrastructure reflecting the real-world context where most patients in similar settings access care, thereby improving generalizability and scalability of study findings. Research reported in this publication was supported by South African Medical Research Council (SAMRC), and UK Government's Newton Fund through United Kingdom Medical Research Council (UKMRC).

People's attitudes towards people living with HIV/AIDS remain a major community challenge. There ... more People's attitudes towards people living with HIV/AIDS remain a major community challenge. There is a need to generate a climate of understanding, compassion and dignity in which people living with HIV/AIDS (PLWHA) will be able to voluntarily disclose their status and receive the support and respect all people deserve. However, many people experience discrimination because they have HIV/AIDS. In a certain area in Khayelitsha, a township in Cape Town, a young woman was killed after disclosing the HIV status after being raped by five men. This has become a barrier to testing, treatment, on quality of life and social responses to HIV/AIDS. While many previous studies have focused on the external stigma in the general population, there is a dearth of studies on stigma among PLWHA themselves and hence the aim of the present study was to investigate stigma attached to HIV/AIDS from the perspective of PLWHA. The focus group research method was used to collect the data. Six focus groups consisting of 8-10 people in each group were held in Khayelitsha drawn from organizations working with PLWHA and Treatment Action Campaign (TAC). Data was analyzed using discourse analysis and the PEN-3 Model was used to explain the themes that emerged from the data. Results showed that PLWHA are affected by both enacted and internal stigma related to HIV/AIDS. It was found that the experiences of discrimination and stigma often originate from the fear and perceptions of PLWHA as immoral or living dead. They suffer rejection at home, work, school and in the health care centres. Results also showed that PLWHA felt shame, guilt, hopelessness and useless. This internalized stigma leads to withdrawal, depression, not to disclose the HIV status and prevent people for testing for HIV and also affect health-seeking behaviour. However, participants who were well informed and those who were members of the support groups reported that they are coping with the illness and they are open about their HIV-status. This suggests that education efforts have been remarkably successful in changing attitudes. It is recommended that stigma reduction programmes should involve PLWHA, community leaders and the community members to be part of the planning and implementation. It is also important to look at the successful programmes already existing in the area and adapt them and also to evaluate the effectiveness. Prof. Leickness Simbayi for your support, encouragement and being patient with me until the end of this process. The Penn-State University and Human Science Research Council for providing me fellowship and the facilities which made it possible for me to finish my thesis. Chelsea Morroni for support, friendship, motivation and containment which kept me going. My husband, children and family for the inspiration, encouragement and providing me space to finish this thesis. PLWHA who participated in this study for sharing your experiences with me. Thank you for trusting me with your sensitive life stories, without you this project was not going to be possible.

Global Health: Science and Practice

Setting The research took place in two separate regions in South Africa: an urban setting in Cape... more Setting The research took place in two separate regions in South Africa: an urban setting in Cape Town, Western Cape and a rural setting near Umtata (Mthatha) in the former Transkei region of the Eastern Cape. This allowed exploration of the key research questions in two very different health care systems, each facing unique challenges: the extremely busy, urban township clinics of Khayelitsha in Cape Town, and the less developed, rural clinics outside of Umtata. In each region, two facilities were selected to participate in research. Each facility provides a range of primary care services. For this research, participants were recruited from HIV care services, family planning services, and STI services only. In Cape Town, the sites were local authority clinics and in Umtata, the sites were Community Health Centers operated by the local authority. Facilities were selected in consultation with provincial / local health care officials based on the following criteria: (a) the degree to which they are typical of primary care clinics in the area, (b) the preference of provincial officials to avoid over-researched facilities, and (c) adequate patient volumes to ensure efficient data collection. Research collaboration In addition to providing insights from different urban and rural settings, the two-province design of the research built on existing collaborations between the School of Public Health at the University of Cape Town and the Department of Obstetrics and Gynaecology at the University of the Transkei (now Walter Sisulu University). This partnership provided a unique opportunity to examine the issues related to DP practices and promotion in two very distinct settings.

Studies in Family Planning, 2012

Arriving late for scheduled contraceptive reinjections is common in many countries and contribute... more Arriving late for scheduled contraceptive reinjections is common in many countries and contributes to discontinuation when providers are unsure how to manage such clients. A clinic-randomized cohort and cross-sectional study with more than 5,000 clients using injectable contraceptives was conducted in the Eastern Cape province of South Africa to test the effectiveness of a provider job aid for managing late-returning clients and promoting continued use of the method. A marginally significant difference in reinjection rates between intervention and control groups was found for those up to two weeks late, and reanalysis excluding one clinic that experienced stockout issues revealed a significant difference. The difference in reinjection rates for those 2-12 weeks late was also found to be significant. The one-reinjection cycle continuation rate for the intervention group was higher than that for the control group, but the difference was not statistically significant. Appropriate management of late-returning clients is critical, and this study illustrates that reinjection rates can be significantly increased with a low-resource provider job aid.

Journal of Behavioral Medicine, 2011

International Family Planning Perspectives, 2007

Research examining hormonal injectable contraceptive continuation has focused on clients' intenti... more Research examining hormonal injectable contraceptive continuation has focused on clients' intentional discontinuation. Little attention, however, has been paid to unintentional discontinuation due to providers' management of clients who would like to continue use but arrive late for their scheduled reinjections. METHODS: A cross-sectional survey of 1,042 continuing injectable clients at 10 public clinics was conducted in South Africa's Western and Eastern Cape provinces. Bivariate logistic regression analyses were used to identify associations between specific variables and the likelihood of receiving a reinjection, among clients who returned to clinics late but within the two-week grace period for reinjection. RESULTS: Of 626 continuing clients in the Western Cape, 29% were up to two weeks late and 25% were 2-12 weeks late for their scheduled reinjection; these proportions among 416 continuing clients in the Eastern Cape were 42% and 16%, respectively. Only 1% of continuing clients in the Western Cape who arrived during the two-week grace period did not receive a reinjection; however, 36% of similar clients in the Eastern Cape did not receive a reinjection. Among late clients in the Eastern Cape who did not receive a reinjection, 64% did not receive any other method. Few variables were significant in bivariate analyses; however, certain characteristics were associated with receiving reinjections among late clients in the Eastern Cape. CONCLUSIONS: It is common for clients to arrive late for reinjections in this setting. Providers should adhere to protocols for the reinjection grace period and have a contraceptive coverage plan for clients arriving past the grace period to reduce clients' risk of unintentional discontinuation and unintended pregnancy.

Health Education Research, 2011

Communicating about sex is a vital component of human immunodeficiency virus (HIV) prevention and... more Communicating about sex is a vital component of human immunodeficiency virus (HIV) prevention and influences how HIV educators convey messages to communities and how couples negotiate safer sex practices. However, sexual communication inevitably confronts culturally based behavioral guidelines and linguistic taboos unique to diverse social contexts. The HIV interventionist needs to identify the appropriate language for sexual communication given the participants and the message. Ethnographic research can help facilitate the exploration of how sex terminology is chosen. A theoretical framework, developed to guide HIV interventionists, suggests that an individual's language choice for sexual communication is influenced by gender roles and power differentials. Indepth interviews, free listing and triadic comparisons were conducted with Xhosa men and women in Cape Town, South Africa, to determine the terms for male genitalia, female genitalia and sexual intercourse that are most appropriate for sexual communication. Results showed that sexual terms express cultural norms and role expectations where men should be powerful and resilient and women should be passive and virginal. For HIV prevention education, non-mother tongue (English and Zulu) terms were recommended as most appropriate because they are descriptive, but allow the speaker to communicate outside the restrictive limits of their mother tongue by reducing emotive cultural connotations.

People's attitudes towards people living with HIV/AIDS remain a major community challenge. There ... more People's attitudes towards people living with HIV/AIDS remain a major community challenge. There is a need to generate a climate of understanding, compassion and dignity in which people living with HIV/AIDS (PLWHA) will be able to voluntarily disclose their status and receive the support and respect all people deserve. However, many people experience discrimination because they have HIV/AIDS. In a certain area in Khayelitsha, a township in Cape Town, a young woman was killed after disclosing the HIV status after being raped by five men. This has become a barrier to testing, treatment, on quality of life and social responses to HIV/AIDS. While many previous studies have focused on the external stigma in the general population, there is a dearth of studies on stigma among PLWHA themselves and hence the aim of the present study was to investigate stigma attached to HIV/AIDS from the perspective of PLWHA. The focus group research method was used to collect the data. Six focus groups consisting of 8-10 people in each group were held in Khayelitsha drawn from organizations working with PLWHA and Treatment Action Campaign (TAC). Data was analyzed using discourse analysis and the PEN-3 Model was used to explain the themes that emerged from the data. Results showed that PLWHA are affected by both enacted and internal stigma related to HIV/AIDS. It was found that the experiences of discrimination and stigma often originate from the fear and perceptions of PLWHA as immoral or living dead. They suffer rejection at home, work, school and in the health care centres. Results also showed that PLWHA felt shame, guilt, hopelessness and useless. This internalized stigma leads to withdrawal, depression, not to disclose the HIV status and prevent people for testing for HIV and also affect health-seeking behaviour. However, participants who were well informed and those who were members of the support groups reported that they are coping with the illness and they are open about their HIV-status. This suggests that education efforts have been remarkably successful in changing attitudes. It is recommended that stigma reduction programmes should involve PLWHA, community leaders and the community members to be part of the planning and implementation. It is also important to look at the successful programmes already existing in the area and adapt them and also to evaluate the effectiveness. Prof. Leickness Simbayi for your support, encouragement and being patient with me until the end of this process. The Penn-State University and Human Science Research Council for providing me fellowship and the facilities which made it possible for me to finish my thesis. Chelsea Morroni for support, friendship, motivation and containment which kept me going. My husband, children and family for the inspiration, encouragement and providing me space to finish this thesis. PLWHA who participated in this study for sharing your experiences with me. Thank you for trusting me with your sensitive life stories, without you this project was not going to be possible.

BMC Women's Health, 2007

Background: Emergency contraception (EC) is widely available free of charge at public sector clin... more Background: Emergency contraception (EC) is widely available free of charge at public sector clinics in South Africa. At the same time, rates of teenage and unintended pregnancy in South Africa remain high, and there are few data on knowledge of EC in the general population in South Africa, as in other resource-limited settings. Methods: We conducted a cross-sectional, interviewer-administered survey among 831 sexually active women at 26 randomly selected public sector clinics in the Western Cape province. Results: Overall, 30% of the women had ever heard of EC when asked directly, after the method was described to them. Only 15% mentioned EC by name or description spontaneously. Knowledge of EC was independently associated with higher education, being married, and living in an urban setting. Four percent of women had ever used EC. Discussion: These data suggest that knowledge of EC in this setting is more common among women of higher socioeconomic status living in urban areas. For EC to play a role in decreasing unintended pregnancy in South Africa, specific interventions are necessary to increase knowledge of the method, where to get it, and the appropriate time interval for its use before the need for EC arises. Future health promotion campaigns should target rural and low socioeconomic status communities.