Browsing by Author "Colvin, Christopher"

Now showing 1 - 16 of 16
  • Thumbnail Image
    Item
    Open Access
    Evaluating the Impact of the Movement for Change & Social Justice's Men's Forum on the Effective Engagement of Men with Health Care Services in Gugulethu
    (2022) Useh, Ebruphiyo Ruth; Colvin, Christopher; Mbokazi, Nonzuzo
    In most parts of the world, men engage much less with health services as compared to women, are less inclined to access preventative services, and have a higher probability of dropping out of care. The Movement for Change and Social Justice is a non-profit organisation focused on empowering the community and ensuring that individuals have sufficient knowledge on health and social matters. In line with this objective, the organisation established a Men's Forum – a program intended to create a space for men to express themselves freely without fear of judgment, as well as foster knowledge on health and social issues that concern men. The purpose of this study is to evaluate how activities of the MCSJ Men's Forum worked to promote or hinder men from effectively engaging with health care services in the community of Gugulethu. Participants were purposively sampled, and a total of 12 were engaged in semi-structured in-depth interviews. The qualitative study made use of Braun and Clarke's 6-phase approach to thematic analysis. The findings reflected seven main themes guided by the Masculinities and Men's Reproductive Health Practices and Outcomes conceptual framework. The study concluded that the Men's Forum plays a vital part in the support and empowerment of men across various age groups in optimising their health, acting as a conduit for health information and services. The implications of this study could mean it essential to include and train community health workers in engaging men with health care services regularly with an additional focus on privacy and cultural sensitivity regarding male patients in soft skill training. Engagement through facilitating health screenings, talks, dialogues, and workshops in the community as part of community outreach health practices could aid in spreading awareness and encourage future access for men.
  • Thumbnail Image
    Item
    Open Access
    Experiences and perceptions of participants and staff involved in HIV research in Gugulethu, South Africa
    (2019) Gomba, Yolanda; Colvin, Christopher; Trafford Zara
    It is important to understand the experiences and perceptions of HIV research from the perspectives of persons who have either participated in or worked on HIV research in lowresource settings. Obtaining such information is important because research in low-resource settings presents several ethical challenges that result in the vulnerability of participants due to factors such as low literacy levels, high rates of food insecurity and unemployment. Conducting research on the aforementioned can help researchers to design studies that mitigate some of the ethical challenges associated with conducting HIV research in lowresource communities. This dissertation adds on to existing literature on the experiences and perceptions of HIV research participants and staff involved in HIV research in low-resource settings. This dissertation is divided into three parts. Part A (Research protocol) discusses the importance of evaluating research participants’ experiences and perceptions of HIV studies conducted in lowresource settings. The section also outlines the purpose of the study, research questions, methodology, ethical considerations, rigour, reimbursement and dissemination of results. Part B (Literature review) presents an overview of the literature on HIV research in low-resource settings, with a specific focus on: ethical challenges, factors that contribute to participants’ decisions to participate in HIV research and findings from other studies which examined experiences and perceptions of HIV research in low-resource settings. The section also identifies gaps in the existing literature. Part C (Journal article) presents the findings of the study and the implications thereof.
  • Thumbnail Image
    Item
    Open Access
    Ezobudoda (manhood things) a qualitative study of HIV-positive adolescent boys and young mens health practices in the Eastern Cape Province of South Africa
    (2019) Gittings, Lesley Blinn; Colvin, Christopher; Hodes, Rebecca
    Men are less vulnerable to HIV acquisition than women, but have poorer HIV-related outcomes. They access HIV services less often and later, and are more likely to die while on antiretroviral therapy (ART). The adolescent HIV epidemic presents further challenges, and AIDS-related illness is the leading cause of death among adolescents in sub-Saharan Africa. Such deaths have tripled since 2000, while declining in all other age groups. There is a clear need to better understand health practices for adolescent boys and young men living with HIV, and the processes through which these practices are formed and sustained. This doctorate explores the biosocial lives of adolescent boys and young men living with HIV in the Eastern Cape Province of South Africa. It engaged health-focused life history narratives (n=36), semi-structured interviews (n=32) and analysis of health facility files (n=43), alongside semi-structured interviews with traditional and biomedical health practitioners (n=14). Young male participants were among the first generation to grow up with access to ART and democratic freedoms. In a context where HIV-positivity and men’s inability to fulfil traditional roles are considered signs of social and moral decay, they felt pressure to be ‘good’ HIV-positive patients and respectable young men. As younger children, they performed to norms of HIVpositive patienthood. As they became older, norms of masculinity, including financial achievement, ulwaluko (traditional initiation/circumcision), ‘moral’ behaviour and engaged fatherhood became more important and began to conflict with performances of ‘good’ patienthood. This was most apparent during and following ulwaluko, where societal norms made it difficult to engage with biomedical treatment and care. Despite this, participants and their families demonstrated agency, creativity and resilience in subverting and re-signifying these norms. Participants did not access traditional products or services for HIV-related issues, a finding that deviates from much of the literature. This study suggests that health practices are mediated not only by gender and culture, but also childhood experiences of growing up deeply embedded in the health system, through which participants forged additional health-seeking tools. Findings affirm the syncretic nature of traditional beliefs, documenting the plural and complementary ways that participants engaged with traditional products and services.
  • Thumbnail Image
    Item
    Open Access
    Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: a qualitative process evaluation of the STRETCH trial
    (BioMed Central Ltd, 2012) Georgeu, Daniella; Colvin, Christopher; Lewin, Simon; Fairall, Lara; Bachmann, Max; Uebel, Kerry; Zwarenstein, Merrick; Draper, Beverly; Bateman, Eric
    BACKGROUND:Task-shifting is promoted widely as a mechanism for expanding antiretroviral treatment (ART) access. However, the evidence for nurse-initiated and managed ART (NIMART) in Africa is limited, and little is known about the key barriers and enablers to implementing NIMART programmes on a large scale. The STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) programme was a complex educational and organisational intervention implemented in the Free State Province of South Africa to enable nurses providing primary HIV/AIDS care to expand their roles and include aspects of care and treatment usually provided by physicians. STRETCH used a phased implementation approach and ART treatment guidelines tailored specifically to nurses. The effects of STRETCH on pre-ART mortality, ART provision, and the quality of HIV/ART care were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of factors affecting the implementation of the programme. METHODS: This study was a qualitative process evaluation using in-depth interviews and focus group discussions with patients, health workers, health managers, and other key informants as well as observation in clinics. Research questions focused on perceptions of STRETCH, changes in health provider roles, attitudes and patient relationships, and impact of the implementation context on trial outcomes. Data were analysed collaboratively by the research team using thematic analysis. RESULTS: NIMART appears to be highly acceptable among nurses, patients, and physicians. Managers and nurses expressed confidence in their ability to deliver ART successfully. This confidence developed slowly and unevenly, through a phased and well-supported approach that guided nurses through training, re-prescription, and initiation. The research also shows that NIMART changes the working and referral relationships between health staff, demands significant training and support, and faces workload and capacity constraints, and logistical and infrastructural challenges. CONCLUSIONS: Large-scale NIMART appears to be feasible and acceptable in the primary level public sector health services in South Africa. Successful implementation requires a comprehensive approach with: an incremental and well supported approach to implementation; clinical guidelines tailored to nurses; and significant health services reorganisation to accommodate the knock-on effects of shifts in practice.TRIAL REGISTRATION:ISRCTN46836853
  • Thumbnail Image
    Item
    Open Access
    Integrating HIV care into nurse-led primary health care services in South Africa: a synthesis of three linked qualitative studies
    (BioMed Central Ltd, 2013) Uebel, Kerry; Guise, Andy; Georgeu, Daniella; Colvin, Christopher; Lewin, Simon
    BACKGROUND: The integration of HIV care into primary care services is one of the strategies proposed to increase access to treatment for people living with HIV/AIDS in high HIV burden countries. However, how best to do this is poorly understood. This study documents different factors influencing models of integration within clinics. METHODS: Using methods based on the meta-ethnographic approach, we synthesised the findings from three qualitative studies of the factors that influenced integration of HIV care into all consultations in primary care. The studies were conducted amongst staff and patients in South Africa during a randomised trial of nurse initiation of antiretroviral therapy (ART) and integration of HIV care into primary care services - the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) trial. Themes from each study were identified and translated into each other to develop categories and sub-categories and then to inform higher level interpretations of the synthesised data. RESULTS: Clinics varied as to how HIV care was integrated. Existing administration systems, workload and support staff shortages tended to hinder integration. Nurses' wanted to be involved in providing HIV care and yet also expressed preferences for developing expertise in certain areas and for establishing good nurse patient relationships by specialising in certain services. Patients, in turn, were concerned about the stigma of separate HIV services and yet preferred to be seen by nurses with expertise in HIV care. These factors had conflicting effects on efforts to integrate HIV care. CONCLUSION: Local clinic factors and nurse and patient preferences in relation to care delivery should be taken into account in programmes to integrate HIV care into primary care services. The integration of medical records, monitoring and reporting systems would support clinic based efforts to integrate HIV care into primary care services.
  • Thumbnail Image
    Item
    Open Access
    Knowledge and perceptions about HIV among adolescent girls and young women aged 15 – 24 years: associations with HIV testing and sexual behaviour – a sub-study of the 2012 South African National HIV Household survey
    (2020) Frieslaar, Farzanah; Colvin, Christopher; Tadokera, Rabecca
    Background. While much progress has been made, HIV remains a major global public health problem. South Africa remains home to the highest number of people living with HIV (7.1 million) in the world. Despite remarkable progress in the past decade, adolescent girls and young women aged 15-24 (AGYW) remain at higher risk of HIV exposure and infection than other groups. We do not know enough about AGYW HIV knowledge and perceptions, although it is likely an important factor to consider in AGYW's HIV risk. This paper investigates knowledge and perceptions about HIV risk behaviours and explores associations with demographic and behavioral characteristics among AGYW in South Africa. Methods. This sub-study is based on the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey, a cross-sectional population-based household survey. A multistage stratified cluster sampling approach was employed to select the study population. Multivariate logistic regression was used to determine associations or factors which were associated with HIV knowledge. Results. Among the sample of 3700 AGYW aged 15-24 years, White [OR=2.44 (95% CI: 1.48-4.03), p=0.001] and Indian [OR=3.85 (95% CI: 2.39-6.18), p=0.000] AGYW were associated with high HIV knowledge compared to Black Africans. AGYW in urban informal [OR=0.64 (95% CI: 0.45-0.90), p=0.011] and rural informal [OR=0.57 (95% CI: 0.33-0.98), p=0.043] were associated with low HIV knowledge compared to urban formal settings. AGYW in Eastern Cape [OR=0.69 (95% CI: 0.48-1.00), p=0.048], KwaZulu-Natal [OR=0.69 (95% CI: 0.48-0.99), p=0.044], North West [OR=0.50 (95% CI: 0.32-0.77), p=0.002] and Limpopo [OR=0.44 (95% CI: 0.27-0.71), p=0.001] provinces were associated with low HIV knowledge compared to AGYW in Western Cape. Unemployed AGYW were associated with low HIV knowledge [OR=0.57, p=0.001]. While AGYW with higher levels of education: grade 12 [OR=1.66 (95% CI: 1.04-2.64), p=0.034] and tertiary [OR=2.68 (95% CI: 1.47-4.89), p=0.001] were associated with high HIV knowledge. AGYW having had sex in the last 12 months were associated with high HIV knowledge [OR=1.70 (95% CI: 1.08-2.72), p=0.023]. On the contrary, having multiple sexual partners in the last 12 months was associated with low HIV knowledge [OR= 0.60 (95%CI: 0.39-0.99), p=0.045] compared to AGYW that had 1 sexual partner in the last 12 months. AGYW with a low risk of alcohol use were associated with high HIV knowledge [OR=1.4 (95% CI: 1.02-1.87), p=0.039] compared to AGYW that abstained from alcohol. The final multivariate logistic regression model showed that AGYW in urban informal settings have low HIV knowledge [aOR=0.59 (95% CI: 0.35-0.99), p=0.046] among all geotypes. Conclusion. Overall, the main findings show a lack of knowledge among AGYW across race, geotype, province and sexual activity. More specifically that low HIV knowledge was associated with AGYW who were Black South Africans, living in informal settings, from Eastern Cape, KwaZulu Natal, North West and Limpopo, unemployed, had lower levels of education, and have multiple sexual partners. However, in the final multivariate analysis, only geotype stood out, indicating that there is an HIV knowledge deficit in urban informal settings. This can be addressed through the promotion of knowledge through education, equitable and accessible availability of education and sexual and reproductive health services, and HCT and support among AGYW living in urban informal settings.
  • Thumbnail Image
    Item
    Open Access
    Men who Care: men’s motivations in taking up positions in community mobilisation organizations in Gugulethu to improve the public healthcare system
    (2018) Malunga, Samantha; Colvin, Christopher; van Pinxteren, Myrna
    Many men in South Africa (SA) want to participate in improving their community. Having lived in the community, they are more attuned to the immediate needs of the community - and male members of the community’s needs in particular - compared to NGOs or external support systems that may try do social development work in SA. There is a great opportunity to include more men in community mobilisation (CM) work and health systems strengthening programs in SA and beyond. Historically, volunteer work, including CM has been seen as a job for women. There are fewer male volunteers in CM than there are female volunteers; hence, more research has been conducted around female volunteers’ experiences and motivations. In order to support the greater inclusion of men in volunteer work, this mini-dissertation explores men’s motivations to participate in CM work. This mini-dissertation is divided in the following three parts. A research protocol (Part A) which focuses on understanding the motivations of male community mobilisers who are involved in activist community work in the Gugulethu Township. A literature review (Part B) which examines existing literature on volunteer work and how gender affects experiences of, and motivations to volunteer. Lastly, a manuscript for Social Dynamics (Part C) that focuses on the gendered experiences and motivations of men who participate in CM work in the Movement for Change and Social Justice (MCSJ), a community organisation in Gugulethu, Cape Town. The knowledge gained from this mini-dissertation can feed into the larger debate present in SA surrounding the need for more male-centred interventions in the public healthcare system and aims to show how the visibility and representation of male volunteers in the health system can have a positive impact on men’s health seeking behaviours in communities through increasing their linkage to and retention in care.
  • Thumbnail Image
    Item
    Open Access
    Negotiating access and buy-in from communities in the context of a South African combination HIV prevention intervention for adolescent girls and young women
    (2020) Armien, Rizqa; Duby, Zoe; Colvin, Christopher
    Background: In response to the persistently high incidence of HIV in adolescent girls and young women in South Africa, the Global Fund invested in a combination HIV prevention intervention aimed at adolescent girls and young women in 10 high priority districts. The HERStory study evaluated the combination HIV prevention intervention after two years of implementation. Using the findings of the HERStory evaluation, this study aims to contribute towards the literature related to understanding factors related to successfully accessing communities and gaining community buy-in or support for community based interventions. The HERStory study explored the identification of the gaps and challenges in the intervention components and the intervention implementation to be able to revise and improve the intervention and its implementation. Methods: In-depth interviews and focus group discussions with community leaders, program implementers and intervention facilitators were conducted. The data consisted of 32 transcripts; a subset of the qualitative data collected for the HERStory evaluation. The analysis for this study sought to better understand the barriers and facilitators of community access and the importance of community buy-in using the HERStory evaluation. Thematic analysis of the data was conducted, supported by Nvivo 12 qualitative data analysis software. Results: The main themes of this secondary analysis were 1) the complexity of negotiating access to communities through key stakeholders, 2) challenges to gaining buy-in, and 3) facilitators and barriers to community based intervention implementation. There were clear facilitators to community access and intervention buy-in such as creating clear communication lines between stakeholders and scheduling regular meetings. Delayed or rushed community engagement resulted in misunderstandings and was identified as barriers to community access and intervention buy-in. Conclusion: Quality community engagement was essential in the facilitation of access and intervention buy-in to promote successful intervention implementation. Recommendations for future interventions include planning enough time for community engagement throughout the intervention including the design phase and establishing clear and effective communication channels between intervention implementers and community stakeholders.
  • Thumbnail Image
    Item
    Open Access
    Perceptions and Practices of Nurses with Respect to Asylum-Seekers and Refugees Accessing Health Care Services In Musina, Limpopo, South Africa
    (2020) Ndemere, Taurai; Colvin, Christopher
    To achieve the goal of universal health coverage, no one should be left behind. To achieve this goal, refugees and asylum seekers should be prioritised due to their heightened risks. This would improve health outcomes and assist in attaining the Sustainable Development Goals (SDGs) of 2030. In the South African context, numerous studies have been conducted on access to health care services from asylumseekers and refugees' perspectives. It is a complicated problem, however, both the service providers' point of view and that of the patient need to be explored and understood deeply for effective action to be taken. A lack of studies from the service providers (professional and enrolled nurses) lens on asylumseekers and refugees accessing healthcare services, specifically in Musina, Limpopo, South Africa, motivated this study. The study aimed at providing more information on the perceptions and practices of nurses on asylum-seekers and refugees accessing health care services. A qualitative approach was utilised to explore the perceptions and practices of nurses with regards to asylum-seekers and refugees accessing healthcare services. The study was conducted at Nancefield clinic and the Musina hospital in Musina with professional nurses. Semi-structured interviews were utilised to collect data and a thematic analysis approach was utilised to analyse the data. The study provided some insight on the perceptions and practices of healthcare providers. Due to the small sample size, it cannot be concluded that there is no systematic discrimination of asylum-seekers and refugees in South Africa. Nurses were incorrectly classifying asylum-seekers and refugees as economic migrants. Most nurses were of the view that the majority of their patients were migrants, including asylum-seekers and refugees. Nurses said that they apply the law in their practices as expected. Nurses believe in work documents and the hierarchy of power. These two factors guide nurses when interacting with asylum-seekers and refugees accessing their services. The study recommends that stakeholders that are working with refugees and asylum-seekers conduct capacity-building activities with nurses to raise awareness on the relationship between migration and health or government requests training.
  • Thumbnail Image
    Item
    Open Access
    Raising perinatally infected children: reflections from HIV-positive adolescents and young people and their guardians in Cape Town, South Africa
    (2023) Mokganyetji, Tebogo; Colvin, Christopher; Stern Erin
    There is an increase in the number of adolescents and young people who are growing up with HIV across the globe. These adolescents and young people are transitioning into adulthood with the pandemic, which necessitates research on the experiences of growing up with HIV and how caregivers manage raising these children. This study explored experiences of adolescents and young people living with HIV by examining the context of growing up with HIV, how caregivers manage raising HIV positive adolescents and young people and the overall management of paediatric HIV. The research investigated a) how adolescents and young people experience the process of HIV disclosure; b) the experiences of adolescents and young people and caregivers with the different healing systems i.e., biomedical, religious, and traditional healing systems; c) how adolescents and young people and caregivers navigate, experience, and manage living with HIV as a chronic illness; and d) some of the key social and cultural practices and contexts that HIVpositive adolescents and young people and their caregivers must negotiate in managing HIV infection. This research was conducted in Khayelitsha Township in Cape Town. Different stakeholders who work on paediatric HIV Khayelitsha were purposively and conveniently sampled to participate in the research. Furthermore, adolescents and young people between the ages of 14 – 24, who were vertically infected and whose HIV status has been fully disclosed and their caregivers participated in the research. Qualitative methods including participant observation, semi-structured interviews were conducted, and participatory research methods including the River of Life maps and Vision Boards and WhatsApp were used. The study design used a mini-ethnographic, longitudinal study which included action research, used a grounded theory approach to interview and conduct the analysis. The data was transcribed analysed thematically to understand the patterns of the emerging data. A further analysis was conducted using NVivo QSR software. The research findings highlight the importance of understanding the complex biomedical, social, and cultural components of HIV and how those intersect with social contexts of raising HIV positive adolescents and young people. The thesis documents the significance of disclosure of HIV status to adolescents and young people as a starting point to retaining them in care. The process of disclosure is noted as complex for the adolescents and young people, their caregivers and for the different people they have relationships with including their extended families, friends, partners, communities, and their schools. This research also maps out the day-to-day experiences of adolescents and young people who know they are growing up with HIV to understand their social context. This social context explores the different facets of life that these adolescents and young people navigate as they seek to make sense of their lives while growing up with HIV. Furthermore, this thesis documents the different ways in which communities understand the concept of healing and health, and how these concepts intersect. The research the points at which the different belief systems interact with how people understand being healthy and the interplay between the biomedical, traditional, and spiritual understandings of being healthy. People's engagement with the different systems of healing are important for HIV management. Participants also created vignettes illustrating their river of lives journey and vision boards depicting their dreams and aspirations. Key recommendations were made about how to further understand the different facets of HIV and how a holistic public health approach that is tailored for adolescents and young people growing up with HIV can facilitate improved HIV management.
  • Thumbnail Image
    Item
    Open Access
    Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention
    (BioMed Central Ltd, 2011) Uebel, Kerry; Fairall, Lara; van Rensburg, Dingie; Mollentze, Willie; Bachmann, Max; Lewin, Simon; Zwarenstein, Merrick; Colvin, Christopher; Georgeu, Daniella; Mayers, Pat; Faris, Gill; Lombard, Carl; Bateman, Eric
    BACKGROUND:Task shifting and the integration of human immunodeficiency virus (HIV) care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment (ART). This paper describes the development and content of an intervention involving these two strategies, as part of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) pragmatic randomised controlled trial. METHODS: DEVELOPING THE INTERVENTION:The intervention was developed following discussions with senior management, clinicians, and clinic staff. These discussions revealed that the establishment of separate antiretroviral treatment services for HIV had resulted in problems in accessing care due to the large number of patients at ART clinics. The intervention developed therefore combined the shifting from doctors to nurses of prescriptions of antiretrovirals (ARVs) for uncomplicated patients and the stepwise integration of HIV care into primary care services. RESULTS: COMPONENTS OF THE INTERVENTION:The intervention consisted of regulatory changes, training, and guidelines to support nurse ART prescription, local management teams, an implementation toolkit, and a flexible, phased introduction. Nurse supervisors were equipped to train intervention clinic nurses in ART prescription using outreach education and an integrated primary care guideline. Management teams were set up and a STRETCH coordinator was appointed to oversee the implementation process.DISCUSSION:Three important processes were used in developing and implementing this intervention: active participation of clinic staff and local and provincial management, educational outreach to train nurses in intervention sites, and an external facilitator to support all stages of the intervention rollout.The STRETCH trial is registered with Current Control Trials ISRCTN46836853.
  • No Thumbnail Available
    Item
    Open Access
    The clinic as a gendered space: an exploratory study examining men's access to and uptake of voluntary counselling and testing services (VCT) in the context of a male-friendly health facility
    (2008) Faull, Maria; Colvin, Christopher
    [pg 78 missing] Men in South Africa test for HIV at lower rates than do women. Investigating ways to increase men's uptake of Voluntary Counselling and Testing (VCT) services is therefore of critical importance to public health. The Site C Men's Clinic in Khayelitsha, where this study took place, is an attempt at increasing men's use of VCT. Men's views about a male-friendly space and its influence on VCT uptake had not yet been investigated in South Africa. The Men's Clinic in Khayelitsha allowed me the opportunity to interview men attending the clinic to explore their perceptions and experiences of VCT within this environment. The central aim was to explore whether men perceive the facility to be enabling in their decision to use VCT now or in the future. Furthermore, the intention of this study was to explore whether male clients perceive male health workers any differently to women staff with specific attention to confidentiality. This is closely linked to the uptake of VCT, as trust in health-workers is central to the process. The study also sought to evaluate how this male-friendly environment may contribute to normalising testing in men, which is another encouraging factor In VCT uptake. Finally, although this is a critical issue for men's health, the study aimed to investigate whether VCT services targeted at men, may benefit women's health too. The interviews were qualitative, semi-structured interviews. Being an exploratory study dealing with men's perceptions of the clinic and its services, the qualitative approach was valid. This interview approach allowed for variety in answers, but also revealed commonality, as themes emerged in response to questions. The project involved 33 qualitative interviews with men attending the clinic In Khayelitsha (including 15 men who tested at the clinic and 18 non-testers). The client interviews took place between 5 - 27th October 2007. Getting men to test for HIV is an urgent task for public health in South Africa. This study explored whether men experienced the clinic to be male-friendly and whether this influenced their attitude to testing. Most men expressed an increase in comfort and personal safety at the facility, which are valued attributes of a VCT facility. Many clients expressed greater trust in male staff, and surprisingly, trust in male patients, which contributed to their comfort at the facility. There was evidence in the interview data to suggest that male clients would contribute to normalising VCT through talking to peers about the clinic and its services. This is also likely to contribute to the greater VCT uptake in men. Testing clients seemed open to talking to their partners, having tested at the clinic. Some clients wanted to return to the facility with their partner to test. This indicates a potentially positive influence on the health of the couple. Although the clinic quantitative data indicates a slow and disappointing start for the clinic, based on the perceptions expressed by these clients, the facility is filling an important health service for men. It is likely to encourage more men to access VCT, because men feel confident in the service and staff. This is arguably in the interests of men and women's health.
  • Thumbnail Image
    Item
    Open Access
    The pendulum of participation: exploring shifting participation of Health Committees during the Covid-19 Pandemic in Cape Town sub-districts
    (2022) Kannemeyer, Natasha; Colvin, Christopher; Haricharan, Hanne
    Community participation is a vital component of public health with meaningful participation centred around empowering communities, establishing trust and developing collaborations between community members, government, health professionals and other key stakeholders. Despite widespread acknowledgment of the importance of community participation, there are numerous barriers to meaningful participation. Power dynamics and the spaces where participation takes place impact both the level and quality of participation. This qualitative study explores how participation in health committee spaces was affected during the Covid-19 pandemic and how the relationship between the state and health committees evolved during the pandemic. Health committees are a form of institutionalised participation situated as part of primary health care clinics and consist of community representatives, clinic managers and municipal political representatives. A function of these committees is to bridge the gap between community members and health facilities. Focus group discussions were conducted with two health committees located in Gugulethu and Manenberg, two economically marginalised areas in Cape Town, South Africa. Participants in the study were comprised of health committee members. Transcripts were analysed using a thematic analysis approach. Initial data analysis was inductive. Two conceptual frameworks: Arnstein's Ladder of Participation and Gaventa's notion of invited and invented spaces were used to interpret the findings. The study found that pre-Covid, the relationship between health committees and the state was limited, with little collaboration. During the pandemic, health committees responded to community needs and filled gaps in the state's reach. Subsequently, the state recognised its limits and the need for collaboration with community actors to reach communities. This brought about an opening of previously closed spaces to include health committees in more meaningful forms of participation. However, like a pendulum swinging back and forth, participation closed back down. In this context, health committees challenged the ‘invited' space and invented their own spaces for participation. A number of challenges with invited participation were identified: lack of recognition, inadequate inclusion in state decisions, planning and implementation of interventions, lack of resources and state support and power dynamics. The study concludes that health committees occupy complex spaces and places of contestation where different actors continuously negotiate the dynamics of the space. Shifting participation requires a redistribution of power, the establishment of partnerships and trust and the creation of innovative, neutral spaces for collaboration.
  • Thumbnail Image
    Item
    Open Access
    Tracing ‘paper', discovering people: three ethnographic case studies exploring the use of health information to improve health services in Gugulethu
    (2020) Van, Pinxteren Myrna; Colvin, Christopher
    Health information plays a vital role in the larger health system. Over the last twenty-five years, South Africa has developed several health information systems (HISs) that aim to collect high-quality health information to be used to inform clinical decision-making, shape new policies and programmes and strengthen other components of the health system. To date, most research in this area has focused on the production of health information and the technical challenges that appear when developing and implementing HISs. Much less is known about how health information is used in practice. This research explores how both community actors and health systems stakeholders at different levels of the health system gain access to, use and exchange health information, both for their own decisionmaking and practice, but also to address persistent health challenges. This research adopted an ethnographic approach, whereby I conducted extensive qualitative research for a period of 18 months in Gugulethu, an underprivileged peri-urban neighbourhood in Cape Town. Three case studies emerged from this research that provide a lens to analysing the role of health information in South Africa. The use and exchange of health information in the larger health system is inherently complex. Key findings from this research project show that firstly, there is a wide interest among a diverse group of stakeholders, including community representatives and NGOs, to use health information. Secondly, despite the interest for using health information, this data is not always available for a variety of reasons, which encourages stakeholders to develop creative strategies to collect new forms of evidence or to gain access to existing forms of data. Thirdly, adopting new strategies, health actors use a combination of routinely collected, semi-formal, and informal data, often concurrently. Lastly, this research demonstrates that health information is never neutral or value-free, but is produced, used and exchanged within a larger social, cultural and religious context, and is thus shaped by these contexts. This research challenges several assumptions about how health information is used in South Africa, and who can, or should, have access to this information. To answer these questions, it is important to open the health information system (HIS) to a more a diverse group of people actively in order to make available a variety of information that informs health stakeholders' daily work, influences health programmes and provides new perspectives on current health issues. Lastly, to further stimulate the use and exchange of health information for health system strengthening purposes, there is a need to provide a dedicated third space, where establishing new relationships and strengthening existing ones among actors at different levels of the health system is actively encouraged as a way to stimulate further use and sharing of health information.
  • Thumbnail Image
    Item
    Open Access
    Tuberculosis infection prevention and control: why we need a whole systems approach
    (2020-05-25) Kielmann, Karina; Karat, Aaron S; Zwama, Gimenne; Colvin, Christopher; Swartz, Alison; Voce, Anna S.; Yates, Tom A; MacGregor, Hayley; McCreesh, Nicky; Kallon, Idriss; Vassall, Anna; Govender, Indira; Seeley, Janet; Grant, Alison D
    Infection prevention and control (IPC) measures to reduce transmission of drug-resistant and drug-sensitive tuberculosis (TB) in health facilities are well described but poorly implemented. The implementation of TB IPC has been assessed primarily through quantitative and structured approaches that treat administrative, environmental, and personal protective measures as discrete entities. We present an on-going project entitled Umoya omuhle (“good air”), conducted in two provinces of South Africa, that adopts an interdisciplinary, ‘whole systems’ approach to problem analysis and intervention development for reducing nosocomial transmission of Mycobacterium tuberculosis (Mtb) through improved IPC. We suggest that TB IPC represents a complex intervention that is delivered within a dynamic context shaped by policy guidelines, health facility space, infrastructure, organisation of care, and management culture. Methods drawn from epidemiology, anthropology, and health policy and systems research enable rich contextual analysis of how nosocomial Mtb transmission occurs, as well as opportunities to address the problem holistically. A ‘whole systems’ approach can identify leverage points within the health facility infrastructure and organisation of care that can inform the design of interventions to reduce the risk of nosocomial Mtb transmission.
  • Thumbnail Image
    Item
    Open Access
    Woman-Centered Outcomes for Medical and Surgical Abortion: A Systematic Review of Core Outcomes
    (2021) Jaffe, Atara; Colvin, Christopher
    Background: The prevalence of global abortion rates coupled with the lack of systematic assessment tools for monitoring women's abortion experiences has necessitated the creation of a core outcome set (COS) outlining key outcomes of women's abortion experiences. Objectives: Utilizing a woman-centered lens, this project attempts to establish this core outcome set through a qualitative systematic review of key abortion outcomes as espoused by women's perspectives across the globe. Methods: A qualitative review was performed to determine outcomes that are meaningful to women experiencing abortion. Findings: After analyzing the qualitative data produced by the 32 included studies, nine core outcomes were established. These outcomes include continuity of care, the capacity to cope effectively with the psychological dimensions of abortion, and the capacity for self-care/self management during their abortion processes. Women also discussed the importance of feeling a sense of autonomy, choice and control during their abortion experiences as well as feeling that healthcare providers met their information needs. Feeling emotionally supported by healthcare providers as well as having felt treated respectfully by healthcare providers, the capacity to control/management of pain, side effects and complications and the social repercussions of abortion were identified as core outcomes. Conclusion: Incorporating these findings into relevant surgical and medical abortion trials has the potential to increase the impact of women's perspectives and experiences on the study of abortion.