Browsing by Author "van der Westhuizen, Claire"

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    Open Access
    Intimate partner violence among adolescent girls and young women in Bulawayo, Zimbabwe and perceived barriers and facilitators to the provision of psychosocial interventions in salons
    (2024) Ndondo, Nonhlanhla; Carney, Tara; Richter, Marlise; van der Westhuizen, Claire
    Background. Women are disproportionately affected by intimate partner violence (IPV), particularly those in low-to-middle-income countries (LMIC). Recent research data suggests that IPV prevalence among adolescent girls and young women (AGYW) in Zimbabwe is estimated to be 36.5%. Innovative intervention models that leverage gendered spaces to provide IPV support have shown great potential in high income countries, but little is known about these in LMIC settings, including in Zimbabwe. The current qualitative study explored the experiences of IPV among AGYW as well as the feasibility of the use of pre-existing female spaces such as salons to provide psychosocial interventions in Bulawayo, Zimbabwe. Methods. Nine AGYW who had experienced IPV participated in virtual and in-person key informant interviews. Two focus groups were conducted with salon and spa workers to explore the potential use of salon-based interventions (n=10). Purposive sampling was used as a recruitment strategy. Thematic analysis was used to analyse the data. Results. The findings indicated that in this study, AGYW participants' experiences of IPV consisted mainly of physical IPV such as being beaten with an object, being slapped, or punched with a fist, followed by psychological and lastly, sexual IPV. The results of the study highlighted the factors that seemed to predispose AGYW participants to IPV such as sociocultural influences, economic disempowerment and partner characteristics and behaviours. AGYW participants also discussed the negative physical and mental health impact of the psychological and sexual abuses they had encountered. Both salon workers and the AGYW interviewed identified peer support facilitated by the positive social capital created in salons, as well as the female centeredness of salons as conducive elements for an acceptable intervention. However, some speculations around confidentiality and accessibility to salons were some of the potential barriers identified for implementing salon based IPV interventions. Conclusion. The findings of this study indicated that there is a need to identify and address IPV, as well as the mental health consequences that AGYW experience due to IPV. While the use of predominantly female spaces, in this case salons, were discussed as feasible spaces to incorporate into IPV support models for AGYW, there were certain barriers which will need to be addressed for this to be considered. In addition, it was clear that the content of such interventions needed to include not only IPV and associated mental health issues, but also include other components such as economic empowerment of AGYW, while also challenging traditional gender norms through salon-based interventions. Furthermore, AGYW alluded to their preference for IPV psychosocial support interventions to be peer-based and female-driven. Salons typically provide these aspects, hence increasing their viability as a choice for community based IPV support.
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    Mental health and antiretroviral therapy adherence among people living with HIV attending an HIV clinic in Blantyre, Malawi
    (2021) Chasweka, Dennis; Sorsdahl, Katherine; van der Westhuizen, Claire
    ABSTRACT Background: Tremendous progress has been achieved in the treatment for HIV/AIDS since the 1980s. This significant improvement and progress in HIV treatment has largely been attributed to antiretroviral therapy (ART). Non-adherence to ART commonly causes ART treatment failure and the development of drugresistant strains of HIV, resulting in increased mortality. Common mental disorders have been found to be strongly associated with non-adherence. In Malawi, where HIV is prevalent, there is a paucity of studies on how common mental disorders are associated with non-adherence. The present study aimed at examining the association between depression, anxiety and alcohol use disorder symptoms and ART adherence among people living with HIV/AIDS (PLWHA) attending an HIV clinic in Blantyre, Malawi. Methods: This was a facility-based quantitative study with a cross-sectional descriptive design with 213 PLWHA attending an HIV clinic. The participants completed a survey consisting of demographics and mental health disorders symptoms screening tools, namely the 9-item Patient Health Questionnaire (PHQ9) for depression symptoms, the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety symptoms and the Alcohol Use Disorders Identification Test (AUDIT) for alcohol use and related harms. ART adherence was assessed using pill count, a self-report measure and a combined measure of both pill count and self-report adherence. Results: The prevalence of depressive symptoms among the participants was 32%, 26% for anxiety symptoms and 16% of participants reported any life-time alcohol use. The majority of participants (75.6%) were found to have good pill count-based adherence while only 41.7% and 33.2% of participants reported good adherence on the self-report and combined measures respectively. The results showed that older participants were more likely to self-report good adherence than younger participants (OR=1.03; 95%CI=1.01-1.06, p-value=0.050). The participants who scored higher on the AUDIT were less likely to self-report good adherence to ART (OR=0.88; 95% CI=0.78-1.00, p-value=0.050). Side-effects were statistically significantly associated with both pill-count and combined adherence. The participants that experienced side effects from the treatment were less likely to be adherent on pill count (OR=0.19; 95% CI=0.07-0.53, p-value=0.001) and the combined adherence measure (OR=0.45; 95% CI=0.24-0.83, pvalue=0.011). Alcohol use was again significantly associated with combined adherence. The participants who reported ever having used alcohol were less likely to be adherent to ART on the combined adherence measure (OR=0.51; 95% CI=0.29-0.93, p-value=0.026). No statistically significant association between depressive and anxiety symptoms and ART adherence was found. Conclusion: The findings show that symptoms of common mental disorders were highly prevalent among PLWHA. Alcohol use, younger age group and experiencing side-effects from ART were significantly associated with ART non-adherence. Further research is required to investigate how depression and anxiety is associated with ART adherence among PLWHA in a Malawian population using larger sample sizes. The current study also highlights the need to routinely screen PLWHA for mental health problems. Further research using advanced designs, such as randomized clinical trials incorporating implementation science approaches, is also needed to evaluate the feasibility and effectiveness of integrating mental health services into HIV care in Malawi.
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    Patient outcomes and experience of a task-shared screening and brief intervention service for problem substance use in South African emergency centres: a mixed methods study
    (2021-05-12) van der Westhuizen, Claire; Malan, Megan; Naledi, Tracey; Roelofse, Marinda; Myers, Bronwyn; Stein, Dan J; Lahri, Sa’ad; Sorsdahl, Katherine
    Abstract Background Screening, brief intervention and referral to treatment (SBIRT) programmes have resulted in generally positive outcomes in healthcare settings, particularly for problem alcohol use, yet implementation is hampered by barriers such as concerns regarding the burden on healthcare professionals. In low-resourced settings, task-sharing approaches can reduce this burden by using non-professional healthcare workers, yet data are scarce regarding the outcomes and acceptability to patients within a SBIRT service. This study aims to evaluate patient-reported outcomes, patient acceptability, perceived benefits and recommendations for improving a task-shared SBIRT service in South African emergency centres (ECs). Methods This mixed methods study incorporates quantitative substance use screening and patient satisfaction data collected routinely within the service at three hospitals, and qualitative semi-structured interviews with 18 EC patient beneficiaries of the programme exploring acceptability and perceived benefits of the programme, as well as recommendations to improve the service. Approximately three months after the acute EC visit, a sub-sample of patients were followed up telephonically to assess patient-reported satisfaction and substance use outcomes. Results Of the 4847 patients eligible for the brief intervention, 3707 patients (76%) used alcohol as their primary substance and 794 (16%) used cannabis. At follow-up (n = 273), significant reductions in substance use frequency and severity were noted and over 95% of patients were satisfied with the service. In the semi-structured interviews, participants identified the non-judgemental caring approach of the counsellors, and the screening and psychoeducation components of the intervention as being the most valuable, motivating them to decrease substance use and make other positive lifestyle changes. Study participants made recommendations to include group sessions, market the programme in communities and extend the programme’s reach to include a broader age group and a variety of settings. Conclusions This task-shared SBIRT service was found to be acceptable to patients, who reported several benefits of a single SBIRT contact session delivered during an acute EC visit. These findings add to the SBIRT literature by highlighting the role of non-professional healthcare workers in delivering a low-intensity SBIRT service feasible to implement in low-resourced settings.
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    Readiness to change is a predictor of reduced substance use involvement: findings from a randomized controlled trial of patients attending South African emergency departments
    (BioMed Central, 2016-02-20) Myers, Bronwyn; van der Westhuizen, Claire; Naledi, Tracey; Stein, Dan J; Sorsdahl, Katherine
    Background: This study examines whether readiness to change is a predictor of substance use outcomes and explores factors associated with RTC substance use among patients at South African emergency departments. Methods: We use data from participants enrolled into a randomized controlled trial of a brief substance use intervention conducted in three emergency departments in Cape Town, South Africa. Results: In adjusted analyses, the SOCRATES “Recognition” (B = 11.6; 95 % CI = 6.2–17.0) and “Taking Steps” score (B = -9.5; 95 % CI = -15.5- -3.5) as well as alcohol problems (B = 4.4; 95 % CI = 0.9–7.9) predicted change in substance use involvement at 3 month follow-up. Severity of depression (B = 0.2; 95 % CI = 0.1–0.3), methamphetamine use (B = 3.4; 95 % CI = 0.5- 6.3) and substance-related injury (B = 1.9; 95 % CI = 0.6–3.2) were associated with greater recognition of the need for change. Depression (B = 0.1; 95 % CI = 0.04 -0.1) and methamphetamine use (B = 2.3; 95 % CI = 0.1 -4.2) were also associated with more ambivalence about whether to change. Participants who presented with an injury that was preceded by substance use were less likely to be taking steps to reduce their substance use compared to individuals who did not (B = -1.7; 95 % CI = -5.0- -0.6). Conclusion: Findings suggest that brief interventions for this population should include a strong focus on building readiness to change substance use through motivational enhancement strategies. Findings also suggest that providing additional support to individuals with depression may enhance intervention outcomes.