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Medina-Marino A, Bezuidenhout D, Hosek S, Barnabas RV, Atujuna M, Bezuidenhout C, Ngwepe P, Peters RPH, Little F, Celum CL, Daniels J, Bekker LG. The Community PrEP Study: a randomized control trial leveraging community-based platforms to improve access and adherence to pre-exposure prophylaxis to prevent HIV among adolescent girls and young women in South Africa-study protocol. Trials 2021; 22:489. [PMID: 34311754 PMCID: PMC8314507 DOI: 10.1186/s13063-021-05402-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/26/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND HIV incidence among South African adolescent girls and young women (AGYW) remains high, but could be reduced by highly effective pre-exposure prophylaxis (PrEP). Unfortunately, AGYW report significant barriers to clinic-based sexual and reproductive health services. Even when AGYW access PrEP as an HIV prevention method, poor prevention-effective use was a serious barrier to achieving its optimal HIV prevention benefits. Determining the acceptability and feasibility of community-based platforms to increase AGYW's access to PrEP, and evaluating behavioural interventions to improve prevention-effective use of PrEP are needed. METHODS We propose a mixed-methods study among AGYW aged 16-25 years in Eastern Cape Province, South Africa. In the first component, a cross-sectional study will assess the acceptability and feasibility of leveraging community-based HIV counselling and testing (CBCT) platforms to refer HIV-negative, at-risk AGYW to non-clinic-based, same-day PrEP initiation services. In the second component, we will enrol 480 AGYW initiating PrEP via our CBCT platforms into a three-armed (1:1:1) randomized control trial (RCT) that will evaluate the effectiveness of adherence support interventions to improve the prevention-effective use of PrEP. Adherence will be measured over 24 months via tenofovir-diphosphate blood concentration levels. Qualitative investigations will explore participant, staff, and community experiences associated with community-based PrEP services, adherence support activities, study implementation, and community awareness. Costs and scalability of service platforms and interventions will be evaluated. DISCUSSION This will be the first study to assess the acceptability and feasibility of leveraging CBCT platforms to identify and refer at-risk AGYW to community-based, same-day PrEP initiation services. It will also provide quantitative and qualitative results to inform adherence support activities and services that promote the prevention-effective use of PrEP among AGYW. By applying principles of implementation science, behavioural science, and health economics research, we aim to inform strategies to improve access to and prevention-effective use of PrEP by AGYW. TRIAL REGISTRATION ClinicalTrials.gov NCT03977181 . Registered on 6 June 2019-retrospectively registered.
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Affiliation(s)
- Andrew Medina-Marino
- Research Unit, Foundation for Professional Development, 10 Rochester Rd, Vincent, East London, Buffalo City Metro, Eastern Cape Province, South Africa.
- The Desmond Tutu HIV Centre, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Dana Bezuidenhout
- Research Unit, Foundation for Professional Development, 10 Rochester Rd, Vincent, East London, Buffalo City Metro, Eastern Cape Province, South Africa
| | - Sybil Hosek
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Ruanne V Barnabas
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Millicent Atujuna
- The Desmond Tutu HIV Centre, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Charl Bezuidenhout
- Research Unit, Foundation for Professional Development, 10 Rochester Rd, Vincent, East London, Buffalo City Metro, Eastern Cape Province, South Africa
| | - Phuti Ngwepe
- Research Unit, Foundation for Professional Development, 10 Rochester Rd, Vincent, East London, Buffalo City Metro, Eastern Cape Province, South Africa
| | - Remco P H Peters
- Research Unit, Foundation for Professional Development, 10 Rochester Rd, Vincent, East London, Buffalo City Metro, Eastern Cape Province, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Connie L Celum
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Joseph Daniels
- Department of Psychiatry and Human Behaviors, Charles R. Drew University of Medicine and Science, Los Angeles, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
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Coetzee BJ, Gericke H, Human S, Stallard P, Loades M. What should a Universal School-Based Psychoeducational Programme to Support Psychological Well-Being amongst Children and Young People in South Africa Focus on and how should it be Delivered? A Multi-Stakeholder Perspective. SCHOOL MENTAL HEALTH 2021; 14:189-200. [PMID: 35273653 PMCID: PMC8897361 DOI: 10.1007/s12310-021-09465-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 12/16/2022]
Abstract
Children and young people are vulnerable to developing mental health problems. In South Africa, this vulnerability is compounded by contextual risk factors such as community violence and poverty. However, mental health services are scarce and costly, which precludes access for many. Universal school-based mental health programmes can prevent the onset of mental health problems in children and young people and have been implemented to good effect in high-income settings. We sought to understand stakeholder perspectives on what such a programme should focus on and how it could be implemented in practice within the South African context. We interviewed children and young people (n = 22), parents (n = 21), teachers (n = 17), and school mental health counsellors (n = 6) recruited from two schools in the Western Cape, South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. We generated three overarching themes: ‘the value of a mental health and well-being programme’, ‘content and delivery’, and ‘practicalities and logistics’. Participants were optimistic about the potential value of such a programme. Developing content that was appropriate for group delivery, flexible and timed to fit within the school schedule was important. Finding ways to make activities meaningful for large classes was important logistically, as was determining to what extent leaners would feel comfortable participating alongside their peers. Participants felt that outsiders, as opposed to school staff, should deliver the programme and that parents should be involved where possible. Developing a mental health programme for children and young people in the South African context requires careful understanding of who the key role players in such an intervention will be and how exactly they want to be involved and, how the challenges associated with practicalities and logistics can be overcome.
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Affiliation(s)
- Bronwynè J. Coetzee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Hermine Gericke
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Suzanne Human
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | | | - Maria Loades
- Department of Psychology, University of Bath, Bath, UK
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van der Westhuizen D, Claassen N, Viljoen M. A case study of two adolescent-parent pairs describing the association between vagal tone and social-emotional adjustment during a Positive Cognitive Behaviour Therapy Programme. J Child Adolesc Ment Health 2018; 30:111-130. [PMID: 30236037 DOI: 10.2989/17280583.2018.1488718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A case study describing the association between vagal tone and social-emotional adaptation in two distressed adolescent-parent (A-P) pairs during a Positive Cognitive Behaviour Therapy Programme (P-CBTP). METHODS Two A-P pairs completed a P-CBTP with pre- and post-intervention biosocial-emotional assessments; weekly training sessions over 7 weeks to develop individual strengths, new adaptive cognitions, positive discipline skills, optimism and knowledge on age-appropriate developmental expressions; augmented by moderate physical activity. Resting vagal tone and vagal reactivity were assessed by time-domain measures of vagal activity (RMSSD). RESULTS Social-emotional adjustment improved in all A-P pairs. Resting vagal tone increased over the intervention period, from low-to-low-normal towards average-for-normal in three subjects. The fourth individual had excessive pre-intervention resting vagal tone that declined in the direction of normal over the intervention period. Vagal reactivity in response to orthostatic stress remained the same pre- to post-intervention. CONCLUSIONS Changes in resting vagal tone demonstrated improvements in psychological functioning in all four subjects over the period of intervention. Results supported the view of the association between vagal tone and mental health not being an absolute positive relationship, but that low, as well as excessive, vagal tone may be maladaptive. Indications are that the same may apply to vagal reactivity to psychological stress. More studies need to examine the association between resting vagal tone and emotion regulation in A-P relationships during P-CBTP, keeping in mind that a linear relationship cannot summarily be expected in population studies.
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Affiliation(s)
- Deborah van der Westhuizen
- a Department of Psychiatry, School of Medicine, Faculty of Health Sciences, University of Pretoria , Pretoria , South Africa
| | - Nicolaas Claassen
- b School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria , Pretoria , South Africa
| | - Margaretha Viljoen
- a Department of Psychiatry, School of Medicine, Faculty of Health Sciences, University of Pretoria , Pretoria , South Africa
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