Research Output Repository (HSRC)
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Experiences and perspectives on linkage to and retention in HIV care following reactive HIV self-testing: insights from a qualitative study in KwaZulu-Natal, South Africa
No full textPaper presented at the INTEREST Conference, 13 MayN/
Co-creation and participatory approaches to health and well-being research
No full textPaper presented at the NRF-HSRC Engaged Research Conference, Birchwood & OR Tambo Conference Centre Conference Centre, Benoni, 22-24 OctoberN/
Decoding market access: a quantitative analysis of challenges faced by small-scale farmers
No full textSmall-scale farming is crucial for rural development and food security in South Africa, yet farmers face significant barriers to formal market access. The aim of this study is to investigate the impact of hindrances to market access for small-scale farmers in Jozini. The study employs the Asset Vulnerability Analytical Framework to assess how critical assets – land, water, financial capital, and farming equipment – shape market access challenges for small-scale farmers. This cross-sectional study utilized data gathered from small-scale farmers in Jozini Municipality through a structured questionnaire. Descriptive statistics were employed to summarize the sample characteristics. Fisher’s Exact Test was used to analyze the relationships among the eight identified market access hindrances faced by small-scale farmers, and the t-test was conducted to assess the association between the hindrances index and the effectiveness of market access interventions for small-scale farmers. On average, over 85.0% of farmers in Jozini identified seven out of eight factors as major barriers to market participation, with the exception of agro-food market requirements, which were reported by 60.4% of farmers. All hindrances were significantly associated with each other, except for inadequate markets in rural areas and agro-food market requirements (p-value = 0.057). Farmers facing barriers were more likely to sell in informal markets (88.7%) compared to those without hindrances (79.2%). Farmers with market access hindrances rated interventions 7.8 points lower on average (p = 0.020) than those without hindrances. The study recommends infrastructure development, financial support, cooperative formation, and capacity-building programmes.
Overview of evidence synthesis: enhancing research for evidence based decision making
No full textPaper presented at the HSRC Health Innovation & Policy webinar, 26 JuneN/
Examining the effect of universal testing and treatment strategies for HIV prevention in Zambia and South Africa: generalizing the results of the HPTN 071 (PopART) trial
No full textHIV Prevention Trials Network (HPTN) 071 (PopART) was a cluster‐randomized trial to evaluate universal testing and treatment (UTT) strategies for HIV prevention. HPTN071 compared three arms: (A) combination prevention with UTT; (B) combination prevention with universal testing and antiretroviral therapy initiation according to local guidelines; and (C) standard of care (SOC). Interventions were implemented in entire randomized communities, with impacts on HIV incidence measured in “population cohorts,” that is the HPTN071 sample. Unexpectedly, a significantly lower incidence was not observed in arm A relative to SOC. Importantly, rates of participation in the HPTN071 sample differed among population subgroups, for example men were underrepresented. To correct for underrepresented subgroups, PopART intervention effects are estimated in a population of interest, adults aged 18−44 in trial provinces, characterized with two nationally representative HIV‐focused surveys. The HPTN071 sample is weighted to match the population of interest by demographics and HIV risk factors. Risk of HIV acquisition is compared across arms, both in the trial population (unweighted) and the population of interest (weighted). Both (1) the risk of HIV acquisition between 1 and 3 years and (2) the risk of HIV acquisition by 3 years are compared. In the trial population, estimated risk in arm A is, counterintuitively, slightly higher than SOC (Year 1−3 Risk Difference [RD]: 0.10%; 95% CI: −1.15%, 1.25%). After weighting, risk in arm A is lower than SOC in the population of interest (RD: −0.34%; 95% CI: −2.04%, 0.96%). Weighting also strengthened the estimated effect in arm B relative to SOC (unweighted RD: −0.66%, 95% CI: −1.88%, 0.46%; weighted RD: −1.18%, 95% CI: −2.85%, 0.15%). Weighted year 3 risk difference estimates indicated even stronger possible intervention effects: A versus SOC −0.83% (95% CI: −2.94%, 0.99%), B versus SOC −1.86% (95% CI: −3.80%, −0.09%). PopART interventions are estimated to be more protective in the population of interest than observed in the HPTN071 sample. These results partially explain the unexpected finding in arm A, providing further support for UTT strategies for HIV prevention. This analysis also highlights the importance of considering heterogeneous treatment effects among population subgroups when measuring the overall efficacy of HIV interventions.
Towards developing a collaborative PhD program across ARUA member universities: experiences from South African universities
No full textCommissioned by the African Research Universities Alliance (ATUA), OctoberThe South African higher education system has been recognised as the leading producer of knowledge on the continent, contributing to 73% of total publications from all ARUA universities in 2018 (Van Shalkwyk et al., 2021). Furthermore, a recent study by ARUA shows that South African universities had higher doctoral enrolments and graduates than their alliance counterparts (ARUA, 2021). What is less obvious is the nature of collaboration, and how this can be enhanced. This report highlights the status of doctoral training in South Africa using evidence from the six South African ARUA member universities. The study explores the nature of the doctoral programme within the member universities as a sample of the system to make recommendations towards the development of collaborative doctoral programmes across the alliance. The report first provides a brief overview of the country's socio-economic status, which has a bearing on the higher education system and how universities and doctoral programmes are organised, and which may influence the direction of the design of collaborative programmes as envisaged by ARUA. It further details the national and institutional policy and operational frameworks, identifying institutional and systemic challenges. The report uses institutional data to explore the doctoral life cycle in South Africa along three main themes: access, structure of the programmes, and experience through the programme; thereafter making recommendations towards designing collaborative arrangements, and challenges that need to be addressed. The report is divided into five sections. The next section provides an overview of South Africa's
socio-economic and political context, including a brief description of the higher education landscape. Section three delves into the case study of the university and the two selected programmes. Section four presents the findings from the data collected from the two case study programmes. Section five provides some recommendations and conclusions.N/
Poverty & inequality in African cities: reflections on challenges and causes
No full textThe African continent is the most rapidly urbanizing continent in the world. However, the challenges associated with this rapid urban growth are enormous, including growing slums, poverty and inequality, combined with weak government capacity.1 Thus, African cities are often seen as a threat or a challenge that needs to be managed.2 Many have argued that slums and bidonvilles should not be considered part of the urban cityscape in Africa. More theoretically, these have been viewed as appendages and parasitic towns that feed major African urban areas. Many have disputed this perspective, arguing that slums and bidonvilles have contributed to better economic outcomes and higher standards of living. It is, therefore, important that the definition of what constitutes an African metropolitan area should take into consideration these important peripheral towns.
While it is obvious that African cities face major challenges, it is important to consider slums and bidonvilles as part of African metropolitan cities, principally because these slums and bidonvilles outperform the rest of
the countries in which they are located.3 The gap between the economic indicators of the slums and bidonvilles and the national average figures is much larger than the corresponding gaps in many parts of the world.
A framework for implementing integrated HIV and non-communicable disease care at primary health care facilities in Southern Africa
No full textComorbidities of HIV/AIDS and non-communicable diseases (NCDs) are increasingly prevalent, affecting up to 30% of individuals living with HIV/AIDS, particularly in Sub-Saharan Africa. Conventional approaches that treat NCDs separately from HIV/AIDS care have been deemed inefficient, highlighting the need for integrated
models. This study aims to develop a framework for integrating NCD care into HIV programs at primary healthcare facilities in Southern Africa. As part of a broader study examining the burden, extent and cost of HIV/NCD integration we employed a modified ‘Best fit’ framework synthesis method. Thematic analysis was the primary method of analysis used to inform the framework. The study expanded on existing framework themes related to effective team-working, organizational leadership, patient-centered care, community/patient/ provider partnerships. It introduced seven additional themes: country specific NCD prioritization, multi stakeholder partnerships, healthcare worker mental wellbeing, unified health information systems, with enhanced privacy, establishing costing databases for HIV/NCD integrated care, robust monitoring and evaluation mechanisms,
and opportunities for regional coordination. Improving existing frameworks for integrating HIV/NCD care is feasible by leveraging established HIV care platforms. These enhancements can support more efficient holistic healthcare delivery across primary healthcare facilities in Southern Africa.
A theory of change for the inclusive education for learners with intellectual disabilities in South Africa
No full textSince the implementation of the inclusive education policy in 2001 in South Africa, several milestones have been celebrated. Nevertheless, studies have reported the significant challenges in the implementation of the policy for learners with disabilities across schools in South Africa, which impede transformation. Reflecting on key research insights from a recent study, this article argues for the development of a Theory of Change (ToC) as a road map or blueprint for implementing inclusive education for learners with intellectual disabilities in South Africa. A ToC is imperative for bridging the gap between policy implementation and outcomes. A qualitative research design was adopted for the study. Data were collected through a desktop review, 12 key informant interviews and 10 focus group discussions with key role players and stakeholders in various positions in the education system (i.e. senior education specialists, special needs teachers, one education operations support officer, a principal, deputy principals and head of departments). The data collected were analyzed thematically. The findings of the study highlighted progress regarding government financial resources and also the various structural barriers impeding the implementation of inclusive education for learners with intellectual disabilities. This article encourages the continued development of theories of change to promote the effective implementation and ensure quality inclusive education for learners with disabilities in South African schools. This article contributes a potential ToC to guide the effective implementation of inclusive education policy and practices for learners with intellectual disabilities in the South African schooling system.
Using autoethnography to research independent music production as household innovation
No full textDigitalization and datafication have brought structural changes to the music industry globally, creating new innovation opportunities as well as risks for industry role-players, including within the artist-audience relationship. In this context, extending the research understanding of independent music production, as Walzer has suggested, is increasingly important. This paper makes a methodological contribution to this research agenda, by demonstrating the use of autoethnography in the study of a household innovation system, and the use of autoethnographic data for reflection on knowledge acquisition and knowledge combination as well as barriers to and enablers of innovation. The paper also makes a conceptual contribution to the literature on innovation capabilities within African informal settings, arguing for a conception of knowledge informality as a distinct feature of knowledge that can be combined with more formal codified knowledges during innovation processes. For public policy to orient to resource-constrained and knowledge-diverse creative communities, new sources of data and types of analysis widen and deepen the evidence-base for creative industry development broadly, and independent music production in particular.