Research Output Repository (HSRC)
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Oral pre-exposure prophylaxis initiation, continuation and adherence among pregnant and postpartum women receiving antenatal and postnatal care: a systematic review
No full textIn 2023, one‐fourth of new HIV acquisitions in children globally resulted from vertical transmission following incident HIV during pregnancy or breastfeeding. Oral pre‐exposure prophylaxis (PrEP) with tenofovir disoproxil and emtricitabine is safe and effective in pregnancy and postpartum, with long‐acting options emerging. Integrating PrEP into antenatal and postnatal care (ANC/PNC) is a crucial person‐centred approach to prevent maternal HIV acquisition and vertical transmission. This review summarizes oral PrEP initiation, continuation and adherence among pregnant and postpartum women receiving ANC/PNC. We systematically searched three databases for English‐language quantitative studies published between 1 January 2015 and 28 March 2024. Eligible studies focused on pregnant and/or postpartum women accessing PrEP through ANC/PNC, and reported on initiation (receipt of prescription or self‐reported use), continuation (persistent use over time) and/or adherence (self‐reported and/or objective). We identified 481 articles; 12 studies from Kenya, Lesotho, Malawi and South Africa met our inclusion criteria. Study heterogeneity (e.g. definitions used, population included, follow‐up time) precluded meta‐analysis. All studies enrolled pregnant women; three also enrolled postpartum women. Median gestational age at enrolment ranged from 20 to 26 weeks, and follow‐up periods from 1 month post‐enrolment to 12 months postpartum. Oral PrEP initiation ranged from 14% to 84%. Continuation at 3 months ranged from 22% to 90% and declined postpartum in all studies. Self‐reported adherence (daily use) ranged from 11% to 81% in the past 7 or 30 days at 1 month (four studies) and from 54% to 81% at 3 months (two studies). Objectively measured adherence ranged from 34% to 62% for detectable tenofovir or tenofovir diphosphate levels at 1 month (three studies). One Kenyan trial demonstrated that universal versus risk‐based offers of oral PrEP resulted in similar PrEP use and HIV incidence. Two‐way SMS communication (Kenya) and real‐time adherence biofeedback counselling using urine tenofovir testing (South Africa) enhanced PrEP continuation/adherence compared to standard‐of‐care.
From feathers to figurines: past symbolism and present significance
No full textDespite the many threats that birds in Africa face today, the connection between people and birds remains strong, as it has been for centuries. This paper examines how birds continue to hold deep social and spiritual meaning for communities through totemism, folklore and cosmology. It was written by a DSI-HSRC intern during her training at the HSRC as part of her master’s dissertation at the University of Pretoria.
Scaling back on Dial-a-ride service will worsen poverty
No full textThe ‘Dial-a-ride’ service has been a welcome approach to promote more active participation by persons living
with disabilities in society. This subsidised transport service was designed for persons with disabilities who cannot make use of mainstream public transport like buses, taxis, or trains.N/
Preventing disasters before they happen: lessons from successful disaster risk reduction in Southern Africa
No full textDisaster headlines often underscore devastation and loss while overlooking success stories where proactive disaster risk reduction (DRRM) measures have averted catastrophe, saved lives, and reduced economic damage. This study addresses the gap in documentation and analysis of DRRM success stories in Africa, particularly within the Southern African Development Community (SADC), arguing that the absence of such narratives hampers a shift from reactive to proactive disaster risk governance. The research aims to extract critical lessons from success stories for enhancing future preparedness and response frameworks. A qualitative research design was employed, integrating document analysis, expert interviews, field observations, and practitioner workshops. Data was triangulated from diverse sources, including national disaster management agency reports (e.g., South Africa’s NDMC, Botswana’s NDMO, Mozambique’s INGC), peer-reviewed literature, UNDRR reports, SADC policy documents, and first-hand experiences from the
authors’ consultancy work in the African Union’s biennial DRRM reporting processes. Case studies examined include Mozambique’s response to Cyclone Idai in 2019, South Africa’s drought and flood risk governance (e.g., the 2023 floods in Eastern and Western Cape), and Malawi’s flood resilience programs. Findings reveal that successful DRRM outcomes are driven by a combination of anticipatory governance, community-based
preparedness, integration of Indigenous Knowledge Systems (IKSs), and investment in infrastructure and ecosystem-based adaptation. These cases demonstrate that locally embedded, yet scientifically informed, interventions enhance resilience and reduce disaster impacts. The study underscores the relevance of theoretical frameworks such as resilience theory, narrative theory, and social learning in interpreting how success stories contribute to institutional memory and adaptive capacity. Policy recommendations emphasize the need for institutionalizing success-story documentation in national DRRM frameworks, scaling up community engagement in risk governance, and fostering regional knowledge-sharing platforms within the SADC. Furthermore, the paper advocates for making DRRM success stories more visible and actionable to transition toward more anticipatory, inclusive, and effective disaster risk management systems.
South African rural smallholder farmers lack market access, affecting food security (unlocking market access potential for rural smallholder farmers to boost food security in South Africa)
No full textHSRC Policy Brief, MarchThis policy brief explores the market access-related challenges that are faced by smallholder farmers in South Africa. Smallholder farmers experience barriers that have serious implications for food security in the country. Over the years, it has been observed that despite food availability, food security remains a perpetual challenge for millions of people who lack access to nutritious food. Nutrition-based challenges, such as obesity (overweight) and undernourishment, are prevalent and this is causing public health problems. Against this reality, the role and value of smallholder farmers cannot be overstated, especially since they produce one-third of the South African food supply. Smallholder farmers often struggle with certain bottlenecks in areas of resourcing, production
infrastructure, post-harvest storage facilities, marketing, produce distribution, and technical capacity, which all point to constrained, sustainable and resilient market access. Locally, at national and provincial levels, the Department of Agriculture and Rural Development (DARD) is at the coalface of facilitating food production and supply.N/
An inclusive BRICS AI strategy empowering small, medium and micro enterprises
No full textHSRC Policy Brief, NovemberArtificial Intelligence (AI) is rapidly reshaping global economies and geopolitics, influencing global power dynamics with significant implications for the BRICS and BRICS Partner countries in how they approach this economic tipping point (Kubasova and Chepinoga, 2023; Pitukhina et al., 2024; Trabelsi, 2024). These implications drive what many call an AI arms race between the United States of America (USA) and China, which are competing for technological and military dominance (Rokvic, 2024). However, these new systems have the potential to drive innovation and economic growth but are impeded by uneven access. For instance, in December 2024, the USA’s Open AI released a new usage tier costing US0 per month per user, which was coupled with their advanced AI features (OpenAI, n.d.). This exorbitant pricing model excludes much of the developing and emerging world. Furthermore, Open AI CEO Sam Altman described 2025 as the year when AI agents join and transform the workforce (Altman, 2024), significantly disrupting the relationship between labour and capital.N/
Who are South African caregivers, how do they feel about education quality and what is their involvement in schools?
No full textThis chapter reports on the first nationally representative study of South African parents’ and caregivers’ perceptions of educational quality and their self-reported involvement in schools. A module of the South African Social Attitudes Survey (SASAS) was designed to elicit a holistic picture of parents’ and caregivers’ current experiences with and participation in their children’s schooling. Data that was collected provides detailed information on who South African parents/caregivers are, their financial and living conditions, and how they choose schools for their children. Additionally, the research was able to develop an understanding of how parents/ caregivers assess educational quality and the extent of their involvement in their child’s school. The importance of understanding parent/caregiver attitudes and perspectives towards schooling cannot be overstated. Globally, research has underscored the positive influence that parent/caregiver participation and
engagement can have on learner confidence and performance (Williams & Sánchez 2012; Baquedano-López, Alexander & Hernandez 2013; Mncube 2010; Đurišić & Bunijevac 2017; Munje & Mncube 2018). However,
research on parent/caregiver involvement regularly overlooks the fact that parents/caregivers are not a homogeneous group, as their personal identities and circumstances intersect with contextual differences between states and regions, the nature of education systems and societies, and the interactions between these dimensions at school level. The variation in how researchers and scholars conceptualize parent/caregiver participation needs to be informed by historical and contextual conditions, as the South African example so vividly demonstrates.
Household healthcare seeking patterns for emergent ill-health in Migori, Western Kenya
No full textHealthcare-seeking decisions reflect personal assessments of illness etiology and severity to determine whether, how, and where to seek care. Understanding these contexts enables targeted interventions to address barriers and ensure timely access to quality services. We examined patterns of household healthcare seeking for emergent ill-health in Western Kenya. As part of a multi-site mixed-methods study evaluating a patient centered, digitally-facilitated self-testing intervention, we analyzed 16 in-depth interviews and two focus group discussions (n = 14) in Migori County, Kenya. Guided by the Andersen Expanded Behavioral Model, we explored psychosocial, enabling, and need factors influencing household decisions. We found that a complex interplay of psychosocial, enabling, and need factors determined if, when, and where households sought care for ill members. Psychosocial influences included prevailing community norms that favored home remedies and self-medication prior to formal care as in the quote below: ‘we will start with home remedy, then to self-medication, then we will start looking for those healers…’. Enabling factors, particularly long waiting times, poor service quality, and lack of transport, discouraged timely facility use, leading households to rely on local pharmacies or alternative providers as reported by this participant ‘When you come here [hospital], you will stay for too long, and then… you will be sent to the chemist to buy medication. So, I am taking the cheaper route, I just go to the chemist [pharmacy] direct I take the medicine…’ Distance to facilities, financial barriers, and lack of health insurance compromise care-seeking. Need-related considerations, especially perceived illness severity, attribution of cause, and the identity of the affected household member (with children prioritized), determined the urgency and type of care sought as illustrated in the quote ‘There are some infections that you do not go to the hospital and some that you have to go to the hospital. So, it depends on the disease you have’. Household healthcare-seeking decisions were shaped by a dynamic interplay of psychosocial, enabling, and need factors. Addressing these multifaceted barriers through targeted, context-specific interventions, such as enhancing health infrastructure and integrating different providers, is crucial to ensuring timely access to quality healthcare.
If you want something to move faster, put it on social media: men’s experiences and perspectives of PrEP access, uptake, and continuation in Kwazulu-Natal, South Africa
No full textPoster presented at the 2025 International Workshop on Adolescence, SRHR & HIV, 1 OctoberN/