Research and Projects at the School of Public Health (SOPH)

Engaging with HIV/AIDS

The extent and diversity of the HIV/AIDS pandemic in South Africa, and the many challenges it creates for the people, households and communities it affects are well known – as are the associated pressures on health systems, services and personnel.

The School of Public Health (SOPH) devotes a large part of its research to the field of HIV/AIDS.  Many of the courses taught to postgraduate students have included issues relating to HIV/AIDS and a short course is taught on ‘Epidemiology and Control of HIV/AIDS, Tuberculosis and Malaria in the Era of Antiretrovirals’. Many of their mini-dissertations show the practical involvement of these part-time students in issues relating to HIV and AIDS.

Working in the field of HIV/AIDS can entail focusing on particular HIV/AIDS-related issues, but can also include broader or related aspects of health. So, for instance, work on health systems, human resources, social determinants of health or management of chronic diseases, can both inform, and be informed by, this significant health issue. The projects the School of Public Health undertakes, the publications they produce and conferences papers they have presented attest to work that is both focused on HIV/AIDS as well as on aspects of health that ultimately relate to this pervasive social and health phenomenon.

The School’s history of working in relation to HIV/ AIDS – and the breadth of the field of public health more generally – made it the ideal place to locate a university-wide Centre for Research in HIV and AIDS. Established in 2009 this new Centre seeks to coordinate UWC’s HIV/AIDS-related activities and promote collaboration in research.  

Working in the field

Since the late 1990s the SOPH has undertaken a range of field-based projects. In a few instances this has entailed establishing a satellite office staffed by employees of the School recruited from the local area. One such site is our office in Harding in the Sisonke district of KwaZulu- Natal. Established in 2002, it has been home to ‘Good Start’-related projects – the most recent of which has been a community-based randomised controlled trial to measure the effect of offering people the opportunity to test for HIV in their homes on HIV testing rates. This is the story of that project.

HIV/AIDS and Health systems

Strengthening health information and human resource management systems in South Africa
Vera Scott, Hilton Synders, Feroza Amien
In this project, project staff has worked with health service partners to develop health information management tools to assess the extent of comprehensive and integrated HIV/TB/STI services in public health facilities in urban and rural health districts. Based on the information generated, the team has identified the human resources and health systems constraints to ensuring quality and sustainability of comprehensive and integrated services. Approaches that strengthen planning, leadership and management capacity have been explored and modelled – including the utilization of health information management tools. This project is undertaken in partnership with the health departments of the City of Cape Town and the Provincial Government of the Western Cape – and is funded by the Department of Health and the Rockefeller Foundation.

HIV/AIDS and Social Determinants

Understanding barriers to access and adherence to antiretroviral treatment in South Africa’s Western Cape Province
Brian Van Wyk, Thato Ramela, Paschaline Stevens
Barriers to access and adherence to anti-retroviral treatment (ART) have been identified as issues of major concern in the Western Cape province, despite the fact that the province is at the forefront in the rollout of ART in South Africa. Such barriers, much like the diseases being treated, are the result of the complex intertwining of political, economic, social-cultural, gender, and biological factors. This three-year ethnographic study assessed the nature and extent of HIV and AIDS treatment initiation and barriers to adherence at three ART sites (Atlantis, Vredenburg and Malmesbury) and their surrounding communities. This project was undertaken in partnership with Fiona Larkan of Trinity College, Dublin and was funded by Irish Aid.

HIV/AIDS and Health Programmes & Interventions

Antiretrovirals and sexual behaviour: A qualitative study to explore the impact of ART on the sexual behaviour of people on therapy
Jessica Rebert, Brian van Wyk, Nikki Schaay, Harry Hausler
Conducted in two sites in KwaZulu-Natal this study aimed to assess the impact of antiretroviral therapy (ART) on the sexual behaviour of people on ART – and to consider the implications this has for the information and support provided to these patients by health workers in public health facilities. The final results of this research will be available in 2011.

Options Western Cape: Implementation and evaluation of a positive prevention intervention among HIV-positive people on ARVs in Cape Town
Nikki Schaay
The aim of this MRC/UCT/HSRC initiated project is to evaluate the implementation of a clinic-based behavioral intervention centered on HIV risk behaviours (entitled ‘Options’) in the Western Cape, and to test whether it is effective in reducing risky sexual behaviour among patients on ARVs. A report ‘Preliminary Findings on the Feasibility of Incorporating Options into Routine Adherence Counseling Practice’ has been presented – and a qualitative analysis of counseling practice before and after the intervention is now being undertaken. This project is being undertaken as collaboration between the Medical Research Council, the University of Cape Town and the Human Science Research Council as well as the Western Cape Provincial Department of Health, in association with Tulane University, Brown University, Centers for Disease Control, University of Connecticut, University of Western Ontario.

Reproductive intention in the context of HIV
Debra Jackson
In this collaboration with the University of Missouri, the reproductive intention and family planning in the context of HIV in rural South Africa is explored.

Multi-country EU and CDC-funded cluster randomized trial of peer support to promote exclusive breastfeeding
PROMISE-EBF – Mickey Chopra, Debra Jackson, David Sanders, Tanya Doherty
This project was one study in the PROMISE consortium with three collaborators each from Africa (Zambia, Uganda, Burkina Faso) and Europe (France, Norway, Sweden). It was a cluster randomised trial in the four African countries to examine the effectiveness of using in home peer support to promote exclusive breastfeeding during the first six months of life. In South Africa there were three project sites and the project included sub-studies on peer support to assist with obtaining social welfare grants, and infant feeding in HIV-positive mothers.

Saving newborn lives: An effectiveness study of integrated, community-based package for maternal, newborn, child and HIV care in  disadvantaged communities in South Africa, 2008-2010
Debra Jackson, Tanya Doherty
This project is a cluster randomized trial on community health workers’ promotion of newborn health in Umlazi, Durban, KwaZulu-Natal. It is being undertaken in collaboration with South African Medical Research Council and Stellenbosch University.

Cluster randomized trial of home-based VCT and TB/HIV/PMTCT Integration – Sisonke District
Debra Jackson, Jeannine Uwimana, Weliswa Binza, Tanya Doherty
This project comprises several CDC (SA) funded studies – undertaken in collaboration with MRC and TBHIV Care. They include the Facility Nurse Mentor Project aimed at promoting integration of HIV/TB/STI and PMTCT services; Action research to examine comprehensive integrated CHW services for HIV/TB/STI and PMTCT services; and a cluster randomized trial to examine the effectiveness of a home-based VCT programme.

Best practices and PMTCT-MNWCH integration
Debra Jackson, Tanya Doherty
This project documented best practices in the integration across South Africa of prevention of HIV transmission from mother to child (PMTCT) – and MNWCH (maternal, neonatal, women and child health). A publication on best practices in PMTCT and handbook for district-level integration of PMTCT into MNWCH services was developed.

National PMTCT evaluation
Debra Jackson, Wondwossen Lerebo, Tanya Doherty, Selamawit Woldesenbet
A situation analysis of EID (early infant development) services and a national survey of six-week expanded programme of immunisation (EPI) clinics were undertaken in all nine provinces to investigate HIV transmission and outcomes in the national PMTCT programme.

Rwanda PMTCT Evaluation: 2010-2011
Debra Jackson
Rwanda is implementing a national PMTCT programme evaluation, using routine testing of mothers and infants at the six-week infant immunization visit. As a co-Principal Investigator, on the South African PMTCT Evaluation, Debra Jackson is consulting with Rwanda UNICEF, National University of Rwanda and Rwanda Department of Health to provide technical assistance and promote collaboration across these two important studies.

Sisonke baseline survey for community-based intervention for TB/HIV/PMTCT integrated care
Debra Jackson, Harry Hausler, Jeannine Uwimana, Wondwossen Lerebo
Despite being advocated by national and international agencies such as the World Health Organisation (WHO), the integration of TB and HIV programmes has been slow, particularly in sub-Saharan Africa. This project aims to integrate TB/HIV & PMTCT services at both facility and community levels using a QI approach, nurse mentors and comprehensive supervision and training of community health workers.

A double blind randomised placebo-controlled trial of the efficacy and safety of infant peri-exposure prophylaxis with lamivudine to prevent HIV-1 transmission by breastfeeding ANRS 12174 - PROMISE-PEP, 2008-2010
David Sanders, Debra Jackson, Tanya Doherty, Cheryl Nikodem, Mandisa Singata et al ANRS/EDCTP
This is a second study within the PROMISE consortium. This is a randomised controlled clinical drug trial examining the effectiveness of alternative drugs to prevent mother to child transmission of HIV (PMTCT) through breastfeeding. Currently only Nevirapine is recommended. No other drugs have been tested for this purpose so results are important for potential options for clinicians in the management of infants at risk for acquiring HIV during their first year of life.

Strengthening African research for responsive health policy and systems: Mapping and analysis of public health research and capacity strengthening initiatives in Africa
Christina Zarowsky, David Sanders, Uta Lehmann, Debra Jackson
This three-year project contributes to the broad-based vision of the UWC Centre for Research in HIV/ AIDS through research and synthesis about broader health policy and systems-oriented capacity development initiatives and approaches, beyond a focus primarily on HIV/AIDS. This project is mapping, analysing, and fostering linkages among programmes of health policy and systems research, training and capacity strengthening in sub-Saharan Africa. It is also strengthening linkages and exchanges between UWC and Canadian researchers and institutions. This will complement the Centre’s vision of integrating HIV/ AIDS into broader health systems, education, and gender analysis and practice.