Health Systems

Identifying and addressing barriers to retention in the cervical cancer treatment cascade among women with HIV in South Africa

The purpose of this study is to develop and test the feasibility and acceptability of a patient-level intervention and provider toolkit to increase retention in care among women with HIV (WWH) who received high-risk abnormal cervical cytology screening test results.

Aim 1a: Explore structural-, community/relational-, and individual-level barriers and facilitators to follow-up appointment attendance and subsequent treatment among women with HIV (WWH) with a recent high-risk abnormal cervical cytology screening test result in Durban, SA.

Aim 1b: Explore provider awareness of the relationship between HIV and cervical cancer and perspectives on barriers to retention in care post-abnormal cervical cytology screening test result via individual qualitative interviews (n<8). We started in October 2024 to recruit up to 30 women to complete the Aim 1a qualitative interviews, up to 8 providers to complete the Aim 1b qualitative interviews, and 8-10 women for the Aim 3 open pilot intervention.

Aim 2: Develop a brief patient-level intervention and provider toolkit to increase retention in care among WWH who received high-risk abnormal cervical cytology

Aim 3: Test the feasibility and acceptability of the intervention in an open pilot (n=8-10

Study title	Identifying and addressing barriers to retention in the cervical cancer treatment cascade among women with HIV in South Africa

Funder	National Institutes of Health (US)
Principal and Co-Principal investigators	Dr Amelia Stanton – Boston University Dr Christina Psaros – Massachusetts General Hospital Prof Jenni Smit – Wits MRU
Site	WMRU – Durban

Developing a Resiliency Intervention to Support Nurses Engaged in the Provision of HIV Care (Phase 2): The Qinisa (Strengthen) Study

This study will pilot test an adapted version of an existing stress management and resiliency-enhancing intervention (the Relaxation Response Resiliency Program; the 3RP) for nurses that care for PLWH in the public sector in SA, to test the feasibility and acceptability of all study procedures.

This phase involved a small proof-of-concept study (N = 8) which has been successfully completed.

An intervention manual is being adapted to be implemented in a randomized pilot study (N = 60) to test the feasibility and acceptability of the adapted intervention

Additionally, this study will collect anonymous clinic client data on demographics, satisfaction with care, client-provider trust, and likelihood of returning to care (N=up to 250-400 surveys). We will also collect clinic-level data to understand how to measure client-related outcomes and clinic metrics of HIV care engagement, such as expected patient return rates/measures of retention, percentage of patients with suppressed viral load, frequency of viral load collection, and percentage of patients initiating second line treatment to best understand how to measure these variables in a larger trial testing the efficacy of the intervention.

Study title	Developing a Resiliency Intervention to Support Nurses Engaged in the Provision of HIV Care (Phase 2): The Qinisa (Strengthen) Study

Funder	National Institutes of Health (US)
Principal and Co-Principal investigators	Dr Christina Psaros – Massachusetts General Hospital Prof Jenni Smit – Wits MRU
Site	National / Provincial

Implementation Research on Introducing and Scaling Up Pre-Exposure Prophylaxis Prevention of HIV Infection within Family Planning/Contraceptive Services in South Africa

This study aims to identify implementation gaps and challenges related to integration of PrEP for HIV prevention in services where contraception is delivered and develop a strategy on how to address these challenges and enhance scale up.

The study will:- 1. Explore the coverage and readiness of PrEP delivery where contraceptive services are provided. 2. Identify feasibility, facilitating and impeding factors that influence the integration of contraception and PrEP services and sustainability at all levels of care. 3. Explore stakeholders’ knowledge and perceptions towards the integration of contraception and PrEP services. 4. Identify clients’ acceptability, perceived barriers and enablers of receiving PrEP where contraceptive services are provided, in order to understand factors that influence clients’ decision making about PrEP initiation and continuation in the context of integrated service delivery. 5. Draw upon findings to develop a strategy with stakeholders that addresses implementation gaps and challenges and the development of indicators to measure integration of PrEP and contraceptive services.

This study will be conducted in South Africa at multiple levels of organization: national, provincial, district (eThekwini District, KwaZulu-Natal [KZN] Province), primary health facilities, and community.

Study title	Implementation Research on Introducing and Scaling Up Pre-Exposure Prophylaxis Prevention of HIV Infection within Family Planning/Contraceptive Services in South Africa

Funder	WHO
Principal and Co-Principal investigators	Prof Jenni Smit (PI) Mags Beksinska (Co-PI) Nzwakie Mosery (Co-PI)
Site	National / Provincial

Nursing Resilience

Study title	Developing a resiliency intervention to support nurses engaged in the provision of HIV care (Phase I)
Study design	This study will adapt, refine, and pilot test an existing stress management and resiliency-enhancing intervention (the Relaxation Response Resiliency Program; 3RP) for nurses providing HIV care in the public sector in SA. We will identify the ways in which the 3RP requires adaptation to meet the needs of nurses based on data collected from focus group discussions (FGDs) and adapt the intervention accordingly. We will enroll N=15-21 nurses to participate in FGDs (up to 3 groups of 5-7 nurses).
Funder	NIH –
Principal investigators	Dr Christina Psaros – Massachusetts General Hospital, Prof Jenni Smit – Wits Maternal Adolescent and Child Health Research
Site	EThekwini clinics providing HIV care

Completed Health Systems Studies

DIFFER: Diagonal Interventions to Fast-Forward Enhanced Reproductive Health

The “Diagonal Interventions to Fast Forward Enhanced Reproductive Health” (DIFFER) research project tests the hypothesis that combining vertical Sexual and Reproductive Health (SRH) interventions, such as services targeted to Female Sex Workers (FSW), with horizontal strengthening of health systems for SRH within existing health facilities, is synergistic, feasible, and likely to be more effective and cost-effective than providing them separately. In particular, the research activities will build capacity to implement interventions for FSW. This multi-country study consisted of a consortium of three African, one Indian and two European partners. The research activities are being undertaken in the African sites (Durban, South Africa; Mombasa, Kenya; and Tete, Mozambique) and in Mysore India. The formative research including a detailed situational and policy analysis informed the development of site and context-specific intervention packages to strengthen SRH services. This study was completed in 2016, dissemination and publication of results is ongoing.

Funder/Sponsor:	The European Union
Principal Investigator:	Prof J Smit (MatCH Research)
Site:	MatCH Research Commercial City Site and community in central Durban
Collaborators:	University of Ghent – International Centre for Reproductive Health (UG-ICRH), Belgium, Ashodaya Samithi (Ashodaya), India, International Centre for Reproductive Health Association, Kenya (ICRH-K), International Centre for Reproductive Health Association Mozambique (ICRH-M), Lifeline, Durban

Recreational Antiretroviral Use in South Africa

The qualitative study aimed to evaluate whoonga; the context of whoonga use, knowledge of ARV diversion for recreational use and unmet health need of whoonga users. Using purposive sampling, a subset of whoonga users was invited from the South African National Council on Alcoholism and Drug Dependence (SANCA) Lulama Treatment Centre Durban (N=30) and a subset of key informants knowledgeable about whoonga (N=10) participated in semi-structured interviews about whoonga. Whonga users aged 18 years and above, admitted voluntarily for inpatient substance use treatment at SANCA were included if able and willing to provide informed consent and speak English or isiZulu. Dissemination is ongoing and the results are currently being written up for publication.

Funder/Sponsor:	Funded by NIH though CFAR grant
Principal Investigator:	Prof J Smit
Site:	SANCA Lulama Treatment Centre
Collaborators:	Havard Medical School and Massachessetts General Hospital. SANCA Lulama Treatment Centre