Current Projects
Details of our projects can be accessed under these thematic areas.
Thematic area 1: Maternal, Family, Child Health, Nutrition (MFCHN)
A proof of concept feasibility study of an outreach mentorship approach for disseminating the updated 2016 WHO HIV and Infant feeding guidelines: 2018 |
PI: Prof. Ameena Goga, Prof Tanya Doherty and Dr Christiane Horwood Overview Aim Collaboration Project status Field work has been completed. Two papers have been published and one is in press. Contact person Publications:
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Thematic area 2: Adolescent and young adults' health and wellbeing
PREPARE Study: Promoting sexual and reproductive health among adolescents in southern and eastern Africa - mobilizing schools, parents and communities |
PI Aim Study methods Collaboration Project status Contact person |
Imbumba Study: Enhanced STI/HIV Partner Notification in South Africa |
PI Dr. Catherine Mathews and Dr. Sarah Dewing Aim Study methods Primary outcomes are 1) sexually transmitted infections and 2) partner notification. Secondary outcomes are 1) unprotected and protected sexual behaviours and 2) partner notification behaviours. Collaboration Project status Contact persons |
SMART Africa |
PI: Mary McKay Overview Aim Collaboration Project Status Contact person |
Safe South Africa: Integrated prevention of HIV risk and intimate partner violence among adolescents in South Africa |
PI: Catherine Mathews and Caroline Kuo Overview South Africa, a country with the largest HIV epidemic and some of the highest rates of IPV perpetration in the world. Few behavioral interventions integrate HIV-IPV prevention and are tailored for the unique age and developmental needs of adolescents. We utilized the insights of adolescent development theory in our school-based preventive intervention strategy by capitalizing on adolescents’ developmental propensities for maximum prevention gains. Adolescence presents an ideal age and developmental transition period for an integrated intervention targeting prevention of HIV behavioral risk reduction and perpetration of IPV including sexual violence. Developmental hallmarks of adolescence – including for example, the role of social norms in motivating behaviors, the importance of peers in shaping behavioral choices, and the desire for increased responsibility – were leveraged for prevention of sexual risk behavior driving acquisition of HIV infection and engagement in IPV. We used positive peer pressure and tapped into adolescents’ desire to be responsible future leaders to motivate adolescents to intervene as bystanders when their peers are involved in HIV risk behaviors or sexual assault and aggression. Aims
Collaboration Gender and Health Research Unit, SAMRC; Brown University, USA Project status Analysis and report-writing Contact person Catherine Mathews (catherine.mathews@mrc.ac.za) |
WAYA study: Wellbeing among adolescents and young adults living with and without HIV in SSA- measures, understandings and determinants |
PI: Darshini Govindasamy (this study forms the basis of her PhD) Co-investigators: Prof Catherine Mathews, Dr Giulia Ferrari, Prof Janet Seeley Background Aims Methods: Mixed-methods review. Publication: Govindasamy, D., Seeley, J., Olaru, I. D., et al. 2020. Informing the measurement of wellbeing among young people living with HIV in sub-Saharan Africa for policy evaluations: a mixed-methods systematic review. Health and quality of life outcomes. 18,1-34. doi:https://doi.org/10.1186/s12955-020-01352-w Aim 2 Methods: Qualitative research (“The Njabulo study”). Data collected via focus-group discussions and in-depth interviews with young people living with and without HIV (aged 15-24 yrs.) and key informant interviews with experts and healthcare workers. Publication: Govindasamy, D., Ferrari, G., Maruping, K., et al. 2020. A qualitative enquiry into the meaning and experiences of wellbeing among young people living with and without HIV in KwaZulu-Natal, South Africa. Social Science & Medicine. 248,113103. doi:https://doi.org/10.1016/j.socscimed.2020.113103 Aim 3 Methods: Construction of a panel dataset using data from the National Income Dynamics study (NIDS) and HIV data from the National Health Laboratory Services. Application of econometric techniques - multi-level modelling Manuscripts in preparation for submission
Collaboration Project Status Contact person Funder: Bongani Mayosi National Health PhD Scholarship, National Research Foundation (NRF) Thuthuka grant, SAMRC Intramural MRC award |
Yomelela Study |
PIs: Dr Catherine Mathews; Prof Seth Kalichman Overview Overall aim We will conduct a 3-arm randomised controlled trial in to compare: (a) Behavioral Self-Regulation + Stigma Management Counseling for HIV treatment retention and adherence, vs. (b) Behavioral Self-Regulation Counseling for HIV treatment retention and adherence, vs. (c) Uniform standard of care HIV patient education. We will enrol 1250 men and women with unsuppressed HIV and receiving HIV treatment and follow them for 15-months post-intervention to assess effects on HIV care retention and HIV suppression (primary outcomes) and ART adherence (secondary outcome). Collaboration Project status Contact person |
HERStory Study: Impact Evaluation of a combination HIV Prevention Intervention for Adolescent Girls and Young Women (AGYW) in Ten South African Districts |
PI: Dr Catherine Mathews Overview From 2016 to the present day, the Global Fund to Fight AIDS, TB and Malaria has invested in a combination HIV prevention intervention for adolescent girls and young women in South Africa (AGYW), with the aim of reducing HIV incidence, teenage pregnancy, gender-based violence, and increasing retention in school and access to economic opportunities. The intervention is being implemented in several districts with high HIV burden by a range of South African organisations, with the support of the South African National AIDS Council. It is aligned with the She Conquers campaign, and the South African National Strategic Plan for HIV, STI’s and TB (2017-2022). Combination HIV prevention interventions merge effective biomedical, behavioural and structural interventions for combined delivery. They are one of the key strategies for reaching the UNAIDS 90-90-90 targets and achieving the Sustainable Development Goal (SDG) of ending the HIV epidemic by 2030. The HERStory Study is an evaluation of the combination HIV prevention intervention for AGYW, conducted by the South African Medical Research Council (SAMRC) and partners. Aims The aim of the evaluation is to determine the impact of the Global-Funded AGYW intervention on HIV incidence among AGYW aged 15 to 24 years living in the intervention districts. The study also evaluates the impact of the intervention on the cognitions, behaviours and social environments of AGYW. Collaboration
Project status First survey of two consecutive representative household surveys has been completed and published. Second phase of research is in the planning phase. Contact person Dr. Catherine Mathews (Catherine.Mathews@mrc.ac.za) Tracy McClinton Appollis (tmappollis@mrc.ac.za) https://www.samrc.ac.za/intramural-research-units/HealthSystems-HERStory |
HERStory 2 Study: Process evaluation of the combination HIV prevention intervention for adolescent girls and young women (AGYW), Global Fund grant period 2019 to 2022 |
PIs: Dr Catherine Mathews, Dr Kim Jonas, and Dr Zoe Duby Overview From 2016 to the present day, the Global Fund to Fight AIDS, TB and Malaria has invested in a combination HIV prevention intervention for adolescent girls and young women in South Africa (AGYW), with the aim of reducing HIV incidence, teenage pregnancy, and gender-based violence and increasing retention in school and access to economic opportunities. Combination HIV prevention interventions, which merge effective biomedical, behavioural and structural interventions for combined delivery, are one of the key strategies for reaching the UNAIDS 90-90-90 targets and achieving the Sustainable Development Goal (SDG) of ending the HIV epidemic by 2030. Scientists in the Health Systems Research Unit have been requested to conduct a process evaluation of the AGYW combination intervention being implemented during the 2019 to 2022 Global Fund grant period. Aims To investigate:
Collaboration
Project status Protocol development Contact person Dr. Catherine Mathews (Catherine.Mathews@mrc.ac.za) Dr Kim Jonas (Kim.Jonas@mrc.ac.za) https://www.samrc.ac.za/intramural-research-units/HealthSystems-HERStory |
Imagine Evaluation |
PIs: Dr Fareed Abdullah, Dr Catherine Mathews, and Dr Zoe Duby Overview Adolescent girls and young women (AGYW) in South Africa face multiple challenges that significantly limit their prospects of health and wellbeing later in life. A myriad of social, structural but also behavioural challenges are driving high rates of HIV infections and unintended pregnancies among young women while simultaneously hindering the uptake and adherence to available prevention, treatment and care. The South African Medical Research Council’s (SAMRC) Office of AIDS and TB Research (OATB Research) has proposed a novel intervention, the Imagine Programme, to improve HIV and pregnancy related outcomes for school-going adolescent girls and young women (AGYW). The programme will focus on grade 8 to 12 female learners in 14 schools in the Moretele sub-district of the North West Province and the Newcastle sub-district of Kwa Zulu Natal over a 2,5-year period commencing in the second half of 2021. The comprehensive package of services identifies both services and enablers “wrapped around” the life of the school-going young woman. These services can roughly be categorised as clinical sexual and reproductive health (SRH) services, psycho-social support services and social structural services. Services and products will be delivered through Imagine Programme School teams, Mobile Clinic teams and Community teams at either the school or at a government facility in the sub-district or at a partner’s community facility. Scientists in the Office of AIDS and TB Research and the Health Systems Research Unit will evaluate the Imagine Programme. Aims The aims of the evaluation include:
Collaboration
Project status Pilot study and preintervention formative research underway Contact person Dr. Catherine Mathews (Catherine.Mathews@mrc.ac.za) Dr Kim Jonas (Kim.Jonas@mrc.ac.za) Website: https://www.samrc.ac.za/intramural-research-units/HealthSystems-imagine-evaluation |
Thematic area 3: Communicable and Non-Communicable Diseases
What are the maternal treatment outcomes, pregnancy outcomes and infant outcomes in women treated for DR-TB during pregnancy. |
PI: Dr. Marian Loveday Aim Study methods Status Collaboration
Study outcomes
Nested study within the DR-TB during pregnancy study: PI: Dr. Marian Loveday Aim Study methods Status Collaboration Prof Gary Maartens, Prof Helen Mclleron, Dr Richard Court: UCT Second nested study within the DR-TB during pregnancy study: PI: Dr. Marian Loveday Aim To explore whether microbiomes of mothers (airways, breastmilk, vagina, gut) and babies (gut) are potentially affected by treatment, and if so, are any microbiome changes associated with infant outcomes and drug exposure? Study methods All recruited participants who have not yet delivered will be screened for eligibility into the microbiome study. Vaginal, gut, breastmilk and sputum samples will be collected from the mother in the 3rd trimester and 6 weeks, 6 months and 12 months after delivery. Microbiome estimates in each specimen type will be correlated with PK data and clinical outcomes (in mothers and babies). Status This study amendment is awaiting ethics approval. |
Survival and TB recurrence after successful drug-susceptible- and rifampicin-resistant TB treatment |
PI: Dr. Marian Loveday Aim Study methods Status Collaboration |
Exploring opportunities and models for improved integration and health service delivery at a community and primary health care level in eThekweni metro, KwaZulu-Natal, South Africa |
PI: Dr. Marian Loveday Aims
The aims of the evaluation component:
Study methods Status Collaboration |
Task sharing mental health services within chronic care in South Africa (MHiNT) |
PI: Deepa Rao; Inge Petersen Overview Aim Collaboration Project Status Funder Contact person |
Southern African Research Consortium for Mental Health INTgration (S-MHiNT) |
PIs: Arvin Bhana, Inge Petersen, Deepa Rao Co-Investigators Overview Aim Aim 1. To establish and engage a trans-disciplinary research consortium of academics, government representatives and non-governmental organizations in South Africa, Mozambique and Tanzania to address the burden of common mental disorders in primary health care settings. Aim 2. To examine multi-level influences on the uptake, implementation, effectiveness and sustainability of an existing scale-up of an integrated mental health package for chronic disorders at primary health care level in two different districts in South Africa which have different resource capacities. Aim 3. To build implementation science and dissemination research (ISDR) capacity in South Africa, Mozambique and Tanzania, recruiting service providers, managers and policy makers as trainees, providing real-world opportunities, mentorship and necessary knowledge to conduct optimal scale-up of evidence-based integrated mental health care. Collaboration Project Status Contact person |
SMS-TEXT Adherence Support (STAR): A multi-stage process evaluation of a mobile-phone intervention to enhance adherence to diabetes treatment and care in Lilongwe, Malawi, Cape Town and Johannesburg |
PI Dr. Natalie Leon Aim Study methods Collaboration Project status Contact person |
The Cape Town iALARM Project: Using routine health information to align services and link and retain men in the HIV cascade |
In South Africa, men are less likely than women to be tested for HIV and to access HIV prevention, treatment and care. This is due to a complex set of social and health systems factors. The iALARM study, headed by Dr Chris Colvin from UCT and Dr Mark Lurie from Brown University, USA, is a 5-year NIH-funded, mixed method collaboration with co-investigators from a number of institutions, including Dr Natalie Leon from the Health Systems Research Unit at the SAMRC. The study attempts to address this problem pf poor linkage to care through two aims, to 1) understand the cultural, social and psychological factors that make it difficult for men to get HIV services and stay in care, and 2) help healthcare workers and managers from NGOs, city and provincial facilities work together to better support men in HIV care. iALARM aims to achieve this through a routine health information system intervention that will allow for better coordination between partners in the area working with HIV positive men. The intervention will integrate routine facility-level data with local-level cohort data of men moving through the HIV cascade in our study site. We use this information to better align services to link and retain men in HIV |
Thematic area 4: Social and Economic Policy and Health
The Health Economics section of the Health System Research Unit frames its work within a Universal Health Coverage and ultimately National Health Insurance perspective. It thus focuses on the following areas: human resources planning, development of investment cases, costing and economic evaluation of existing services, private sector research, and more recently applying this work to COVID19 response.
Study 1: A birth cohort assessing the utilisation of the CSG and its link to dietary diversity, and child growth |
PI: Dr Wanga Zembe, Dr Vundli Ramokolo, Prof Tanya Doherty, Prof David Sanders, Prof Rina Swart The birth cohort commenced in March 2016. Fieldwork is in progress with the aim to recruit and follow up 500 mothers and their children. Collaboration: The Centre of Excellence for Food Security, and UWC School of Public Health, Contact person |
Study 2: Social protection, youth economic empowerment and social support for adolescent girls and young women at risk of poor health and wellbeing |
PI: Dr Wanga Zembe Co-Investigators: Lieve Vanleeuw; Yanga Zembe A two-year mixed-methods research project that aims to assess (i) the levels of social support, economic empowerment and social protection available to adolescent girls and young women (AGYW), and (ii) the impact thereof on health and wellbeing of AGYW. The main outcomes of the project are:
Project status: The rapid review has been completed and a progress report for year 1 has been submitted to funders. The qualitative component of the project was carried out in 2019, as well as secondary analysis of data and engagement with stakeholders. Further analysis of data and writing up of reports and publications from the work have commenced. Contact person Wanga Zembe (wanga.zembe@mrc.ac.za) |
Study 3: Exploring the experiences of CSG recipients and non-recipients regarding coping, access to social protection, food security, income security, and safety in the time of Covid-19 |
PI: Dr Wanga Zembe-Mkabile, Dr Vundli Ramokolo, Prof Tanya Doherty Overview Study Aim To explore the experiences of Covid-19 among recipients and non-recipients of the CSG in Langa Township, Western Cape For this qualitative study we are conducting twenty telephonic qualitative interviews over two time points with participants (mother-child pairs) that we have been following up for two years in a longitudinal cohort study assessing the impact of the CSG on child nutritional status and food security. For this additional piece of research we are exploring participants’ experiences of accessing social grants in the time of Covid-19; their experiences of securing food for their children and households, experiences of restrictions to movement, loss of earnings due to not working and social distancing while living in informal settlements and or small housing structures with small or no yard space; experiences with safety; perspectives and concerns they might have for themselves and their children and families at this time; and what they see as the role of social grants and the CSG in particular in providing support to impoverished and vulnerable households and communities in the time of Covid-19. The study will provide learnings and lessons on how poor households reliant on small social grants cope during pandemics such as Covid-19 and the ways in which the social security system in South Africa can better respond to and support children and families from poor households. Collaboration Project status Contact person |
Study 4: Patient experiences of the burden of TB in the context of syndemic interaction and social protection, in Cape Town South Africa |
PIs: Lieve Vanleeuw, Wanga Zembe Overview TB remains a major health problem and the number one cause of death in South Africa. While TB is closely associated with poverty, it can also push households into worsening impoverishment through costs associated with the disease such as the cost of food and travel and the loss of income. In addition, household contacts of TB patients have an increased risk of developing TB. Transmission of TB can infect multiple members of the household which in turn can aggravate the social and economic burden of TB and diminish household resilience over time. TB patients frequently also suffer from chronic conditions like HIV and diabetes. The coordination of health and social services for each of these conditions can put an extra burden on the patient. The co-occurrence of TB and chronic conditions, in the context of a broader set of socio-economic factors such as household vulnerability to multiple and recurring transmission of TB, fragmented social and healthcare services, and poverty can have a syndemic effect on the burden of TB for patients. Aim The study aims to explore patient experiences of the multiplicative burden of TB caused by the co-occurrence of TB and chronic conditions such as HIV and diabetes, in the context of a broad set of socio-economic factors such as household vulnerability to multiple and recurring transmission of TB, poverty, overcrowding, stigma, and fragmented social and healthcare services. It furthermore aims to explore patient experiences of existing interventions like contact screening, integration of services and the disability grant that can potentially alleviate the syndemic burden of TB in the Western Cape, South Africa. Project status Semi-structured interviews have been conducted with TB patients and healthcare workers at 2 clinics and officials from the South African Social Security Agency (SASSA) in Cape Town. Collected data is currently being analysed and written up for publication. Collaboration Tampere University Finland Tampere TB Foundation Finland Contact person Lieve Vanleeuw: Lieve.vanLeeuw@mrc.ac.za |
Study 5: Patient experiences of the burden of TB before and during the COVID-19 crisis |
PIs: Lieve Vanleeuw, Wanga Zembe Overview Amid the COVID-19 crisis TB patients face increased vulnerability due to the consequences of the COVID-19 response such as loss of income, challenges to access healthcare services and anti-TB medication, increased stigma, and a loss of social support structures. Many of them are already poor, and many depend on informal work or have lost their jobs. The COVID-19 social and economic response in South Africa, however, might also offer some alleviation to TB patients’ burden by accessing the Covid-19 Social Relief of Distress Grant (SRDG) designed for unemployed working age adults who are destitute because of the virus. Our study will explore how the COVID-19 epidemic and response have affected the social, economic, and health situation of TB patients, as well as how COVID-19 measures to alleviate the social and economic effects of the COVID-19 epidemic and response such as the Social Relief of Distress Grant have affected TB patients’ vulnerability. Aims
Collaboration Tampere University Finland Tampere TB Foundation Finland Project status Protocol approved by the SAMRC Ethics Committee. Interviews to start in October 2020. Contact person Lieve Vanleeuw: Lieve.vanLeeuw@mrc.ac.za |
Study 6: Exploring the links between food and nutrition messaging, local food knowledge systems and food experiences and eating practices in Langa |
PI: Prof Yanga Zembe, Co-PI: Dr Wanga Zembe Aim: To explore the engagement of poor people with public health policies, interventions and food knowledge systems, including social media, and how these shape their food experiences and eating practices in Langa Township, Cape Town Objectives
Methods: For this qualitative study 20 telephonic qualitative interviews will be conducted with participants (primary caregivers) and five with spaza shop owners from a cohort of mother-child pairs that we have been following up for two years in a longitudinal cohort study assessing the impact of the CSG on child nutritional status and food security Collaborators: CoE for Food Security Project status: Awaiting ethical approval; data collection soon to commence. Contact person: yanga.zembe@gmail.com |
Human Resource planning
Planning PHC human resources needs for 2025 and 2030 |
PIs: Emmanuelle Daviaud and Donela Besada Aim: To develop an incremental needs-based model to estimate PHC HR needs (skill mix and quantity) for 2025 and 2030. Study methods: Assessment of needs for PHC services based on population structure, burden of disease and NDoH target coverages. Skill mix: Allocation of types of visits based on scope of practice. Staff needs calculated for the country and by 100,000 population. Includes community-based services (WBOTs), clinics, CHCs, school health and environmental health. Collaboration: Member of the Ministerial Task Team Workstream 1 Project status: Completed. Model results included in the HR Strategic Plan for 2025 Contact person: Emmanuelle Daviaud (Emmanuelle.Daviaud@mrc.ac.za) |
Time Analysis to Improve Workforce Planning for HIV Services |
PI: Emmanuelle Daviaud Co-PI: Donnela Besada Aim Methods The analysis will use a mixed-method approach combining an observational time and motion time study (using a random work sampling approach) with self-administered time-based diaries (time analysis). Collaboration Project status Emmanuelle Daviaud: edaviaud@mrc.ac.za |
Investment Cases
Development of an Investment Case for Mental Health in South Africa |
PI: Professor Crick Lund Co-PI: Donela Besada (SAMRC) and Sumaiyah Docrat (UCT) Aim Study methods Collaboration Project status Donela Besada (Donnela.Besada@mrc.ac.za) |
Costing and Economic Evaluation of Existing Services
Mobile messaging support to control type 2 diabetes (StAR2D): a multicentre randomized controlled trial |
PI: Prof. Andrew Falmer (Oxford University) Co-PIs: N. Levitt, MN Nyirenda Co-Investigators: KB. Bobrow, N. Leon, E. Daviaud, D. Besada Aim: The overall aim of this project is to test the effectiveness of sending short message service (SMS) texts in improving health outcomes and supporting medication adherence in patients with type 2 diabetes in the context of implementing a low-cost, mobile-health communication infrastructure in an operational setting . The cost analysis aims to assess the affordability of such intervention for the provider. Analysing patients’ costs seeks to identify whether these can constitute a barrier to adherence. Methods: The cost analysis focussed on both providers and patients’ costs in a PHC site in Cape Town (SA) and an outpatient site in Lilongwe (Malawi). Actual costing, as different from protocol based modelling, was carried out to obtain per site the routine cost per patient per treatment year and cost of the messaging intervention if scaled-up to country level. Patient costs focused on transport costs and time in facility. E daviaud and D Besada were responsible for the economic component of the study Collaboration: University of Cape Town, Malawi College of Medicine, South African Medical Research Council, University of Oxford Project status: Project completed. Publications: Publication on cost analysis in process Contact person: Emmanuelle Daviaud (Edaviaud@mrc.ac.za) |
Thematic area 5: Knowledge synthesis for strengthening health systems
Assessing the effects of interventions to improve Health Information Systems (HIS): A systematic Review |
PI Dr. Natalie Leon Aim Study methods Collaboration Project status Contact person |
South African Initiative for Systematic Reviews on Health Policies and Systems (SAI) |
PI Dr Simon Lewin and Dr. Natalie Leon Aim Collaboration Project status Contact person |
Healthcare workers' perceptions and experience of primary healthcare integration: a qualitative evidence synthesis |
PI Ms Hlengiwe Moloi and Dr Natalie Leon AIM We aim to explore healthcare workers' perceptions and experience of Primary health care (PHC) integration interventions. This can help us understand the influence healthcare workers have on the implementation of PHC integration, and the possible impacts this may have on the success or otherwise of PHC integration. PHC integration has been promoted as a health sector reform tool to promote Universal Health Care, especially in low-resource settings, but the uptake and implementation has been uneven, and the evidence of success remains elusive. Thus, our study will contribute to the knowledge base. Study methods Collaboration Project status Ms Hlengiwe Moloi (hlengiwe.moloi@mrc.ac.za) |