The HIV epidemic and the COVID-19 pandemic: A double tragedy for sub-Saharan African women.

After four decades of the HIV epidemic, women from sub-Saharan Africa remain at a differentially high risk of acquisition. The Joint United Nations Programme on HIV and AIDS (UNAIDS) statistics show that the majority of HIV infections occur in this population and region. Evidence from previous humanitarian crises demonstrated adverse maternal consequences as a result of neglect for the provision of essential maternal, sexual and reproductive health services. The ongoing COVID-19 pandemic has had a similar effect, including an additional risk of HIV acquisition amongst women in sub-Saharan Africa. The COVID-19 pandemic has aggravated the risk of sub-Saharan Africa women to HIV infection because of a multitude of factors including child marriages, teenage pregnancies, dropping out of school, increase in incidence of sexual and gender-based violence and reduced access to preventive and treatment services for HIV and sexually transmitted infections. These include provision of care for rape and sexual and gender-based violence victims and provision of pre-exposure and postexposure prophylaxis for HIV and other STIs. Failure to urgently restore and maintain robust HIV prevention and treatment during the ongoing COVID-19 pandemic poses a risk of reversing the gains made over the years in reducing the incidence and morbidity from HIV amongst the population of sub-Saharan Africa women. There is need for an urgent and robust discourse to formulate effective interventions for protecting women and girls living in sub-Saharan Africa from an aggravated risk of HIV infection during the ongoing COVID-19 pandemic and other future humanitarian crises.

Patient-centred care: reality or rhetoric-patients' experiences at ARV clinics located in public hospitals in KwaZulu-Natal, South Africa.

BACKGROUND: The South African public antiretroviral therapy (ART) programme is considered one of the largest and most successful ART programmes worldwide. Hence, a study exploring the patients' experiences of the public antiretroviral therapy (ART) programme in the second decade of the programme is relevant as no study has been published on patients' experiences at these sites. OBJECTIVES: To explore patients' experiences of care in the public ART programme at four ARV clinics within the eThekwini District, KwaZulu-Natal. METHOD: A mixed-methods study design with 12 in-depth patient interviews, non-participatory observation, and a stratified random sample of 400 patients completed questionnaires. Qualitative data were thematically analysed. Quantitative data were analysed using a SPSS 24 package to determine frequencies and differences in patients' responses (p < 0.05). The socio-ecological model framed the study. RESULTS: All 412 patients reported valuing the provision of free ARVs. Patients' positive experiences included: routine blood results mostly being available, most staff greeted patients, there were sufficient nurses, patients were satisfied with the time that they spent with doctors, clean clinics, and private and safe counselling areas. The negative experiences included: poor relationships with nurses, negative staff attitudes, disrespectful staff, information was lacking, inadequate counselling at times, varying and inflexible appointments, challenges with data capture and registration systems; varying ARV collection frequencies, routine health tests and processes per site, and the absence of patient committees and representatives. CONCLUSION: The results reflected positive and negative experiences which varied between the facilities, as processes and systems differed at each site. Innovative patient-centred processes and programmes could be implemented to ensure patients have mostly positive experiences. As part of continuous improvement, patients' experiences should be regularly explored to ensure that the ART programme meets their needs and expectations.

Mapping Evidence of Self-Sampling to Diagnose Sexually Transmitted Infections in Women: A Scoping Review.

BACKGROUND: Sexually transmitted infections (STIs) are a major global healthcare burden, disproportionately affecting women. Self-sampling interventions for diagnostic purposes have the potential to improve STI healthcare management and expand STI services. However, there is currently no published evidence of the global use of self-sampling interventions to diagnose STIs in women. The main aim of this scoping review was to map evidence on the use of self-sampling interventions to diagnose STIs in women. METHODOLOGY: The methodology of this scoping review was guided by Arksey and O'Malley and Levac. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Medline (EBSCO), ProQuest, and Cochrane. For grey literature, a search was conducted in Open Grey, World Health Organization, Google, and conference proceedings and dissertations. All search results were screened and assessed for eligibility. Thereafter data from eligible studies was extracted and analysed. The quality of these studies was appraised using the Mixed Methods Appraisal Tool 2018 version. RESULTS: A total of 770 articles were retrieved from databases and grey literature sources. A total of 44 studies were eligible for data extraction following title, abstract and full-text screening. Of the included studies, 63% presented evidence of research conducted in high-income countries and 37% presented evidence in low- and middle-income countries. Studies presented evidence on the following: feasibility of self-sampling in remote areas; acceptance and ease of use of self-sampling interventions; types of self-sampled specimens; pooled samples for diagnosing STIs; laboratory diagnostic assays for STI using self-sampled specimens; and self-testing of self-sampled specimens. CONCLUSIONS: Self-sampling interventions are feasible and easy to use and, therefore, can improve STI management and treatment in women across various age groups and various access levels to good-quality healthcare. Despite this, there is a lack of evidence of self-sampling interventions designed according to user preferences. We recommend studies to collaborate with women to co-develop user-friendly self-sampling interventions to diagnose STIs in women.

Mapping evidence of depression in HIV-seropositive MSM in sub-Saharan Africa: a scoping review protocol.

BACKGROUND: Depression is one of the most prevalent mental disorders among an estimated 25.6 million people living with HIV (PLHIV) in sub-Saharan Africa (SSA). The depression rate is higher in HIV-seropositive men who have sex with men (MSM) regardless of their sexual orientation, identity or romantic attraction. This is due to various types of stigma including HIV-related stigma, social stigma, self-stigma and mental health stigma. Opportunistic infections, unemployment, poverty and food insecurity also predispose HIV-seropositive MSM to depression. Moreover, depression in heterosexual and sexual minority groups challenges and additionally burdens SSA health care systems due to inadequate economic developments, lack of mental health professionals who specialise in the treatment of depression, few MSM-centred facilities, inadequate mental health infrastructure (hospitals and clinics) and complimentary resources. Although studies have highlighted links between mental health disorder, an HIV diagnosis and sexual minority groups, there is limited research that focusses on depression and its causal factors in MSM living with HIV in SSA. Hence, the relevance of conducting this scoping review. METHODS: A scoping review guided by Arksey and O'Malley's framework, the enhancements and recommendations of Levac, Colquhoun and O'Brien, Daudt and associates and the 2015 Johanna Briggs Institute's guidelines will be conducted. Systematic electronic searches of databases and search engines such as Google, Google Scholar, CINAHL (EBSCOhost), MEDLINE (Ovid), and PsycInfo (Ovid) will be conducted to attain published peer-reviewed articles of all study designs. Grey literature will be sourced from media and conference abstracts and reports, governmental reports and unpublished dissertations and theses. Additionally, websites of humanitarian organisations and other relevant departmental websites will also be searched. Literature published between 2010 and 2020 that meets the review's inclusion criteria, research question and sub-question will be included in this review. All the retrieved literature will be exported to an Endnote X9.2 library after duplicates have been removed. DISCUSSION: We anticipate mapping relevant literature on depression and the causal factors in HIV-seropositive MSM living in SSA. Once analysed and summarised, the data will be useful in identifying literature gaps, informing systematic reviews and future research. The findings could also assist in depression and sexuality dialogues, and awareness campaigns that address mental health issues, stigma and discrimination among this key population living in SSA.

Mapping evidence of young people's experiences of sexual aggression in the United Kingdom: A systematic scoping review protocol.

BACKGROUND: According to the UK's Office for National Statistics, England and Wales reported a 2.9% increase in sexual aggression cases (3.4 million females and 631,000 males) between 2009 and 2019. In Scotland, sexual aggression cases increased by 66%, with 40% of these sexual violations being perpetrated on individuals under the age of 18 years, while incidents relating to sexual misconduct in Northern Ireland increased by 21.0%, with only 41.2% of those cases being prosecuted. Acts of sexual aggression can have physical, emotional and mental consequences which predispose young people to subsequent short- and long-term mental and social disorders and comorbidities. Such consequences include feelings of guilt, shame, anger, experiencing post-traumatic stress disorders, antisocial behaviour, alcohol and drug misuse and dependency, confusion surrounding sexuality and sexually transmitted illnesses including the human immuno-deficiency virus. However, despite the societal, health, economic and educational implications for young people in the UK and increasing statistics, few studies address this scourge. Hence, the objective is to systematically map evidence of young people's experiences of sexual aggression in the UK and identify literature gaps that could inform future research. METHODS: The included literature for this scoping review is published peer-reviewed articles of all research designs; grey literature including governmental reports, policy statements, conference and media reports; and unpublished theses. Electronic searches of databases and search engines such as Embase, Google, Google Scholar, EBSCOhost, CINAHL, PubMed, Education Resources Information Centre (ERIC), PsycInfo, World Health Organization (WHO), media organizations, governmental and education departments and higher learning websites for published literature. Additional searches will include screening citations in reference lists of articles and perusing "Cited by" logs. All retrieved literature will be exported to an Endnote X9.2 library. Duplicate documents will be deleted prior to title screening commencing. An adapted Mixed Method Appraisal Tool (MMAT) will be independently used by two reviewers to ensure a rigorous study and quality assessment of all included studies. DISCUSSION: This scoping review employs a mixed-method approach to map and select relevant literature and summarize and report on young people's experiences of sexual aggression in the UK. Once the data is summarized, it could inform planning and policy pertaining to a safe and effective sexual health curriculum for all young people, assist with the development of effective strategies to reduce sexual aggression and guide future research.

School-going transgender youths' experiences at health care facilities: a systematic scoping review protocol.

BACKGROUND: Globally, miniscule improvements have been implemented regarding equality, inclusion, access, and protection of people with diverse gender identities whilst accessing health care facilities of which transgender youth form part. Literature has highlighted that the care transgender youth receive at health care facilities can result in positive or negative outcomes. School-going transgender youth constitute a unique group whose experiences at health care facilities warrant ongoing research. Hence, the objective of this scoping review is to systematically map evidence of school-going transgender youths' experiences at health care facilities regarding service delivery, support, and policies and to identify literature gaps that could inform future research. METHODS: We will conduct a scoping review, using peer-reviewed journal articles that present literature on school-going transgender youths' experiences at health care facilities. Searches for relevant articles will be conducted on the following databases: PubMed, Cochrane Library, Campbell collaboration, Scopus, Embase, and MEDLINE. Additional searches will be conducted on institutional websites or web-based search portals. Two reviewers will independently extract data from all relevant search engines incorporating the study objective, research questions, and eligibility criteria. The inclusion criteria include published full-text qualitative, quantitative, and mixed-method studies that address the topic with no language and publication year limitations to reflect a comprehensive range of literature that includes the implementation of the SDGs. All literature that does not meet the inclusion criteria will be excluded. The quality of included studies will be appraised using the mixed methods appraisal tool (MMAT) - version 2018. DISCUSSION: We anticipate mapping the experiences of school-going transgender youth at health care facilities. Once summarized, the data could be useful to clinical educators, health workers, policy makers, and guide future research to ensure that the human and patients' rights of transgender youth, are globally acknowledged, protected, and respected within health care facilities.

Mapping evidence on malnutrition screening tools for children under 5 years in sub-Saharan Africa: a scoping review protocol.

BACKGROUND: In sub-Saharan Africa (SSA), malnutrition remains a major public health challenge, particularly among children under 5 years of age. Despite nutritional screening tools being developed and available to detect early malnutrition in under five-year-old children, malnutrition continues to be a health concern. However, the level of evidence on nutritional screening tools for predicting early malnutrition at the community level in a high disease burden setting is unclear. The objective of this scoping review is to systematically map the evidence on malnutrition screening tools for children under 5 years in sub-Saharan Africa (SSA) and to identify knowledge gaps. METHODS: The proposed study will be guided by an improved Arksey and O'Malley's framework, Levac et al. 2010 recommendations, and the 2015 Joanna Briggs Institute guidelines. We will conduct a systematic search of relevant imperial sources of evidence from the following databases: CINAHL with full text, Academic search complete via EBSCOhost, Google Scholar, Science Direct, and PubMed. We will search for grey literature from the following humanitarian and aid organization websites: World Health Organization (WHO), The United Nations International Children's Emergency Fund (UNICEF), and governmental departments. Following the database searches and title screening, eligible sources of evidence will be exported to an EndNote X9 reference library. Thereafter, duplicate articles will be removed in preparation for abstract and full article screenings. Data from the included sources of evidence will be extracted, and the emerging themes will be analyzed. The relationship between the emerging themes and the research questions will be critically examined. The quality of the included sources of evidence will be determined by using the Mixed Method Appraisal Tool (MMAT) version 2018. The search results will be presented in adapted Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews chart (PRISMA-ScR). DISCUSSION: We anticipate finding relevant literature on malnutrition screening tools for children under 5 years in SSA. This study is likely to reveal research gaps, which could guide future research on malnutrition screening tools.

Does the public antiretroviral treatment programme meet patients' needs? A study at four hospitals in eThekwini, KwaZulu-Natal, South Africa.

BACKGROUND:  Patients play a major role in the success of any antiretroviral treatment (ART) programme. Hence, their needs should be articulated on a regular basis for interventional processes to promote adherence, retention and quality care. AIM:  This study investigated whether patients' needs were being met, described which needs were met, which were not and how such needs could be met. SETTING:  The study took place at four ART clinics in eThekwini district public hospitals. METHODS:  This study formed part of a larger study that utilised a sequential mixed-methods design. However, only the qualitative component is documented herein. Twelve HIV-infected patients engaged in in-depth interviews (three patients from each of the four hospitals). A socio-ecological framework divided responses into four categories, namely, the individual, interpersonal, institutional and policy. Each category presented (1) patients' needs that are being met, (2) needs that are not being met, (3) recommendations on how they can be met and (4) researchers' observations. RESULTS:  All 12 patients reported that all their needs were not being met. They further shared their met needs, unmet needs and made recommendations for meeting their unmet needs. These needs varied per antiretroviral clinic because of unique processes at each institution. CONCLUSION:  To adequately address the needs of HIV-infected patients, it is imperative for all stakeholders involved in the public ART programme to gain an understanding of what constitutes 'patients' needs'. The results reflect patients' willingness to be involved in their care, treatment and interventional strategies to adequately meet their needs.

Does the public antiretroviral treatment programme meet patients' needs? A study at four hospitals in eThekwini, KwaZulu-Natal, South Africa

Background: Patients play a major role in the success of any antiretroviral treatment (ART) programme. Hence, their needs should be articulated on a regular basis for interventional processes to promote adherence, retention and quality care.Aim: This study investigated whether patients' needs were being met, described which needs were met, which were not and how such needs could be met.Setting: The study took place at four ART clinics in eThekwini district public hospitals.Methods: This study formed part of a larger study that utilised a sequential mixed-methods design. However, only the qualitative component is documented herein. Twelve HIV-infected patients engaged in in-depth interviews (three patients from each of the four hospitals). A socio-ecological framework divided responses into four categories, namely, the individual, interpersonal, institutional and policy. Each category presented (1) patients' needs that are being met, (2) needs that are not being met, (3) recommendations on how they can be met and (4) researchers' observations.Results: All 12 patients reported that all their needs were not being met. They further shared their met needs, unmet needs and made recommendations for meeting their unmet needs. These needs varied per antiretroviral clinic because of unique processes at each institution.Conclusion: To adequately address the needs of HIV-infected patients, it is imperative for all stakeholders involved in the public ART programme to gain an understanding of what constitutes 'patients' needs'. The results reflect patients' willingness to be involved in their care, treatment and interventional strategies to adequately meet their needs

Patients' recommendations for a patient-centred public antiretroviral therapy programme in eThekwini, KwaZulu-Natal.

BACKGROUND: The South African antiretroviral therapy (ART) programme, which is in its second decade of existence, includes many successes and challenges. This study provides patients' recommendations to address the challenges they currently experience at four antiretroviral (ARV) clinics based in urban public hospitals in order to provide a patient-centred service. OBJECTIVES: To use patients' recommendations to develop intervention strategies to improve patients' experiences of the public ART programme. METHOD: A three-stage, sequential, mixed-method study was implemented. Stage 1 recruited five patients from the four sites to formulate and test a structured questionnaire prior to data collection. Stage 2 recruited a stratified random sample of 400 patients (100 from each hospital) to complete the administered structured questionnaire. Stage 3 purposively selected 12 patients (three from each of the four sites) to participate in in-depth audio-recorded interviews using an interview schedule. RESULTS: The 412 patients prioritised six recommendations, which are as follows: waiting areas should be enclosed to protect patients from the elements (rain, sun, lightening, wind and cold); patients should not have to return their files to the main hospital or ARV clinic themselves; stable patients should collect their ARV drugs every three months; pharmacy opening and closing times should be revised to suit patients' needs; HIV-positive patient representatives should be elected at each ARV clinic to address patients' concerns and/or challenges to ensure that the programme could be more patient-centred and ARV clinic operating times should be extended to open later during weekdays and over weekends. CONCLUSION: Patients living with HIV have a valuable contribution to make in assessing service delivery and making recommendations to create a patient-centred healthcare environment, which will feasibly increase their adherence to ART.