Barriers to contraceptive use in humanitarian settings: Experiences of South Sudanese refugee women living in Adjumani district, Uganda; an exploratory qualitative study.

INTRODUCTION: Contraceptive use can be lifesaving, empowering and cost-effective for women and girls. Access to contraception is still challenging to female refugees due to several barriers including language, low educational level, lack of information, influence by family members, limited income, cultural and religious norms. This study explored barriers to contraceptive use among South Sudanese refugee women living in Adjumani district, Uganda. METHODS: An exploratory study design using qualitative methods were employed involving women of reproductive age (15-49 years). Purposive sampling was used to select participants for Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) from three settlements in Adjumani district. We conducted four FGDs, each consisting of 8 participants. We also conducted fourteen in-depth interviews (IDIs) with women of reproductive age. The IDI and FGD guides were translated into local languages before they were used to collect data. The interviews were recorded, transcribed verbatim and translated into English. Audio recordings were labeled before being translated back to English. Deductive, team-based coding was implemented, and a codebook developed. Transcripts were entered, and data coded using Atlas ti version 14. Data were analyzed using content analysis to produce the final outputs for the study. RESULTS: The study found several challenges to contraceptive use. These included gender dynamics, socially constructed myths on contraceptive use, cultural norms, limited knowledge about contraceptives, men's negative attitudes, antagonism of contraceptive use by leaders and reprisal of women who use contraception. CONCLUSION: The study concluded that there is need for community strategies to break down the barriers to contraception utilization among refugee women. Such strategies should involve men and women alongside gatekeepers to enhance sustainability.

Investigation of the prevalence and factors influencing tobacco and alcohol use among adolescents in Nigeria: A systematic literature review.

The increase in tobacco and alcohol prevalence among Nigerian teenagers necessitates the need to understand the factors influencing use. The aim of this systematic literature review was to synthesis evidence from studies on tobacco and alcohol use among Nigerian adolescents and young adults in order to determine factors influencing tobacco and alcohol use. Six databases MEDLINE, Embase, CINAHL, PsycINFO, PubMed, ScienceDirect, and Google Scholar were used to search for peer-reviewed articles reporting the prevalence and predictors of tobacco and alcohol use among adolescents/youths published between 2010 and 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided this review. From our search, twelve articles from the 6 geopolitical zones within Nigeria were included. The high prevalence of tobacco and alcohol use among Nigerian adolescents necessitates the need to understand the factors influencing use. A high prevalence rate was recorded among the male gender. Gender, age, and curiosity appear to place adolescents at extra risk for tobacco and alcohol use. Lack of parental monitoring, peer influence, low socio-economic status, low education level, stressful life events, advertisements, availability, and accessibility are factors identified to influence adolescents' alcohol and tobacco use. Alcohol and tobacco use remains a major public health issue as it continues to contribute largely to the growing occurence of diseases globally. Our review showed that adolescents' alcohol and tobacco use behaviour is triggered by various factors on the personal, interpersonal, organisational, community, and policy levels, and these factors are understood to predict or protect against alcohol and tobacco use.

Ageing with HIV: challenges and coping mechanisms of older adults 50 years and above living with HIV in Uganda.

INTRODUCTION: Globally, adults 50 years and older are an increasing proportion of persons living with HIV (PLHIV), accounting for 16% of the patient group globally. The long-term effects of antiretroviral use are still being discovered and have been associated with several comorbidities; Stigma presents challenges for those in need of services and health care and can significantly affect mental health and treatment adherence. Understanding the experiences and challenges of older PLHIV will inform the development of interventions to improve their care, health, and quality of life, which may help prevent the further spread of HIV. We explored the experiences and challenges of older PLHIV aged 50 years and above. METHODS: We conducted 40 in-depth interviews with elderly PLHIV aged 50 years and above who had lived with HIV for more than ten years. We also explored the experiences and challenges of ageing with HIV in two hospitals. We analysed the data thematically. RESULTS: The key themes that emerged included; late diagnosis of HIV, depression and fear at the time of diagnosis, acceptance of close family, stigma from community, polypharmacy, development of comorbidities, financial burden, resilience, and mastery of own care. CONCLUSION: Older adults experience several challenges, and there is a need to develop special clinics providing appropriate care for the ageing and their social life. Prevention, Early diagnosis and appropriate treatment of HIV, and appropriate geriatric care are essential for the well-being of elderly PLHIV.

"Ten Days of Paid Incarceration and Mental Torture" Experiences of Quarantined Individuals Arriving in the UK from Red Listed Countries in Southern Africa Amid the COVID-19 Pandemic.

COVID-19 has affected many communities across the world prompting different strategies of containing it. The strategies to contain COVID-19 included restrictive environments such as self-isolation and quarantine. This research study was set to explore the experiences of quarantined individuals arriving in the United Kingdom (UK) from red listed countries in Southern Africa. This research study utilises an exploratory qualitative approach. Semi-structured interviews were used to collect data from twenty-five research participants. A thematic approach underpinning the four phases of data analysis in The Silence Framework (TSF) was used to analyse the data. The study found that the research participants reported confinement, dehumanisation, feeling swindled, depressed, anxious and stigmatised. Less restrictive and non-oppressive quarantine regimes should be considered to foster positive mental health outcomes on individuals undergoing quarantine during pandemics.

Strategies to improve the care of older adults 50 years and above living with HIV in Uganda.

INTRODUCTION: With effective antiretroviral therapy (ART), many persons living with HIV (PLHIV) live to old age. Caring for aged PLHIV necessitates the engagement of caregivers and patients to establish agreed-upon goals of treatment. However, there is limited literature on friendly and centered models of care for elderly PLHIV. We explored strategies to improve care in HIV clinics among PLHIV aged 50 years and above in Uganda. METHODS: We conducted 40 in-depth interviews in two hospitals with elderly PLHIV aged 50 years and above who had lived with HIV for more than ten years. We explored strategies for improving care of elderly PLHIV at both health facility and community levels. The in-depth interviews were audio-recorded and transcribed verbatim. The thematic approach guided data analysis. RESULTS: The elderly PLHIV suggested the following strategies to improve their care: creating geriatric clinics; increasing screening tests for non-communicable diseases in the ART clinics; community and home-based ART delivery; workshops at health facilities to provide health education on aging effectively; creating community support groups; financial assistance for the elderly PLHIV and advances in science. CONCLUSIONS: There is need to improve community HIV care especially for the elderly and social and economic support in the community. Involving the elderly PLHIV in developing strategies to improve their health goes a long way to improve the patients' quality of care. There is a need to incorporate the raised strategies in HIV care or older adults.

Exploring the risk factors of child malnutrition in Sub-Sahara Africa: A scoping review.

Background: Malnutrition prevents children from reaching their full physical and mental potential. Health and physical consequences of prolonged states of malnourishment among children are: delay in their physical growth and motor development; lower intellectual quotient (IQ), greater behavioural problems and deficient social skills; susceptibility to contracting diseases. According to the 2015 Millennium development goal (MDG) report, sub-Saharan Africa (SSA) accounts for one third of all undernourished children globally, highlighting that malnutrition still remains a major health concern for children under 5 years in the sub-region, thus buttressing the need for urgent intervention. Aim: The aim of this study is to explore the risk factors of child malnutrition in sub-Saharan Africa through a scoping review. Methods: The scoping review was conducted using the following specific subject databases: EBSCOhost, google scholar, Pub med, demographic research and research gate. Attention was paid to keywords during navigation to ensure consistency of searches in each database. Two limiters were applied in all five databases. These included the use of the English language and articles published on child malnutrition in sub Saharan Africa. Results: The researchers identified eight themes for inclusion in the findings. The themes fell into four major categories being maternal related, family related, child related as well as context related factors. These themes reflect factors associated with child malnutrition. Conclusion: This scoping review revealed that there are quite a number of risk factors that lead to child malnutrition. Therefore, there is an urgency for strategic interventions aimed at improving child nutrition through female education if the 2030 end malnutrition SDG 2.2 are to be achieved.

Exploring the impacts of and reactions to HIV diagnosis in older adults: narratives from Ga-Rankuwa, South Africa.

There is an increase in prevalence of human immunodeficiency virus (HIV) infection among older adults. This new emerging social group is being overlooked, owing to the focus on groups that have traditionally been regarded as "high risk". This article set out to explore the impact of and reaction to HIV infection among older adults at the point of diagnosis. This study used a qualitative exploratory design that included a purposive sample of older adults currently receiving HIV treatment. The researchers recruited 12 participants who met the study's inclusion criteria. Face-to-face interviews were used to collect data. A thematic approach was used to analyse the data. The study found that the impact on and reaction of older adults following HIV diagnosis included anger and shock, feeling suicidal, blaming others, fear of stigma and discrimination, loss of trust and intimacy, fear of disclosure to new partners and denial. The study concluded that there is a need to improve sexual health and HIV services that cater for the needs of older adults as a new emerging group affected by HIV. Furthermore, HIV testing and prevention counselling should be offered to older adults just as it is to younger patients.

Effect of COVID-19 on older adults 50 years and above living with HIV in a less-developed country.

Introduction: Globally, control measures have been communicated to reverse the COVID-19 pandemic. In Uganda, as soon as the first case of COVID-19 was identified, strict lockdown measures were enforced, including a ban on all public and private transport, night curfew, closure of schools, and suspension of religious and social gatherings and closure of non-essential shops and markets. These measures affected access to health services, which could have been worse for older people living with HIV (PLHIV). In this study, we explored how COVID-19 affected the health and social life of older PLHIV.Methods: We conducted a qualitative study in HIV clinics of two hospitals in Uganda. We completed 40 in-depth interviews with adults above 50 years who had lived with HIV for more than 10 years. The interviews explored the effect of COVID-19 on their health and social life during the lockdown. We analysed data thematically.Results: The overarching themes regarding the effects of COVID-19 on older adults living with HIV were fear and anxiety during the lockdown, lack of access to health care leading to missing HIV clinic appointments and not taking their ART medicines, financial burden, loss of loved ones, and effect on children's education. Some patients overcame health-related challenges by sending motorcycles to their health facilities with their identifying documents to get the medicines refilled. Some health care providers took the ART medicines to their patients' homes.Conclusion: The COVID-19 lockdown negatively affected the health and social well-being of older PLHIV. This calls for strategies to improve HIV care and treatment access during the lockdown to sustain the HIV program gains in this vulnerable population.

Exploring barriers to antiretroviral therapy adherence among pregnant women: A scoping literature review.

BACKGROUND: Antiretroviral therapy (ART) is one of the most effective ways of preventing HIV-related maternal mortality. However, the rates of retention in care and long-term adherence remain extremely low. OBJECTIVE: The aim of this study was to explore barriers to antiretroviral therapy adherence among pregnant women. SEARCH STRATEGY: The search for articles was conducted using EBSCO Host, PubMed, Google scholar, and Cumulative Index of Nursing and Allied Health Literature (CINAHL). SELECTION CRITERIA: The studies included were conducted between 2000 and 2020 and covered barriers to antiretroviral therapy. DATA COLLECTION AND ANALYSIS: Data was collected from 8 selected articles and analyzed using Arksey and O'Malley five stages framework. MAIN RESULTS: Barriers to antiretroviral therapy adherence included side effects of the therapy and financial constraints limiting access to food, transport, and medication. Other barriers included cultural and religious factors, lack of spouse support, stigma, and discrimination. CONCLUSION: There is need to support pregnant women undergoing antiretroviral therapy to mitigate barriers associated with the uptake of the therapy.

Contested notions of challenges affecting Community Health Workers in low- and middle-income countries informed by the Silences Framework.

Despite increasing evidence of the challenges affecting Community Health Workers (CHWs) such as those related to training, supportive supervision and remuneration, there is a need to explore concerns and challenges from the perspective of CHWs themselves. This commentary highlights some of the contested and unexplored notions of challenges affecting CHWs in low- and middle-income countries (LMICs) informed by the Silences Framework. This framework defines experiences that are under-explored, misunderstood or difficult to share because of the often invisible power relations within communities, but also in setting the research agenda. These challenges include the heavy workload imposed by several stakeholders, dealing with religious and cultural practices, and gendered barriers of care. The workload of CHWs is a major source of stress and anxiety as they have to balance both government and other stakeholders' agendas to deliver interventions with their own need to provide for their families for those whose work is unpaid. The tensions of CHWs carrying out their work among members of the community whose religious or cultural beliefs are different from theirs also needs to be considered. Gender issues are an impediment to the work of CHWs, particularly with community members of the opposite sex around sensitive health issues. Lastly, CHWs have found themselves victims of domestic suspicion while fulfilling their duties in communities, such as when seen having conversations with spouses of other individuals in the community. Solutions to these challenges need to be co-produced with CHWs to both to strengthen their relationship with the communities they serve and shape more sustainable interventions for delivery of healthcare in LMICs.

Triggers of mental health problems among frontline healthcare workers during the COVID-19 pandemic in private care homes and domiciliary care agencies: Lived experiences of care workers in the Midlands region, UK.

COVID-19 was first reported in China and later spread across the world causing panic because there is no cure for it. The pandemic has adversely affected frontline health workers and patients, owing to poor preparedness. The study explored the triggers of mental health problems among frontline healthcare workers during the COVID-19 pandemic. An exploratory qualitative approach was utilised in the study. Forty individual semi-structured interviews were held with frontline healthcare workers. A thematic approach underpinned by some aspects of interpretive phenomenological analysis (IPA) and the Silences Framework (SF) was utilised. The research found that triggers of mental health problems among frontline health workers in private care homes and domiciliary care agencies are fear of infection and infecting others, lack of recognition/disparity between National Health Service (NHS) and social care, lack of guidance, unsafe hospital discharge, death and loss of professionals and residents, unreliable testing and delayed results and shortage of staff. It is important to support frontline workers in private care homes and domiciliary care agencies.

Exploring the Impact of Religion, Superstition, and Professional Cultural Competence on Access to HIV and Mental Health Treatment Among Black Sub-Sahara African Communities in the English City of Birmingham.

HIV and mental health are sensitive subjects among Black Sub-Saharan African (BSSA) communities despite the disproportionate impact of HIV among this population and high comorbidity between HIV and mental disorders. This study explored the impact of religion, superstition, and professional cultural competence on access to HIV and mental health services among BSSA communities in the English city of Birmingham. Researchers utilised explorative qualitative methods. Specifically, 12 focus groups were conducted followed by a semi-structured interview with a member from each focus group. Data were analysed using a thematic approach guided by the four phases of the silences framework. Results suggest that religion, superstition, and professional cultural competence affect access to HIV and mental health services among BSSA communities. Findings indicate a need to educate religious leaders on the impact of HIV and mental health stigma as well as a need for cultural competence training among health professionals.

Exploring The Challenges Faced by Informal Home Based Palliative (HBP) Caregivers in Ndola District, Zambia.

In order to explore informal Home-based palliative caregivers' challenging experiences, this study gives an overview of the need of Home-based palliative caregivers in communities. Dialogs using In-depth interviews (IDI's) with twenty-five (25) purposively and conveniently selected respondents aged 18 years and over were conducted. They were not professional caregivers but volunteers from within the community attached to health facilities in Ndola. Discussions on global, Africa and Zambian' situations, and Ndola in particular were included. The findings, using thematic analysis, were lack of supporting resources, inadequate coordination, lack of training, undesirable working conditions and unreliable transport network. The study will facilitate formulation of guiding principles and policies for palliative care practices through recommendations based on results from this study to improve and sustain palliative care services.

Exploring the challenges of women taking antiretroviral treatment during the COVID-19 pandemic lockdown in peri-urban Harare, Zimbabwe.

OBJECTIVE: To explore the challenges of women taking antiretroviral treatment (ART) during the COVID-19 pandemic lockdown in a peri-urban area. METHODS: An exploratory qualitative study approach was used. Semi-structured questions were devised and used to elicit data on the impact of the COVID-19 lockdown on women accessing treatment for HIV. Twenty women were interviewed through contacts from community and faith organizations in peri-urban Harare. All interviews were audio-recorded, transcribed verbatim and entered into NVivo to make analysis easy. The data were thematically analyzed, underpinned by the four phases of data analysis in the Silences Framework. RESULTS: The study discovered that transport problems, confusing COVID-19 restrictions, abuse by police and soldiers at roadblocks, a shortage of medication, lack of health check-up routines, involuntary default of ART, and a shortage of personal protective equipment affected HIV-positive women accessing ART during the COVID-19 lockdown. CONCLUSION: People living with HIV need a robust supporting environment and a functioning health system. In response to COVID-19 all services were halted to prevent the spread of COVID-19. Pandemic preparedness is important in keeping an adequate supply of ART and responding to the needs of individuals on HIV treatment.

Transition to adult care: Exploring factors associated with transition readiness among adolescents and young people in adolescent ART clinics in Uganda.

BACKGROUND: Transition readiness refers to a client who knows about his/her illness and oriented towards future goals and hopes, shows skills needed to negotiate healthcare, and can assume responsibility for his/ her treatment, and participate in decision-making that ensures uninterrupted care during and after the care transition to adult HIV care. There is a paucity of research on effective transition strategies. This study explored factors associated with adolescent readiness for the transition into adult care in Uganda. METHODS: A cross-sectional study was conducted among 786 adolescents, and young people living with HIV randomly selected from 9 antiretroviral therapy clinics, utilizing a structured questionnaire. The readiness level was determined using a pre-existing scale from the Ministry of Health, and adolescents were categorized as ready or not ready for the transition. Bivariate and multivariate analyses were conducted. RESULTS: A total of 786 adolescents were included in this study. The mean age of participants was 17.48 years (SD = 4). The majority of the participants, 484 (61.6%), were females. Most of the participants, 363 (46.2%), had no education. The majority of the participants, 549 (69.8%), were on first-line treatment. Multivariate logistic regression analysis found that readiness to transition into adult care remained significantly associated with having acquired a tertiary education (AOR 4.535, 95% CI 1.243-16.546, P = 0.022), trusting peer educators for HIV treatment (AOR 16.222, 95% CI 1.835-143.412, P = 0.012), having received counselling on transition to adult services (AOR 2.349, 95% CI 1.004-5.495, P = 0.049), having visited an adult clinic to prepare for transition (AOR 6.616, 95% CI 2.435-17.987, P = < 0.001) and being satisfied with the transition process in general (AOR 0.213, 95% CI 0.069-0.658, P = 0.007). CONCLUSION: The perceived readiness to transition care among young adults was low. A series of individual, social and health system and services factors may determine successful transition readiness among adolescents in Uganda. Transition readiness may be enhanced by strengthening the implementation of age-appropriate and individualized case management transition at all sites while creating supportive family, peer, and healthcare environments.

Exploring the perceptions of dignity among patients and nurses in hospital and community settings: an integrative review.

Background: Patients have a right to be treated with dignity. However, reports have continually identified concerns regarding the quality of care and dignity in hospitals. Undignified care can have unfavourable impact on the patient's recovery such as leading to depression and loss of will to live. The aim of this study was to explore dignity as perceived by patients and nurses within hospital and community environments. Methods: An integrative review methodological approach was adopted. Nine databases including Medline, CINAHL plus with full text, Web of Science, Embase, Pubmed, Psycinfo, Scopus, Nursing and Allied Health Source, and Science Direct were systematically searched for relevant articles using a predetermined set of inclusion criteria. Articles were included if they were primary empirical studies, peer reviewed, published between 2008-2019, assessing patients' or nurses' perception of dignity outside the end-of-life context, conducted in one of the European countries and written in English. Included papers were analysed using constant comparative analysis. The preferred reporting system for systematic review and meta-analysis (Prisma) flow diagram was used for quality appraisal and review. Results: Fourteen relevant articles were included in this review. Four overarching themes and 10 subthemes were identified as impacting on patient dignity. Overarching themes include autonomy, healthcare delivery factors, organisational factors and the meaning of dignity, whilst subthemes include dependence/independence, choice, staff attitudes, communication, privacy, structure of services, staff shortages, physical environment, respect and person-centred care. Conclusion: There are a wide range of factors impacting on patient dignity. Adopting evidence-based interventions supported by adequate theoretical backing can help to enhance patient dignity in hospital and community settings.

Exploring the efficacy of music in palliative care: A scoping review.

OBJECTIVE: There is an increasing recognition of the significance of music as a complementary therapy in palliative care. Limited studies exist on how music is used as a coping mechanism by palliative care patients. Therefore, the purpose of this scoping review was to explore the efficacy of music interventions for palliative care. METHOD: We conducted a literature search between June and November 2019 in the Cumulative Index of Nursing and Allied Health Literature (CINAHL), British Nursing Index (BNI), and PubMed, which includes MEDLINE. The search identified eight articles which met the inclusion and exclusion criteria. RESULTS: Using thematic analysis, six themes were synthesied to show how music contributes to palliative care. The six themes include Pain management; Relaxation; Happiness and hope; Anxiety and depression management; Enhanced spirituality; and Improved quality of life. These themes reflect the psychological and emotional benefits palliative care patients derive from music therapies. SIGNIFICANCE OF RESULTS: Music therapy can be an effective psychosocial approach when managing palliative symptoms through its therapeutic effects on physical, psychological, emotional, and spiritual well-being.

Lived experiences of stressors and problems of higher education students on teacher education course in the Eastern Highlands of Zimbabwe, 2019.

INTRODUCTION: there is increasing levels of stressors and hardship among higher education students especially in low and middle income countries. Higher education institutions have an important role to play in the provision of robust and comprehensive support for students who experience stressors and hardship. Research and action in this area has however not been prioritized by the institutions in Zimbabwe. This study examined students´ expression of their experience with stressors and problems of studying in higher education in the Eastern Highlands of Zimbabwe. METHODS: the study employed a qualitative approach using the phenomenology approach. Three institutions of higher education in the eastern border highlands of Zimbabwe were considered. Four focus group discussions were conducted with eight participants in each group. A one-to-one semi-structured interview with eight individual participants was also conducted to further examine the issues raised in the focus groups. Data were analyzed thematically using the Silences Framework theoretical model. RESULTS: five overarching themes emerged from the analysis: (i) the stress of completing assessments without adequate learning materials. (ii) Unfair placement workload results into poor assessment outcomes. (iii) College-life is more difficult due to financial constraints. (iv) Marital problems interfering with college work: there is no mental health service available. (v) Enduring pains of bereavement with no emotional support or helpline. CONCLUSION: the study recommends the need to develop an inter-ministerial mental health strategy for institutions of higher learning with the view of implementing policies that address students suffering in Zimbabwean HE institutions.

Using Andersen's Behavioral Model of Health Care Utilization to Assess Contraceptive Use among Sexually Active Perinatally HIV-Infected Adolescents in Uganda.

BACKGROUND: Contraceptive practices of perinatally HIV-infected adolescents (PHIAs) have implications related to pregnancy prevention, risks of HIV heterosexual transmission, reinfection, and vertical transmission. The study assessed contraceptive use among sexually active PHIAs in Uganda. METHODS: Mixed methods consisting of a survey and in-depth interviews were employed among 213 sexually active PHIAs who were attending antiretroviral therapy (ART) clinics. The study was guided by Andersen's Behavioral Model of Health Service Use as a theoretical framework to identify factors that influence contraceptive use. These factors include health care factors, personal characteristics, enabling factors, and needs. The outcome was contraceptive use. Multivariable logistic regression was used to establish determinants of contraceptive use. Qualitative data were analyzed by thematic analysis. RESULTS: Most PHIAs were female (67.6%); the mean (SD) and median (IQR) age was 17.5 (±1.4) and 18 (17-19) years. The mean age of sexual debut and at marriage were 15 (±1.7) and 17 (±1.1), respectively. Condoms were the most known method of family planning (indicated by 55.4%). Only 16.9% of the participants knew about dual protection (condom use for FP as well as HIV/STI prevention). Of the PHIAs, 43.6% had ever used modern contraception and 56.9% of the females had ever been pregnant. The odds of contraceptive ever-use were significantly higher among adolescents aged 17-19 years (OR 5.1, 95% CI: 2.1-13.3) compared to those aged 10-16 years, those in school (OR 1.8, 95% CI: 1.07-3.2) compared to those out of school, and those with perceived need to use FP (OR 2.0, 95% CI: 1.1-3.9) compared to their counterparts. The odds of contraceptive used were lower among females (OR 0.13, 95% CI: 0.06-0.28) compared to males. From the in-depth interviews, the attitude of health workers, availability of health workers, having a friend using family planning, and waiting time were viewed to affect contraceptive use. CONCLUSION: Contraceptive use among sexually active perinatally HIV-infected adolescents was (43.6%). However, out of those who used family planning majority were using short-term methods. The unmet need for family planning was high (47%) with high reports of pregnancy (56.9%). The factors associated with contraceptive use included education, age, sex (predisposing factors), and perceived need of family planning (need factors). Other factors that could affect contraceptive use from qualitative analysis included attitude of health workers, availability of health workers, having a friend using family planning (predisposing factors), and waiting time (health system factors). HIV care for adolescents should be promoted using SRH approach. There is a need to provide training for all providers to cater for SRH services. We should continue to provide youth-responsive adolescent sexual and reproductive health services across all ART facilities and build a supportive environment and continue to integrate SRH services into HIV care.

Exploring the impact of COVID-19 pandemic lockdown on informal settlements in Tshwane Gauteng Province, South Africa.

Informal settlements remain a public health problem as they lack basic infrastructure. Furthermore, it is challenging to enforce public health regulations and protocols to prevent the spread of infection during a pandemic. This paper was set out to explore the impact of lockdown during COVID-19 among people living in informal settlements. An exploratory qualitative design was utilised. Purposive sampling was used to select research participants. In-depth one-to-one interviews were held involving 30 research participants through a WhatsApp online telephone platform. A thematic approach underpinned by the four stages of data analysis in interpretive phenomenological analysis was utilised to analyse the data. The study found that during the the research participants were affected by lack of space to practice social distancing, over-burdened infrastructure, lack of savings, loss of income and shortage of food, hunger and diseases, anxiety and depression and poor access to education. There is a need to prioritise the needs of informal settlers and endeavour to establish permanent homes. Health promotion and communication initiatives and pandemic awareness programmes are needed to mitigate the impact of lockdown during a pandemic in informal settlements.