Usability and Acceptability of a Conversational Agent Health Education App (Nthabi) for Young Women in Lesotho: Quantitative Study.

BACKGROUND: Young women in Lesotho face myriad sexual and reproductive health problems. There is little time to provide health education to women in low-resource settings with critical shortages of human resources for health. OBJECTIVE: This study aims to determine the acceptability and usability of a conversational agent system, the Nthabi health promotion app, which was culturally adapted for use in Lesotho. METHODS: We conducted a descriptive quantitative study, using a 22-item Likert scale survey to assess the perceptions of the usability and acceptability of 172 young women aged 18-28 years in rural districts of Lesotho, who used the system on either smartphones or tablets for up to 6 weeks. Descriptive statistics were used to calculate the averages and frequencies of the variables. χ2 tests were used to determine any associations among variables. RESULTS: A total of 138 participants were enrolled and completed the survey. The mean age was 22 years, most were unmarried, 56 (40.6%) participants had completed high school, 39 (28.3%) participants were unemployed, and 88 (63.8%) participants were students. Respondents believed the app was helpful, with 134 (97.1%) participants strongly agreeing or agreeing that the app was "effective in helping them make decisions" and "could quickly improve health education and counselling." In addition, 136 (98.5%) participants strongly agreed or agreed that the app was "simple to use," 130 (94.2 %) participants reported that Nthabi could "easily repeat words that were not well understood," and 128 (92.7%) participants reported that the app "could quickly load the information on the screen." Respondents were generally satisfied with the app, with 132 (95.6%) participants strongly agreeing or agreeing that the health education content delivered by the app was "well organised and delivered in a timely way," while 133 (96.4%) participants "enjoyed using the interface." They were satisfied with the cultural adaptation, with 133 (96.4%) participants strongly agreeing or agreeing that the app was "culturally appropriate and that it could be easily shared with a family or community members." They also reported that Nthabi was worthwhile, with 127 (92%) participants reporting that they strongly agreed or agreed that they were "satisfied with the application and intended to continue using it," while 135 (97.8%) participants would "encourage others to use it." Participants aged 18-24 years (vs those aged 25-28 years) agreed that the "Nthabi app was simple to use" (106/106, 100% vs 30/32, 98.8%; P=.01), and agreed that "the educational content was well organised and delivered in a timely way" (104/106, 98.1% vs 28/32, 87.5%; P=.01). CONCLUSIONS: These results support further study of conversational agent systems as alternatives to traditional face-to-face provision of health education services in Lesotho, where there are critical shortages of human resources for health. TRIAL REGISTRATION: ClinicalTrials.gov NCT04354168; https://www.clinicaltrials.gov/study/NCT04354168.

Maladaptive behaviours of maternal orphans in high schools of Tshwane North of Gauteng, South Africa.

BACKGROUND: Some orphaned adolescents find it difficult to cope and adjust to the loss of a mother. Studies to explore specific adjustment challenges experienced by this vulnerable group, are necessitated by the growing need to inform support services for orphans. AIM: This study sought to explore maladaptive behaviours among adolescent maternal orphans. SETTING: Participants were recruited from the Tshwane North secondary schools of Gauteng province in South Africa. METHODS: A qualitative exploratory design was employed; maternal adolescent orphans were purposively selected and included in a one-on-one qualitative enquiry. Twenty-five participants were included in the study. Data were analysed thematically using NVivo12. RESULTS: Emerged themes were: negative thoughts such as suicidal ideation, negative perception of self; silence coded as 'keep life matters private and hide personal feelings'; having psychosocial problems reported as anger, fighting, shouting, crying, short temper; engaging in risky behaviours in the form of smoking and alcohol use and unsafe termination of pregnancy; social withdrawal by self-isolation and being afraid of people. CONCLUSION: Whole school peer interaction groups could address the functional problems of social ability and silence. Skills development programmes, and other activities that enhance constructive use of free time, instil hope and build self-esteem are recommended.Contribution: The findings of this study serve as a basis to inform interventions that are geared towards supporting adolescent orphans through the school health teams, as one of the domains of the re-engineering of South Africa's primary health care system.

Risk factors for sexually transmitted infections among men who have sex with men.

BACKGROUND: Sexually transmitted infections (STIs) are a global public health concern and sub-Saharan Africa, has limited data on STIs in the men who have sex with men (MSM) population. Syndromic management has controversies for treating asymptomatic STIs (ASTIs). AIM: The aim of this study was to describe the risk factors for STIs among MSM. SETTING: This study was conducted in Tshwane North, Gauteng Province in South Africa. METHODS: A cross-sectional quantitative design was employed using structured questionnaires, rapid plasma reagent test, from December 2021 to May 2022. Bivariate and multivariate analyses were used for statistical analysis. RESULTS: A total of 200 MSM with the mean age of 27.6, standard deviations: 6.8 participated, and STIs prevalence was 66%, with 37% concurrent infections. Ureaplasma urealyticum was (24%), Mycoplasma hominis (23%), Chlamydia trachomatis (20%), Treponema pallidum (20%) and Neisseria gonorrhoeae (9%). The risk factors for acquisition of STI include having a new partner in the last month (OR = 1.68; CI: 0.98-3.13). CONCLUSION: The prevalence of ASTIs is high. Serial and multiple sexual partners are the risk factors.Contribution: This study contributes to the body of knowledge of the burden of STIs among high-risk population.

Adaptation of the Gabby conversational agent system to improve the sexual and reproductive health of young women in Lesotho.

Introduction: Young women from the low-middle-income country of Lesotho in southern Africa frequently report limited knowledge regarding sexual and reproductive health issues and engage in risky sexual behaviors. The purpose of this study is to describe the adaptation of an evidence-based conversational agent system for implementation in Lesotho and provide qualitative data pertaining to the success of the said adaptation. Methods: An embodied conversational agent system used to provide preconception health advice in the United States was clinically and culturally adapted for use in the rural country of Lesotho in southern Africa. Inputs from potential end users, health leaders, and district nurses guided the adaptations. Focus group discussions with young women aged 18-28 years who had used the newly adapted system renamed "Nthabi" for 3-4 weeks and key informant interviews with Ministry of Health leadership were conducted to explore their views of the acceptability of the said adaptation. Data were analyzed using NVivo software, and a thematic content analysis approach was employed in the study. Results: A total of 33 women aged 18-28 years used Nthabi for 3-4 weeks; eight (24.2%) of them were able to download and use the app on their mobile phones and 25 (75.8%) of them used the app on a tablet provided to them. Focus group participants (n = 33) reported that adaptations were culturally appropriate and provided relevant clinical information. The participants emphasized that the physical characteristics, personal and non-verbal behaviors, utilization of Sesotho words and idioms, and sensitively delivered clinical content were culturally appropriate for Lesotho. The key informants from the Ministry leadership (n = 10) agreed that the adaptation was successful, and that the system holds great potential to improve the delivery of health education in Lesotho. Both groups suggested modifications, such as using the local language and adapting Nthabi for use by boys and young men. Conclusions: Clinically tailored, culturally sensitive, and trustworthy content provided by Nthabi has the potential to improve accessibility of sexual and reproductive health information to young women in the low-middle-income country of Lesotho.

A Qualitative Study of the Benefits and Utility of Brief Motivational Interviewing to Reduce Sexually Transmitted Infections among Men Who Have Sex with Men.

Several studies have demonstrated the effectiveness of motivational interviewing (MI) in reducing sexual risk behaviors. However, limited information is available on the acceptability of brief MI among men who have sex with men (MSM) in poor resource settings like sub-Saharan Africa. The objective of this study was to assess the views of MSM about the benefits and utility of brief MI (bMI) in changing their risky behavior. A qualitative study among men who have sex with men (MSM) who were enrolled in a longitudinal observational study between December 2021 and May 2023. The setting was in Tshwane North and participants were scheduled for baseline, 6-month, and 12-month visits. All participants received 20 min one-on-one face-to-face brief motivational interview (bMI) sessions during their follow-up visits. At month 12, an exit interview was conducted with consenting conveniently sampled participants (n = 23) who had completed all scheduled visits and received three bMI sessions. The findings indicated that the most recalled conversation was related to multiple sexual partners, having sex under the influence of alcohol, and MSM learned more about sexually transmitted diseases. Many expressed being comfortable with the sessions because the counselor was respectful and non-judgmental. Most found the bMI sessions to have a positive impact on changing and reducing risky sexual behaviors, particularly it reportedly increased their use of condoms and reduced the number of multiple partners. MSM found the bMI to be useful and acceptable in reducing sexual risk behaviors among MSM.

Community Perceptions of HIV Stigma, Discriminatory Attitudes, and Disclosure Concerns: A Health Facility-Based Study in Selected Health Districts of South Africa.

Research data about HIV stigma perceptions and discriminatory attitudes among the general population are limited. Furthermore, the willingness of HIV-negative individuals to engage with HIV prevention and disclosure interventions has not been established in South Africa. The study investigated community perceptions of stigma as well as discriminatory attitudes towards HIV disclosure to understand if and how these perceptions might influence the uptake of disclosure interventions. This facility-based study used a validated questionnaire to measure the four constructs of HIV stigma among 670 adults recruited from health districts of two provinces of South Africa. Of these, 72% were female, 87% had ever been tested for HIV, and 31% knew someone who has HIV. Stigma towards people living with HIV (PLHIV) is widespread in the general population. A high proportion (75%) endorsed disclosure concerns, 75% perceived stigma to be common, and 56% endorsed negative statements indicating perceived stigma in communities. Fear, moral and social judgement, and rejection underlined their perceptions about PLHIV. Almost half (45.7%) were unwilling to care for family members sick with AIDS, suggesting negative distancing reactions and discriminatory attitudes towards PLHIV. The widespread discriminatory attitudes and the perceived stigma that is evident in the general population might heighten the disclosure concerns endorsed, promote non-disclosure, and increase HIV transmission. To design interventions, it is crucial to be cognisant of disclosure concerns, discriminatory attitudes, and perceived stigma evident in communities. Thus, the findings underscore the need to increase efforts to challenge and reduce community drivers of negative discriminatory attitudes and perceived stigma.

Assessing Condom Use and Views on HIV Counselling and Testing among TVET College Students in Limpopo Province, South Africa.

South Africa's population is predominantly young, presenting a powerful resource for the country. Despite this, adolescents and young people remain at the epicentre of the HIV epidemic, particularly adolescent girls and young women (AGYW). There are limited studies that investigate the views on HIV Counselling and Testing (HCT) and condom use among adolescents and young people, and college students in particular, in South Africa. This cross-sectional study assessed condom use among college students and their views and opinions on HCT. Utilising an adapted questionnaire from the Australian Secondary students and the South African Sexual Health survey, the data from 396 students were analysed using univariate and multiple logistic regression performed using Stata IC version 16. The majority of the students (n = 339, 85.8%) had a sexual partner at the time of the study. Our findings reveal a relatively high occurrence of condom use in the last sexual encounter (n = 225, 60%) and high HCT uptake (n = 50, 88.4%). Females were generally more comfortable regarding HIV services compared to their male counterparts. More than half, 54.6% vs. 36.0% were comfortable about testing, 34.0% vs. 48.3% felt very scared about testing for HIV, 3.6% vs. 10.1% reported that they were not ready to take an HIV test, 7.6% vs. 5.6% intended getting tested soon (p = 0.0002). Condom use was significantly associated with the use of a condom during the first sexual encounter (aOR = 4.71, 95% CI: 2.14, 10.37) and knowing their partner's HIV status (aOR = 2.08, 95% CI: 1.19-3.65). The HCT and condom promotion strategies implemented by Higher Health in TVET colleges is showing success and colleges in other parts of the region could emulate these best practices. Program developers should consider tailor-made combinations of prevention interventions that would appeal to both female and male college students to improve condom use and uptake of HIV testing services.

The acceptability and perceived use of HIV self-testing among technical vocational education and training students in Limpopo province.

Background: Human immunodeficiency virus self-testing (HIVST) is a most recent testing modality to reach young people to test for HIV, due to their increased vulnerability of contracting HIV. Limited literature is available describing sexual behaviours and the acceptability of HIVST and its perceived use among students. Aim: The aim of this study was to assess the acceptability and perceived use of HIV self-testing among students in Limpopo province, South Africa. Setting: The study was conducted in Limpopo province, at a technical and vocational education and training (TVET) college. Methods: A cross-sectional study was conducted with a sample of 396 students recruited from a TVET college. Results: The mean age of the students was 22.9 years, with the majority of the students being female (77.2%). The majority (81.4%) of the students sampled reported regular sexual activity. Sixty per cent of the students had used condoms during their last sexual encounter. The acceptability of HIVST was high, with more women showing the willingness to take up HIVST (82.5%). Being sexually active (odds ratio [OR] 1.23; (confidence interval [CI]: 2.14 -6.94; p = 0.000), a number of sexual partners (OR 1.045; CI: 1.98 -10.02; p = 0.000) and condom use during the last sexual encounter (OR 0.62; CI: 3.81 -9.59; p = 0.000) were factors associated with HIVST. Conclusion: The high acceptability of HIV shows a need for innovative demand creation in sexual and reproductive health (SRH) programming. Contribution: The study contributes to the body of literature about the acceptability and perceived use of HIV self-testing among students. Findings can be used for improving HIVST interventions using innovative approaches.

Knowledge and Perceptions of Healthcare Workers about the Implementation of the Universal Test and Treat Guideline in Under-Resourced, High-HIV Prevalence Rural Settings.

BACKGROUND: South Africa (SA) began implementing its Universal Test and Treat (UTT) policy in September 2016 and Same Day Initiation (SDI) in 2017, aiming to meet the UNAIDS 90-90-90 targets by 2020. With significant advances in HIV testing, large gaps remain in the linkage and retention in care. As part of a contribution to the successful implementation of UTT, this study aims to examine progress in the implementation of the UTT and to identify gaps and facilitators in the successful implementation of the guidelines from the perspective of healthcare providers from under-resourced, high-HIV prevalence rural settings. METHODS: We conducted a census of all 170 professional nurses from 18 primary healthcare (PHC) clinics in Rustenburg, South Africa, between October 2018 and February 2019. The perceptions, knowledge and attitudes of nursing staff associated with UTT implementation were investigated though the dissemination of self-administered questionnaires. Stata 16.0 was used to analyse the data. Frequency and contingency tables were used to present categorical data. The precision of the estimates was measured using a 95% confidence interval (95% CI), and the p-value of statistical significance is p < 0.05. RESULTS: The facilities were found to have adequate governance and supervision, but gaps were identified, including staffing challenges, bottlenecks and under-resourced service delivery platforms. It was found that a high level of knowledge is a predictor of positive perception of the UTT programme and its implementation. Being supported by capacity development and having positive perceptions of UTT were important motivators for UTT implementation. CONCLUSIONS: This study was able to identify potential facilitators of the UTT strategy implementation at the selected facilities. Clinical guidelines and policies on UTT contributed to successful implementation, which means that the process of closing the gaps identified should prioritise the delivery, support and prioritisation of capacity development, infrastructure and the provision of clinical guidelines to all healthcare workers. It is recommended that nurses receive training on UTT and its benefits to increase their knowledge and promote its successful implementation in clinics.

Sexual Behaviour and Attitudes towards Safe Sex of Youth Receiving Antiretroviral Care at Public Health Facilities in Palapye District, Botswana.

BACKGROUND: Sexual behaviour of HIV-infected youths is very important in determining the direction of the HIV epidemic, as these youths are reservoirs of HIV and can propagate its transmission if they engage in risky sexual behaviours. However, support structures for secondary prevention are weak even in healthcare settings. There is a need to understand the sexual behaviour of these youths and, in turn, tailor appropriate secondary prevention strategies, hence the current study was designed to assess sexual behaviour and attitudes towards safe sex of youth receiving antiretroviral care at public health facilities in Palapye district, Botswana. METHOD: This quantitative, descriptive cross-sectional survey was used to describe the sexual behaviour and attitudes towards safe sex and identify factors associated with risky sexual behaviours among HIV-infected youths aged between 15 and 19 years receiving antiretroviral therapy (ART) care from public healthcare facilities in Palapye District, Botswana. RESULTS: A total of 188 youths participated in this study, 56% being females while 44% were males. We reported that 15.4% had ever had sex. At their last sexual encounter, more than half of the youths (51.7%) had not used condoms. More than a third of the participants were under the influence of alcohol during their last sexual experience. Generally, the youths had good attitudes towards safe sex, as most youths said they would prioritise protecting their sexual partners and themselves from HIV and STIs. Alcohol use, substance use and not considering religion as important were strongly associated with having ever had sex. CONCLUSIONS: A significant proportion of HIV-infected youths are sexually active, whereas their preventive practices such as condom use are poor despite good attitudes towards safe sex. Alcohol use, substance use and not perceiving religion as important were associated with risky sexual behaviours.

Factors associated with buying sex and the knowledge that condoms prevent HIV among long-distance truck drivers at Kazungula weighbridge terminal, Chobe District, Botswana.

Background: Long-distance truck drivers (LDTDs) have a higher rate of HIV infection compared to the general population. This is due to their living and working conditions which predispose them to riskier sexual behaviours. Inadequate knowledge of HIV and AIDS, coupled with risky sexual behaviours such as unprotected sex with commercial sex workers (CSWs), predisposes LDTDs to contract and propagate HIV. This study aims to determine the factors associated with buying sex and the knowledge that condoms prevent HIV transmission among long-distance truck drivers at Kazungula weighbridge terminal in the Chobe District of Botswana.Methods: A cross-sectional descriptive survey was employed and 399 LDTDs participated. A questionnaire was used to collect sociodemographic data and information on knowledge of HIV and AIDS and the sexual behaviours of the LDTDs.Results: The results reveal that more than half of the LDTDs (56.9%; n = 227) had paid for sex with CSWs at some point in their travels, and 27.1% (n = 108) reported having had unprotected sex with CSWs. The LDTDs who preferred to have sex with CSWs without a condom had about five times the odds of buying sex with CSWs than those who preferred to use a condom (AOR 4.9; 95% CI 2.85-8.46). Disliking condom use was a factor contributing to less knowledge of condom use preventing HIV among the LDTDs (AOR 0.4; CI 0.17-0.97).Conclusion: It can be concluded from the results of this study that the LDTDs engage in considerable risky sexual behaviours, and associated factors were found to be multidimensional. This population remains of concern in HIV acquisition and transmission. Therefore, there is a need for a robust public health response to deal with the problem of both new infection and re-infection with HIV in this population.

Practice, attitudes and views of right to access of sexual and reproductive health services by LGBTQI among primary health care nurses in Tshwane.

BACKGROUND: Sexual and reproductive healthcare services (SRHS) are crucial investments for improving individual well-being and granting an opportunity to exercise sexual and reproductive rights. Primary health care (PHC) nurses are described as gatekeepers, preventing many individuals, including the members of the lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) community, from accessing much-needed healthcare services. AIM: The study aimed at exploring the experiences and perceptions of PHC nurses during the provision of SRHS for members of the LGBTQI community. SETTING: The study was conducted among eight clinics around Tshwane in South Africa. METHODS: Twenty-seven professional nurses were selected purposively, using an exploratory design approach. A semistructured interview guide and in-depth face-to-face interviews were used to gather data. Data were analysed using thematic content analysis (TCA). RESULTS: Four themes emerged: understanding of SRHS, attitudes of PHC nurses, frequency of rendering services based on utilisation of SHR and views of nurses on the right to access SRHS. CONCLUSION: A heteronormative approach was mostly indicated when rendering SHRS to the members of the LGBTQI community. Members of the LGBTQI community do not use the SRHS as often as heterosexual patients; lack of training, skills and knowledge were identified as barriers to rendering much-needed SRHS for members of the LGBTQI community.Contribution: The findings of this study assisted in demonstrating the PHC nurses' perceptions, experiences, skills and knowledge of LGBTQI SRHS, thus improving the members of the LGBTQI community's accessibility and utilisation of SRHS.

Change in Sexual and Reproductive Health Knowledge among Young Women Using the Conversational Agent "Nthabi" in Lesotho: A Clinical Trial.

Background: Young women worldwide face problems like unwanted pregnancy and sexually transmitted infections. Providing sexual and reproductive health education to this population remains a priority. It is unknown if using digital health interventions to deliver health education in human resource-constrained settings is effective. Methods: We conducted a clinical trial of the Nthabi intervention to determine participant's knowledge before and after discussion of family planning, folic acid and healthy eating among young women aged 18-28 years in two rural districts of Lesotho who used the Nthabi conversational agent system on either smartphones or tablets for up to six weeks. The number of correct pre- and post-test responses were compared using generalized linear models that directly estimated the proportions and percentages of correct responses. Results: Of the 172 participants enrolled, the mean age was 22.5 years, 91% were unmarried, 69% completed high school, 23% were unemployed and 66% were students. The mean number of interactions with Nthabi was Family planning was chosen to be discussed by 82 (52.2%), of the 172 participants and of those, 49 (59.8%) completed the content on this topic, and 26 (53.1%) completed the post-test. For the 11 questions about family planning, there were 717 (76.6%) correct responses on the pre-test and 320 (89.9%) on the post-test (p = 0.0233). Folic acid was chosen to be discussed by 74 (47.1%) of 172 participants, and of those, 27 (36.5%) completed the content on this topic, and all 27 (100%) completed the post-test. For the 5 questions about folic acid use, there were 181 (45.3%) correct responses on the pre-test and 111 (71.6%) on the post-test (p < 0.0001). The number of correct responses on the post-test was positively associated with the number of sessions that the participant engaged with Nthabi. Conclusion: The Nthabi conversational agent system increased knowledge of family planning methods and folic acid use among young women in Lesotho. Digital health interventions like Nthabi offer new opportunities to deliver reproductive health information in countries that have limited human resources for health. Trial Registration: ClinicalTrials.gov ID: NCT04354168.

Knowledge, Understanding and Satisfaction with the Implementation of the Performance Management System at a District Hospital in the Madibeng Subdistrict, South Africa.

The Performance Management and Development System (PMDS) is an essential asset in aligning the strategic objectives of both the National and Provincial departments of health with the individual targets and Key Responsibility Areas (KRAs) of the individual employees working in these departments. The system is not without challenges. The sources of contention can be with the rewards mechanism of the system, bias in the application of the system and the incorrect use of the system for punitive measures. The objective of this study was to determine the perceived knowledge, understanding and satisfaction levels of employees at Brits District Hospital regarding the PMDS. Another objective was to provide an intervention targeting the knowledge and understanding of the key concepts of the system. A quantitative cross-sectional and longitudinal action research method was applied by tracking the responses of 64 healthcare workers three times, firstly in a questionnaire and then in an intervention checklist. The respondents were selected via proportionate stratified sampling. Data were analysed via STATA statistical software package 13.0. The respondents had a poor knowledge and understanding of how to score the PMDS. The respondents where highly dissatisfied with the development of their weaknesses and the recognition of their strengths. Training needs to be prioritized on both the PMDS and the employees' areas of weakness affecting their performance toward their assigned Key Responsibility Areas. Employees need to be recognised for areas in which they show strength.

Primary Healthcare Nurse's Barriers and Facilitators to Providing Sexual and Reproductive Healthcare Services of LGBTQI Individuals: A Qualitative Study.

In most cases, we only hear Lesbians, Gays, Bisexuals, Transgender, Queer, and Intersex (LGBTQI) patients complaining about nurses being the reason for not accessing and utilizing healthcare services; for example, studies reports on the different attitudes of healthcare providers including nurses against LGBTQI patients. However, factors influencing the behavior of South African Primary Healthcare (PHC) Nurses toward LGBTQI patients are rarely reported. The study aimed to explore how PHC nurses experienced and perceived sexual and reproductive health services for LGBTQI individuals in Tshwane, Gauteng Province, South Africa. The study followed qualitative research using an exploratory design approach. The sample included 27 PHC nurses from Tshwane, Gauteng Province, South Africa. In-depth face-to-face interviews were coded and analyzed using Thematic Content Analysis (TCA) which included five interrelated steps. The results revealed three main themes: barriers to the provision of LGBTQI-related SRHS, facilitators for the provision of SRHS to LGBTQI individuals, and strategies to improve LGBTQI individuals' SRHS accessibility and availability. Common barriers were related to the institutions, PHC nurses, the general public, and LGBTQI patients themselves. Regardless of the challenges faced by PHC nurses, there were some enabling factors that pushed them to continue rendering SHRS to LGBTQI patients who came to their clinics. Almost all PHC nurses suggested the importance of awareness, transparency, collaboration, and the need for training related to LGBTQI healthcare issues.

Pre-Diagnosis Health Seeking Behaviors and Experiences Post-Diagnosis, among Men Diagnosed with Tuberculosis in a District of Gauteng Metropolitan City, South Africa: In-Depth Interviews.

BACKGROUND: Tuberculosis remains the number one killer among infectious diseases in South Africa. The TB disease burden is said to be higher among males, 1.6 times more than females in 2018. Moreover, men are reported to have poor healthcare-seeking behaviors. Loss in social and physical functioning, including reduced sexual desires and changes in family life, have been reported following a TB diagnosis. This study explored the meaning that male TB patients attach to their TB diagnosis and impact of TB infection in their lives and those of the people living with them. METHODS: This exploratory qualitative study was conducted among 25 participants recruited among male patients seeking TB care from two clinics in informal settlements of the city of Johannesburg. In-depth interviews with open-ended questions were conducted using an audio recorder for the collection of data. Data analysis was conducted on the NVivo version 12 software following an inductive thematic approach. RESULTS: The ages of the participants ranged between 18 and 61 years. Most were unemployed, and only a few were married or in steady relationships. From the two emerging themes, pre-TB diagnosis health-seeking behaviors and post TB-diagnosis experiences, several subthemes were identified. For the former theme, the subthemes include, seeking help from community-based healers and self-medicating, waiting for some period to see if the alternative medicine or treatment worked, taking time to visit a healthcare facility, triggers to seek healthcare, and symptoms reported on presentation to the healthcare facility. The post-TB diagnosis subthemes include making sense of the TB diagnosis, context of disclosing the TB status, fear of social exclusion and experiences of stigma, support received during illness, life changes after TB infection and diagnosis, and lessons learned from the TB experience and future healthcare-seeking behavior. CONCLUSION: Secrecy about the TB diagnosis indicates fear of social exclusion, and this could be due to the highly stigmatized nature of TB. Waiting to see if alternative medication worked, delayed the TB diagnosis, with consequent late initiation of the anti-TB treatment. The life changes experienced post-TB diagnosis affect the quality of life of the participants and their families. The study recommends that these issues be addressed as a priority.

Differences in Sexual Behavior and Partner Notification for Sexually Transmitted Infections Between the Out of School Youth and University Students in a Peri-Urban District in South Africa-A Cross-Sectional Survey.

The increase in sexually transmitted infections (STIs) in young people is a public health concern. Among those in university and out of school, different contextual factors contribute to their risky sexual behavior and increased susceptibility to STIs and HIV. There are limited comparative studies examining risky sexual behavior and partner notification (PN) between these two groups, particularly in South Africa. We investigated sexual behaviors, self-reported STI diagnosis, health seeking behavior, and preferred PN methods of university students and out of school youth. A descriptive cross-sectional survey was used using convenient sampling to select 917 students across five health sciences universities and through periodic sampling 699 out of school youth were selected from two main local shopping centers in South Africa. Descriptive statistics, bivariate and multivariable logistic analysis were performed using Stata IC version 14. More university students (71.7%) than out of school youth were in casual relationships (28.3%), with half of out of school youth being in steady relations (50.2%). Moreover, university students (65.7%) used a condom in the past 6 months compared to their counterparts (34.3%). Of the 124 youth who were diagnosed with STI in the past 12 months, majority (n = 106, 85%) were out of school youth. The probability of notifying a partner about a STI infection was 82% among university students compared to their counterparts (p = >0.05). The odds of notifying a partner was 1.79 times more for those having multiple sexual partners than those who had only one partner. Both groups preferred a face-to-face STI disclosure with partner; however, more university students (67%) preferred SMS notification than PN referral slips as compared to out of school youth (42%). Both the university students and the out of school youth engaged in risky sexual behaviors. Both groups preferred face-to-face and clinic SMS partner notifications, even though university students were in the majority. There is a need for developing health promotion scripts on disclosing STIs to sexual partners to empower the majority of the youth who prefer face-to-face PN over the prescribed methods.

Self-Reported Prevalence of HIV Infection, Sexually Transmitted Infections and Risky Sexual Behavior among Mental Health Care Users Accessing Healthcare Services in Tshwane District, South Africa.

The rate of HIV and sexually transmitted infections among mental patients is higher than that of the general population worldwide. Many risky sexual behaviors are associated with mental illness. However, mental health care users (MHCUs) are not specifically targeted for HIV preventative care, and routine HIV testing is not done among this population. Limited studies have investigated self-reported HIV and STI prevalence and associated risky sexual behavior in persons with mental illnesses accessing health care services in South Africa in particular. This study set out to determine both the Sexually Transmitted Infections (STI) and human immunodeficiency virus (HIV) self-reported prevalence and sexual practices of MHCUs. A descriptive cross-sectional survey using purposive sampling was used to select 107 MHCUs across five clinics within Gauteng Province of South Africa who were above the age of 18, had a mental illness, and were currently stable and receiving chronic medication. Descriptive statistics were performed using Stata IC version 16. The chi square test was used to indicate statistical significance (p < 0.05) of differences in frequency distributions. More males (52.5%) than females were currently in a sexual relationship (50.0%), having multiple sexual partners (n = 4.13%), and having alcohol-driven sex (n = 4.19%). The majority of MHCUs (n = 82.77%) had an STI in the past six months, and a quarter (n = 21.25%) were HIV-positive with over two-thirds of MHCU (n = 69.70%) perceiving themselves not at risk for HIV. MHCUs engaged in risky behaviors had a low perception of the risks of contracting HIV. Bivariate analysis of gender by sexual behavior revealed that female MHCUs are more at risk of being forced to have sex compared to males (p = 0.006). Integrated interventions should be put in place to ensure that MHCUs' sexual and reproductive health are not left behind and issues such as sexual education, safe sex, and sexually transmitted infections should form part of the care of MHCUs.

Prevalence of delay in seeking tuberculosis care and the health care seeking behaviour profile of tuberculous patients in a rural district of KwaZulu Natal, South Africa.

INTRODUCTION: patient delay in seeking TB (tuberculosis) care is reported as one of the major hurdles undermining the efforts of controlling TB by many TB control programmes of the world. The main aim of this study was to determine the prevalence of this phenomenon and to profile the TB patients that delayed seeking TB care in a rural area of KwaZulu Natal province of South Africa. METHODS: this was a cross-sectional study, conducted among 200 TB patients attending primary health care facilities in Ugu District. Patient data were collected by a self-administered questionnaire, entered into an Excel file and imported into the EpiInfo 7 statistical software for analysis. Frequency tables were used to display the data and the p value was used for statistical significance. RESULTS: about 40% of the participants delayed seeking TB care in this study, and these were mostly individuals who were married, the employed and those who walked to the clinic. Delay was also prevalent among those that self-medicated, bought medication from the pharmacy and sought TB care from a private doctor. The reasons included the great distances, long queues waiting at the facilities, and not feeling ill. CONCLUSION: the 4 weeks cut-off in seeking TB care in this study far exceeds the recommended 2 weeks. This study recommends periodic active TB case finding and active engagement between the public and the private health sectors.

A Comparative Analysis of Risky Sexual Behaviors, Self-Reported Sexually Transmitted Infections, Knowledge of Symptoms and Partner Notification Practices among Male and Female University Students in Pretoria, South Africa.

The surge of sexually transmitted infections (STIs) among young people is of public health importance, and the notification and treatment of sex partners after the diagnosis of an STI is a public health approach to prevent and reduce further transmissions. There are limited studies that investigate partner notification among young people in general, and university students in South Africa in particular. We investigated self-reported STIs and partner notification practice, intentions, and preferences among university students. We also assessed their STI knowledge and risky sexual behaviour in relation to STIs. The study was a descriptive cross-sectional survey that used multistage sampling to select 918 students across the five schools of a health sciences university in South Africa. Descriptive statistics and bivariate logistic analysis were performed using Stata IC version 16. More males (54.1%) than females were currently in a sexual relationship (47.3%), more males reported multiple sexual partners (n = 114, 46%), engaged in transactional sex (n = 13, 5.3%), and had one-night stands (n = 68, 28.1%) in the past 12 months (p = 0.001). Moreover, half (55.9%) had poor knowledge of STIs with an overall mean knowledge score of 2.9 ± 2.0, and the majority (85.8%) perceived themselves to be at low risk of acquiring STIs. The odds of intentions to disclose an STI infection to a sexual partner and delivering a partner notification slip to ex-sexual partners were not statistically significant (p = 0.95; p = 0.10), with the likelihood of disclosure being 1.3 times for female students compared to males. Female students were 1.5 times as likely to prefer a doctor to send an SMS notification to their sexual partners (p = 0.02) compared to their male counterparts, while the preference of an SMS notification was 41% (p = 0.03) among female students. Students engaged in risky behaviours but had a low perception of the risks of acquiring STIs. Although they had preferences of different methods of partner notification, both male and female students preferred SMS partner notifications from a doctor, even though women were in the majority. Health care providers should put in place interventions so that young people can safely inform their partners about STIs.