Engaging beneficiaries in family-centred interventions is a well-documented challenge. Programme engagement evidence is limited for low- and middle-income countries. This study assessed the effect of incentives on participant engagement in a family-centred HIV prevention programme among caregiver and adolescent groups in KwaZulu Natal. Incentive packages were randomly assigned by site, ranging from optimal (to address major structural barriers) to basic (routinely provided by organisations serving vulnerable youth). Attendance rates for 490 caregivers and their 583 adolescents were measured. Cross tabulations of attendance and incentive data demonstrated the highest level of caregiver attendance and programme completion among groups receiving optimal incentives.
Interventions that promote sexual health communication between adolescents and their parents or other primary caregivers are an important tool for reducing female adolescents’ behavioral risk. Understanding the mechanisms by which interventions effectively foster communication can inform future programs. Using mixed methods data from an evaluation of Let’s Talk, this analysis explores the role of parental knowledge, the quality of the parent-adolescent relationship, and the mental health of both parties on caregiver-adolescent sexual health communication. Findings suggest that a holistic intervention approach emphasizing caregiver-adolescent relationship development and designed to support the mental health of both parties may hold significant promise for enhancing sexual health communication.
Background: Child and youth care workers (CYCWs) are a crucial and growing component of South Africa’s national response to HIV and AIDS and other issues affecting children and families. CYCWs use the community-centred Isibindi model of care to reach the most vulnerable with key services including psychosocial, health, economic and education support. Like others in similar professions, they may be at risk for occupational challenges affecting retention.
Let’s Talk is a structured, family-centered adolescent HIV prevention program developed for use in South Africa using key components adapted from programs successfully implemented in the US and South Africa. It is designed to address individual HIV transmission risk factors common among orphaned and vulnerable adolescents, including elevated risk for poor psychological health and sexual risk behavior. These efforts are accentuated through parallel programing to support caregivers’ mental health and parenting skills.
Many children in South Africa live outside of parental care due to orphanhood, parental labour migration, unemployment and unstable formal partnerships. Few studies have examined risk factors for parent-to-child physical aggression (PCPA), a term encompassing varying severities of physically aggressive acts, among children residing outside of parental care. In this context prior custody preparation is uncommon, and alternative caregivers have been found to experience high levels of psychological distress and burden. This study examined these risk factors using secondary analysis of baseline cross-sectional survey data drawn from a bereavement support group evaluation.
Preventing HIV among young people is critical to achieving and sustaining global epidemic control. Evidence from Western settings suggests that family-centred prevention interventions may be associated with greater reductions in risk behaviour than standard adolescent-only models. Despite this, family-centred models for adolescent HIV prevention are nearly non-existent in South Africa − home to more people living with HIV than any other country. This paper describes the development and formative evaluation of one such intervention: an evidence-informed, locally relevant, adolescent prevention intervention engaging caregivers as co-participants.
To our knowledge, this is the first study to document correlates of complicated grief among bereaved adolescents in sub-Saharan Africa. Participants included 339 female adolescents in South Africa who experienced the loss of a loved one at least six months prior to the survey; their primary caregivers were also surveyed. One-fifth of adolescents were classified as having complicated grief using the Inventory of Complicated Grief Revised for Children in conjunction with grief-induced functional impairment.
Background: Bereavement increases children’s risk for psychological disorders, highlighting the need for effective interventions, especially in areas where orphanhood is common. We aimed to assess the effects of an eight-session support group intervention on the psychological health of bereaved female adolescents in South Africa.
Community-based care and support programmes for orphaned and vulnerable children and their families are a critical component of HIV prevention and treatment efforts worldwide. The challenges of evaluating community-based programmes for HIV-affected families limit the evidence base for effective social work programming. Addressing these challenges can improve the validity of evaluations to provide better direction for the programme under study as well as promote best practices generally.
Children and adolescents affected by HIV are at elevated risk of depression, yet research on related interventions in this population is scarce in sub-Saharan Africa. This study sought to examine the effects of interpersonal psychotherapy for groups (IPTG) on depressive symptomology among orphaned and vulnerable adolescents in South Africa. A cluster randomized controlled trial wherein adolescents ages 14–17 enrolled in community-based programming for HIV-affected and vulnerable families were randomly assigned by geographic cluster to participate in a 16-session IPTG intervention or the standard of care (n = 489).
The objective of this study was to assess standard grief measures through cognitive interviews with bereaved adolescents in Free State, South Africa, and make recommendations designed to improve the measurement of grief in this and similar populations. Twenty-one parentally bereaved adolescents participated in semi-structured cognitive interviews about the Core Bereavement Items (CBI) questionnaire, Grief Cognitions Questionnaire for Children (GCQ-C), or Intrusive Griefs Thoughts Scale (IGTS).
HIV counseling and testing (HCT) is critical for children in generalized epidemic settings, but significant shortfalls in coverage persist, notably among orphans and others at disproportionate risk of infection. This study investigates the impact of a home visiting program in South Africa on orphaned and vulnerable children’s uptake of HCT. Using propensity score matching, survey data for children receiving home visits from trained community-based care workers were compared to data from children living in similar households that had not yet received home visits (n = 1324).
Evidence-based approaches are needed to address the high levels of sexual risk behavior and associated HIV infection among orphaned and vulnerable adolescents. This study recruited adolescents from a support program for HIV-affected families and randomly assigned them by cluster to receive one of the following: (1) a structured group-based behavioral health intervention; (2) interpersonal psychotherapy group sessions; (3) both interventions; or (4) no new interventions.
Cash transfer programs hold significant potential to mitigate the economic burdens resulting from the HIV epidemic and enhance the wellbeing of affected children. South Africa offers two cash transfers designed specifically to benefit children: the Child Support Grant, for low income families with children, and the Foster Child Grant, for children living outside of parental care. Given the high proportion of HIV-affected children who qualify for these grants, increasing grant access among eligible families is a natural objective for many programs targeting orphans and vulnerable children.
HIV places acute stressors on affected children and families; especially in resource limited contexts like sub-Saharan Africa. Despite their importance, the epidemic’s potential consequences for family dynamics and children’s psychological health are understudied. Using a population-based sample of 2,487 caregivers and 3,423 children aged 8–14 years from the Central Province of Kenya, analyses were conducted to examine whether parental illness and loss were associated with family functioning and children’s externalizing behaviors.
Home visiting is a popular component of programs for HIV-affected children in sub-Saharan Africa, but its implementation varies widely. While some home visitors are lay volunteers, other programs invest in more highly trained paraprofessional staff. This paper describes a study investigating whether additional investment in paraprofessional staffing translated into higher quality service delivery in one program context. Beneficiary children and caregivers at sites in KwaZulu-Natal, South Africa were interviewed after 2 years of program enrollment and asked to report about their experiences with home visiting.
The AIDS epidemic has created an unprecedented number of orphans. While largely absorbed by extended family, this additional responsibility can weigh heavily on their caregivers. The concept of caregiver burden captures multiple dimensions of well-being (e.g., physical, social and psychological). Measuring the extent and determinants of caregiving burden can inform the design of programmes to ease the negative consequences of caregiving. This study uses the baseline data from a study assessing interventions for orphans and vulnerable adolescents in the Eastern Cape, South Africa.
Children and families affected by HIV are at considerable risk for psychological distress. Community-based home visiting is a common mechanism for providing basic counseling and other services to HIV-affected families. While programs emphasize home visitor training and compensation as means to promote high-quality service delivery, whether these efforts result in measurable gains in beneficiaries’ well-being remains largely unanswered. This study employs a longitudinal quasi-experimental design to explore whether these kinds of investments yield concomitant gains in psychological outcomes among beneficiaries.
Child maltreatment is a serious concern in South Africa and significantly undermines the development and wellbeing of children affected by it. This study aimed to explore the types of abuse that were reported for children brought to the Sunlight Safe House; an after-hours service for abused and abandoned children based in Johannesburg. The sample consisted of 1 461 cases opened at the Sunlight Safe House between January 2006 and June 2012 and included children from birth to 18 years of age.
HIV and AIDS have altered the context in which millions of children in sub-Saharan Africa are raised. Many are under the care of a widowed or ill parent, and others are residing with their extended family. Caregivers of orphans and other vulnerable children (OVC) face a variety of stressors that may adversely affect children. This study explores potential benefits of caregivers’ membership in support groups on their own psychosocial well-being, and on the treatment and psychosocial well-being of OVC aged 8–14 under their care.