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Article ; Online: Social Determinants of Alcohol and Other Drug Misuse Among Women Living with HIV in Economically Underserved Communities in Cape Town, South Africa: A Cross-Sectional Study.

Browne, Felicia A / Gichane, Margaret W / Shangase, Nosipho / Ndirangu, Jacqueline / Bonner, Courtney Peasant / Wechsberg, Wendee M

AIDS and behavior

2022 Volume 27, Issue 4, Page(s) 1329–1338

Abstract: This study aimed to understand how social determinants-the economic and social factors that affect health and well-being-are associated with self-reported and biological alcohol and other drug misuse in South Africa among women living with HIV. Logistic ... ...

Abstract	This study aimed to understand how social determinants-the economic and social factors that affect health and well-being-are associated with self-reported and biological alcohol and other drug misuse in South Africa among women living with HIV. Logistic regression analyses were performed using baseline data from an implementation science trial conducted from 2015 to 2018 with 480 Black and Coloured women who were living with HIV and reported recent alcohol or other drug misuse. Educational attainment, type of housing, access to running water, food insecurity, and housing instability were examined. Women with higher education had reduced odds of any drug misuse-both biological (aOR: 0.53; 95% CI: 0.33-0.84) and self-reported (aOR: 0.37; 95% CI: 0.22-0.64). Women living in formal housing had increased odds of a positive alcohol screening test (aOR: 1.92; 95% CI: 1.16-3.18) and women with housing instability had increased odds of self-reported alcohol misuse-daily (aOR: 1.99; 95% CI: 1.18-3.35) and weekly (aOR:1.91; 95% CI: 1.19-3.07). Food insecurity was associated with reduced odds of self-reported alcohol misuse (aOR: 0.40; 95% CI: 0.25-0.64) and increased odds of self-reported drug misuse (aOR: 2.05; 95% CI: 1.16-3.61). These findings indicate the complexity of the relationship between social determinants and alcohol and other drug misuse, and may have implications for addressing social and structural determinants as part of multilevel interventions focused on reducing alcohol and other drug misuse among key populations of women in South Africa.
MeSH term(s)	Humans ; Female ; Cross-Sectional Studies ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; HIV Infections/diagnosis ; Social Determinants of Health ; South Africa/epidemiology ; Alcoholism ; Drug Misuse
Language	English
Publishing date	2022-11-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	1339885-4
ISSN	1573-3254 ; 1090-7165
ISSN (online)	1573-3254
ISSN	1090-7165
DOI	10.1007/s10461-022-03869-1
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Article ; Online: The Importance of the Individual in PrEP Uptake: Multilevel Correlates of PrEP Uptake Among Adolescent Girls and Young Women in Tshwane, South Africa.

Bonner, Courtney Peasant / Minnis, Alexandra M / Ndirangu, Jacqueline W / Browne, Felicia A / Speizer, Ilene / Nyblade, Laura / Ahmed, Khatija / Wechsberg, Wendee M

AIDS and behavior

2023 Volume 27, Issue 12, Page(s) 4124–4130

Abstract: Adolescent girls and young women (AGYW) account for 25% of new HIV infections in South Africa. Pre-exposure prophylaxis (PrEP) is approved by the South African Government, but the factors that promote PrEP uptake among AGYW are not well understood. This ... ...

Abstract	Adolescent girls and young women (AGYW) account for 25% of new HIV infections in South Africa. Pre-exposure prophylaxis (PrEP) is approved by the South African Government, but the factors that promote PrEP uptake among AGYW are not well understood. This study examines multilevel factors associated with PrEP uptake among AGYW in six clinic catchment areas in Tshwane (Pretoria), South Africa. After consent/assent, PrEP-eligible AGYW (n = 448) completed a questionnaire assessing factors at the individual, network/interpersonal, and community levels and were prescribed PrEP in study clinics, if interested. A multivariable model, adjusting for clustering, assessed factors associated with PrEP uptake over a 9-month period. At the individual level, multiple partners in the past 3 months (OR = 0.47), perceived risk of HIV (OR = 0.71), and PrEP-related shame (OR = 0.63) were correlated with lower odds of PrEP uptake (ps ≤ 0.05). The findings highlight modifiable factors that should be addressed to support PrEP uptake efforts.
MeSH term(s)	Humans ; Female ; Adolescent ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; HIV Infections/drug therapy ; South Africa/epidemiology ; Anti-HIV Agents/therapeutic use ; Pre-Exposure Prophylaxis ; Cluster Analysis
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2023-07-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	1339885-4
ISSN	1573-3254 ; 1090-7165
ISSN (online)	1573-3254
ISSN	1090-7165
DOI	10.1007/s10461-023-04126-9
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Article ; Online: The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa.

Myers, Bronwyn / Browne, Felicia A / Carney, Tara / Kline, Tracy / Bonner, Courtney Peasant / Wechsberg, Wendee M

International journal of environmental research and public health

2021 Volume 18, Issue 21

Abstract: Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes ... ...

Abstract	Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes associations between combinations of abuse type and timing with mental health, substance use, and sexual risk outcomes among a sample of 499 AGYW (aged 16 to 19) who had left school early and were recruited for a cluster randomized trial in Cape Town, South Africa. Approximately one-third (33.5%; 95% CI: 28.7, 38.6) of participants reported lifetime abuse. Exposure to more than one type of abuse was associated with increased risk of depression (β = 3.92; 95% CI: 2.25, 5.59) and anxiety (β = 3.70; 95% CI: 2.11, 5.28), and greater odds of polydrug use (OR = 2.10; 95% CI: 1.02, 4.34) and substance-impaired sex (OR = 2.17; 95% CI: 1.31, 3.86). Exposure to multiple types of abuse during childhood/early adolescence and again in late adolescence was associated with increased risk of depression (β = 4.65; 95% CI: 3.15, 6.14), anxiety (β = 4.35; 95% CI: 2.70, 6.02), and polydrug use (OR = 2.37; 95% CI: 1.03, 5.73). Findings underscore the need for trauma-informed interventions that reduce mental health, substance use, and sexual risks among AGYW who have experienced multiple forms of abuse and recurrent abuse.
MeSH term(s)	Adolescent ; Child ; Female ; HIV Infections ; Humans ; Mental Health ; Outcome Assessment, Health Care ; Schools ; South Africa/epidemiology ; Substance-Related Disorders/epidemiology
Language	English
Publishing date	2021-10-29
Publishing country	Switzerland
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph182111403
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Article ; Online: Binge drinking and condom negotiation behaviours among adolescent girls and young women living in Cape Town, South Africa: sexual control and perceived personal power.

Singer, Suzanne E / Wechsberg, Wendee M / Kline, Tracy / Browne, Felicia A / Howard, Brittni N / Carney, Tara / Myers, Bronwyn / Bonner, Courtney Peasant / Chin-Quee, Dawn

BMC public health

2023 Volume 23, Issue 1, Page(s) 2282

Abstract: Background: Condom use among young people in South Africa has declined in recent years and adolescent girls and young women continue to bear the highest incidence of HIV in the country. Young women who have dropped out of school may be more at risk ... ...

Abstract	Background: Condom use among young people in South Africa has declined in recent years and adolescent girls and young women continue to bear the highest incidence of HIV in the country. Young women who have dropped out of school may be more at risk because of traditional gender norms that create substantial power imbalances and a lack of power to negotiate condom use with their male partners, especially when using alcohol and other drugs. Methods: This study presents an analysis of baseline data provided by 500 adolescent girls and young women (AGYW) from Cape Town communities between November 2016 and November 2018 who were reached for a cluster-randomised trial conducted to assess the efficacy of an evidence-based, young woman-focused intervention seeking to reduce HIV risk and substance use behaviours. The analysis focuses on associations between binge drinking, condom use, and sexual negotiation, including impaired sex (any substance use at last sex). Results: AGYW who reported frequent condom negotiation with their partners were 8.92 times (95% CI: [4.36, 18.24]) as likely to use a condom when alcohol or other drugs were not used at last sex and 5.50 times (95% CI: [2.06, 14.72]) as likely when alcohol or other drugs were used at last sex (p < 0.05). AGYW who reported frequent binge drinking in the past month (n = 177) had significantly reduced odds of condom use at last sex, irrespective of whether the sex was impaired (OR 0.60, 95% CI: [0.49, 0.73]) or not impaired (OR 0.69, 95% CI: [0.60, 0.81]). Discussion: The findings highlight the need for interventions that reach AGYW in South Africa by specifically aiming to educate AGYW about the effect of binge drinking on negotiating power in their relationships, thus providing them with the knowledge and skills to increase agency regarding condom use. Trial registration: ClinicalTrials.gov Identifier: NCT02974998 (recruitment completed). 29/11/2016.
MeSH term(s)	Adolescent ; Female ; Humans ; Male ; Binge Drinking/epidemiology ; Binge Drinking/prevention & control ; Condoms ; Ethanol ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; Negotiating ; Sexual Behavior ; Sexual Partners ; South Africa/epidemiology ; Substance-Related Disorders
Chemical Substances	Ethanol (3K9958V90M)
Language	English
Publishing date	2023-11-18
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-023-17188-0
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Article ; Online: Sustainability of a gender-focused HIV and alcohol risk-reduction intervention in usual care settings in South Africa: a mixed methods analysis.

Gichane, Margaret W / Wechsberg, Wendee M / Ndirangu, Jacqueline / Howard, Brittni / Bonner, Courtney Peasant / Browne, Felicia A / Zule, William A

AIDS care

2021 Volume 33, Issue sup1, Page(s) 11–17

Abstract: Intervention sustainability is a critical yet understudied aspect of implementation science research. To address this gap, we examined the sustainability of the Women's Health CoOp (WHC), a gender-focused, evidence-based, HIV and alcohol risk-reduction ... ...

Abstract	Intervention sustainability is a critical yet understudied aspect of implementation science research. To address this gap, we examined the sustainability of the Women's Health CoOp (WHC), a gender-focused, evidence-based, HIV and alcohol risk-reduction intervention, after an implementation trial. We used a mixed methods design consisting of questionnaires (
MeSH term(s)	Female ; HIV Infections/prevention & control ; Humans ; Risk Reduction Behavior ; South Africa ; Substance-Related Disorders/therapy ; Women's Health
Language	English
Publishing date	2021-09-19
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1012651-x
ISSN	1360-0451 ; 0954-0121
ISSN (online)	1360-0451
ISSN	0954-0121
DOI	10.1080/09540121.2021.1966694
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Article ; Online: "Because all mothers is not the same": The development and implementation of an in loco parentis informed consent procedure to enroll adolescent girls and young women to participate in HIV research.

Bonner, Courtney Peasant / Fisher, Celia B / Carney, Tara / Browne, Felicia A / Gichane, Margaret W / Howard, Brittni N / Turner, Leslie / Wechsberg, Wendee M

Journal of adolescence

2021 Volume 93, Page(s) 234–244

Abstract: Introduction: South Africa has one of the highest incidences of HIV among adolescent girls and young women (AGW), ages 15-24, and recent research has focused on developing interventions for HIV prevention. However, the South African National Health Act ... ...

Abstract	Introduction: South Africa has one of the highest incidences of HIV among adolescent girls and young women (AGW), ages 15-24, and recent research has focused on developing interventions for HIV prevention. However, the South African National Health Act requires those under 18 years of age to obtain a guardian's permission to participate in research. Limiting research enrolment to AGYW who can obtain guardian consent may lead to non-representative findings. Therefore, innovative, inclusive consent approaches that protect AGYW from the risks of research are needed. Methods: This report details the development and implementation of an approach called the in loco parentis (in place of parent) consent procedure. In loco parentis consent provides a vehicle for adolescent participation that protects adolescents from potential social harms. The in loco parentis consent procedure does not seek to obtain independent minor consent but seeks to obtain permission for the minor to participate in research from a trusted adult who is not a minor's parent or legal guardian. This report also qualitatively explores the experiences of 31 AGYW who were recruited into a behavioral HIV prevention study using this method. Results: Findings suggest that the in loco parentis consent procedure is a feasible and acceptable method to inclusively AGYW in HIV research. Conclusions: The in loco parentis procedure may provide a more inclusive strategy to recruit AGYW for HIV research to increase the generalizability of findings.
MeSH term(s)	Adolescent ; Adult ; Black People ; Female ; HIV Infections/prevention & control ; Humans ; Informed Consent ; Mothers ; Parents ; Young Adult
Language	English
Publishing date	2021-12-09
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	303529-3
ISSN	1095-9254 ; 0140-1971
ISSN (online)	1095-9254
ISSN	0140-1971
DOI	10.1016/j.adolescence.2021.11.001
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Article ; Online: Current Interventions for People Living with HIV Who Use Alcohol: Why Gender Matters.

Wechsberg, Wendee M / Browne, Felicia A / Bonner, Courtney Peasant / Washio, Yukiko / Howard, Brittni N / van der Drift, Isa

Current HIV/AIDS reports

2021 Volume 18, Issue 4, Page(s) 351–364

Abstract: Purpose of review: Alcohol is the most misused substance in the world. For people living with HIV (PLWH), alcohol misuse may impact ART adherence and viral suppression. This review of the most recently published alcohol intervention studies with PLWH ... ...

Abstract	Purpose of review: Alcohol is the most misused substance in the world. For people living with HIV (PLWH), alcohol misuse may impact ART adherence and viral suppression. This review of the most recently published alcohol intervention studies with PLWH examines how these studies considered gender in the samples, design, and analyses. Recent findings: Three searches were conducted initially, and 13 intervention studies fit our criteria with alcohol outcomes. In general, most studies did not consider gender and had used small samples, and few demonstrated significant efficacy/effectiveness outcomes. Five studies considered gender in their samples or analyses and/or were woman-focused with larger samples and demonstrated significant outcomes. It is essential for women who misuse alcohol to not only be well represented in alcohol and HIV research but also for studies to consider the barriers to reaching them and their contextual demands and/or co-occurring issues that may affect participation and outcomes in intervention research.
MeSH term(s)	Female ; HIV Infections/drug therapy ; Humans ; Medication Adherence
Language	English
Publishing date	2021-06-10
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	2151206-1
ISSN	1548-3576 ; 1548-3568
ISSN (online)	1548-3576
ISSN	1548-3568
DOI	10.1007/s11904-021-00558-x
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Article ; Online: Outcomes of Implementing in the Real World the Women's Health CoOp Intervention in Cape Town, South Africa.

Wechsberg, Wendee M / Browne, Felicia A / Ndirangu, Jacqueline / Bonner, Courtney Peasant / Kline, Tracy L / Gichane, Margaret / Zule, William A

AIDS and behavior

2021 Volume 25, Issue Suppl 3, Page(s) 276–289

Abstract: Women in South Africa living with HIV who use alcohol may not adhere to ART, affecting the country's 90-90-90 targets. The Women's Health CoOp (WHC), a woman-focused HIV intervention, has shown efficacy in numerous trials with key populations of women in ...

Abstract	Women in South Africa living with HIV who use alcohol may not adhere to ART, affecting the country's 90-90-90 targets. The Women's Health CoOp (WHC), a woman-focused HIV intervention, has shown efficacy in numerous trials with key populations of women in South Africa who use alcohol and drugs. In a hybrid implementation effectiveness study, the WHC was implemented in usual care clinics by healthcare providers in a modified stepped-wedge design. We present the outcomes of alcohol use and ART adherence with 480 women, with a 95% 6-month follow-up rate across 4 implementation cycles. Compared with the first cycle, women in the fourth cycle were significantly less likely (OR = 0.10 [95% CI 0.04, 0.24]) to report alcohol use disorder risk and were 4 times more likely (OR = 4.16 [95% CI 1.05, 16.51]) to report ART adherence at 6-month follow-up. Overall, acceptability and satisfaction were extremely high. The WHC intervention was successful in reaching key populations of women to reduce alcohol use and increase ART adherence, which is essential for South Africa to reach the 90-90-90 goals.
MeSH term(s)	Alcohol Drinking/epidemiology ; Alcohol Drinking/prevention & control ; Anti-HIV Agents/therapeutic use ; Ethanol ; Female ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; Humans ; South Africa/epidemiology ; Women's Health
Chemical Substances	Anti-HIV Agents ; Ethanol (3K9958V90M)
Language	English
Publishing date	2021-04-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	1339885-4
ISSN	1573-3254 ; 1090-7165
ISSN (online)	1573-3254
ISSN	1090-7165
DOI	10.1007/s10461-021-03251-7
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Article: Accuracy and Utility of the AUDIT-C with Adolescent Girls and Young Women (AGYW) Who Engage in HIV Risk Behaviors in South Africa.

Kline, Tracy / Owens, Corina / Bonner, Courtney Peasant / Carney, Tara / Browne, Felicia A / Wechsberg, Wendee M

Journal of applied measurement

2019 Volume 20, Issue 1, Page(s) 112–122

Abstract: Hazardous drinking is a risk factor associated with sexual risk, gender-based violence, and HIV transmission in South Africa. Consequently, sound and appropriate measurement of drinking behavior is critical to determining what constitutes hazardous ... ...

Abstract	Hazardous drinking is a risk factor associated with sexual risk, gender-based violence, and HIV transmission in South Africa. Consequently, sound and appropriate measurement of drinking behavior is critical to determining what constitutes hazardous drinking. Many research studies use internal consistency estimates as the determining factor in psychometric assessment; however, deeper assessments are needed to best define a measurement tool. Rasch methodology was used to evaluate a shorter version of the Alcohol Use Disorders Identification Test, the AUDIT-C, in a sample of adolescent girls and young women (AGYW) who use alcohol and other drugs in South Africa (n =100). Investigations of operational response range, item fit, sensitivity, and response option usage provide a richer picture of AUDIT-C functioning than internal consistency alone in women who are vulnerable to hazardous drinking and therefore at risk of HIV. Analyses indicate that the AUDIT-C does not adequately measure this specialized population, and that more validation is needed to determine if the AUDIT-C should continue to be used in HIV prevention intervention studies focused on vulnerable adolescent girls and young women.
MeSH term(s)	Adolescent ; Alcoholism/epidemiology ; Female ; HIV ; HIV Infections/epidemiology ; Humans ; Risk-Taking ; South Africa/epidemiology ; Young Adult
Language	English
Publishing date	2019-03-27
Publishing country	China (Republic : 1949- )
Document type	Journal Article
ISSN	1529-7713
ISSN	1529-7713
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Article ; Online: Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women: conflicting perspectives in South Africa.

Nyblade, Laura / Ndirangu, Jacqueline W / Speizer, Ilene S / Browne, Felicia A / Bonner, Courtney Peasant / Minnis, Alexandra / Kline, Tracy L / Ahmed, Khatija / Howard, Brittni N / Cox, Erin N / Rinderle, Abigail / Wechsberg, Wendee M

BMC public health

2022 Volume 22, Issue 1, Page(s) 1916

Abstract: Background: Globally, an urgent need exists to expand access to HIV prevention among adolescent girls and young women (AGYW), but the need is particularly acute in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) offers an effective HIV ... ...

Abstract	Background: Globally, an urgent need exists to expand access to HIV prevention among adolescent girls and young women (AGYW), but the need is particularly acute in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) offers an effective HIV prevention method. In many countries, however, accessing PrEP necessitates that AGYW visit their local health clinic, where they may face access challenges. Some countries have implemented youth-friendly services to reduce certain challenges in local health clinics, but barriers to access persist, including clinic stigma. However, evidence of clinic stigma toward AGYW, particularly with respect to PrEP service delivery, is still limited. This mixed methods study explores stigma toward AGYW seeking clinic services, in particular PrEP, from the perspective of both clinic staff (clinical and nonclinical) and AGYW who seek services at clinic sites in Tshwane province, South Africa. Methods: Six focus group discussions were conducted with AGYW (43 total participants) and four with clinic staff (42 total participants) and triangulated with survey data with AGYW (n = 449) and clinic staff (n = 130). Thematic analysis was applied to the qualitative data and descriptive statistics were conducted with the survey data. Results: Four common themes emerged across the qualitative and quantitative data and with both AGYW and clinic staff, although with varying degrees of resonance between these two groups. These themes included (1) clinic manifestations of stigma toward AGYW, (2) concerns about providing PrEP services for AGYW, (3) healthcare providers' identity as mothers, and (4) privacy and breaches of confidentiality. An additional theme identified mainly in the AGYW data pertained to stigma and access to healthcare. Conclusion: Evidence is needed to inform strategies for addressing clinic stigma toward AGYW, with the goal of removing barriers to PrEP services for this group. While awareness has increased and progress has been achieved around the provision of comprehensive, youth-friendly sexual and reproductive health services, these programs need to be adapted for the specific concerns of young people seeking PrEP services. Our findings point to the four key areas noted above where programs seeking to address stigma toward AGYW in clinics can tailor their programming.
MeSH term(s)	Adolescent ; Anti-HIV Agents/therapeutic use ; Female ; HIV Infections/drug therapy ; HIV Infections/prevention & control ; Humans ; Pre-Exposure Prophylaxis ; Social Stigma ; South Africa
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2022-10-14
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-022-14236-z
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