Browsing by Author "Kagee, Ashraf"

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    Afri-Can Forum 2
    (Biomed Central, 2016-07-12) Mukudu, Hillary; Martinson, Neil; Sartorius, Benn; Coetzee, Jenny; Dietrich, Janan; Mokgatswana, Kgaugelo; Jewkes, Rachel; Gray, Glenda E.; Dugas, Marylene; Behanzin, Luc; Guedou, Fernand A.; Gagnon, Marie-Pierre; Alary, Michel; Rutakumwa, Rwamahe; Mbonye, Martin; Kiwanuka, Thadeus; Nakamanya, Sarah; Muhumuza, Richard; Nalukenge, Winfred; Seeley, Janet; Atujuna, Millicent; Wallace, Melissa; Brown, Ben; Bekker, Linda G.; Newman, Peter A.; Harryparsad, Rushil; Olivier, Abraham J.; Jaspan, Heather B.; Wilson, Douglas; Dietrich, Janan; Martinson, Neil; Mukudu, Hillary; Mkhize, Nonhlanhla; Morris, Lynn; Cianci, Gianguido; Dinh, Minh; Hope, Thomas; Passmore, Jo-Ann S.; Gray, Clive M.; Henrick, Bethany M.; Yao, Xiao-Dan; Rosenthal, Kenneth L.; Henrick, Bethany M.; Yao, Xiao-Dan; Drannik, Anna G.; Rosenthal, Kenneth L.; Chanzu, Nadia; Mwanda, Walter; Oyugi, Julius; Anzala, Omu; Mbow, Moustapha; Jallow, Sabelle; Thiam, Moussa; Davis, Alberta; Diouf, Assane; Ndour, Cheikh T.; Seydi, Moussa; Dieye, Tandakha N.; Mboup, Souleymane; Goodier, Martin; Rilley, Eleanor; Jaye, Assan; Yao, Xiao-Dan; Omange, R. W.; Henrick, Bethany M.; Lester, Richard T.; Kimani, Joshua; Ball, T. B.; Plummer, Francis A.; Rosenthal, Kenneth L.; Behanzin, Luc; Guedou, Fernand A.; Geraldo, Nassirou; Mastetse, Ella G.; Sossa, Jerome C.; Zannou, Marcel D.; Alary, Michel; Osawe, Sophia; Okpokoro, Evaezi; Okolo, Felicia; Umaru, Stephen; Abimiku, Rebecca; Audu, Sam; Datong, Pam; Abimiku, Alashle; Nyange, Jacquelyn; Olenja, Joyce; Mutua, Gaudensia; Jaoko, Walter; Omosa-Manyonyi, Gloria; Farah, Bashir; Khaniri, Maureen; Anzala, Omu; Cockcroft, Anne; Tonkin, Kendra; Girish, Indu; Mhati, Puna; Cunningham, Ashley; Andersson, Neil; Farah, Bashir; Indangasi, Jackton; Jaoko, Walter; Mutua, Gaudensia; Khaniri, Maureen; Nyange, Jacquelyn; Anzala, Omu; Diphoko, Thabo; Gaseitsiwe, Simani; Maiswe, Victoria; Iketleng, Thato; Maruapula, Dorcas; Bedi, Keabetswe; Moyo, Sikhulile; Musonda, Rosemary; Wainberg, Mark; Makhema, Joseph; Novitsky, Vladimir; Marlink, Richard; Essex, Max; Okoboi, Stephen; Ssali, Livingstone; Kalibala, Sam; Birungi, Josephine; Egessa, Aggrey; Wangisi, Jonathan; Okullu, Lyavala J.; Bakanda, Celestin; Obare, Francis; Boer, I. M. S.; Semvua, Hadija H.; Van den Boogaard, Jossy; Kiwango, Krisanta W.; Ngowi, Kennedy M.; Nieuwkerk, Pythia T.; Aarnoutse, Rob E.; Kiwelu, Ireen; Muro, Eva; Kibiki, Gibson S.; Datiri, Ruth; Choji, Grace; Osawe, Sophia; Okpokoro, Evaezi; Okolo, Felicia; Umaru, Stephen; Abimiku, Rebecca; Datong, Pam; Abimiku, Alashle; Fomsgaard, A.; Karlsson, I.; Jensen, K. J; Jensen, S. S.; Leo-Hansen, C.; Jespersen, S.; Da Silva Te, D.; Rodrigues, C. M.; Da Silva, Z. J.; Janitzek, C. M.; Gerstoft, J.; Kronborg, G.; Okpokoro, Evaezi; Osawe, Sophia; Daitiri, Ruth; Choji, Grace; Umaru, Stephen; Okolo, Felicia; Datong, Pam; Emily, Nyariki; Joyce, Olenja; Robert, Lorway R.; Anzala, Anzala; Viljoen, Katie; Wendoh, Jerome; Kidzeru, Elvis; Karaoz, Ulas; Brodie, Eoin; Botha, Gerrit; Mulder, Nicola; Gray, Clive; Cameron, William; Stintzi, Alain; Jaspan, Heather; Levett, Paul N.; Alexander, David; Gulzar, Naveed; Grewal, Prabvir S.; Poon, Art F Y.; Brumme, Zabrina; Harrigan, P. R.; Brooks, James I.; Sandstrom, Paul A.; Calvez, Stryker; Sanche, Stephen E.; Scott, Jamie K.; Swartz, Leslie; Kagee, Ashraf; Lesch, Anthea; Kafaar, Zuhayr; De Wet, Anneliese; Okpokoro, Evaezi; Osawe, Sophia; Daitiri, Ruth; Choji, Grace; Umaru, Stephen; Okolo, Felicia; Datong, Pam; Abimiku, Alashle; Dietrich, Janan; Smith, Tricia; Cotton, Laura; Hornschuh, Stefanie; Van der Watt, Martin; Miller, Cari L.; Gray, Glenda; Smit, Jenni; Jaggernath, Manjeetha; Ndungu, Thumbi; Brockman, Mark; Kaida, Angela; Akolo, Maureen; Kimani, Joshua; Gelmon, Larry; Chitwa, Michael; Osero, Justus; Cockcroft, Anne; Marokoane, Nobantu; Kgakole, Leagajang; Maswabi, Boikhutso; Mpofu, Neo; Ansari, Umaira; Andersson, Neil; Nakinobe, Elizabeth; Miiro, George M.; Zalwango, Flavia; Nakiyingi-Miiro, Jessica; Kaleebu, Potiano; Semwanga, John R.; Nyanzi, Emily; Musoke, Saidat N.; Nakinobe, Elizabeth; Miiro, George; Mbidde, Edward K.; Lutalo, Tom; Kaleebu, Pontiano; Handema, Ray; Chianzu, Graham P.; Thiam, Moussa; Diagne-Gueye, Diabou; Ndiaye, Mame K.; Mbow, Moustapha; Ndiaye, Birahim P.; Traore, Ibrahima; Dia, Mamadou C.; Thomas, Gilleh; Tour-Kane, Coumba; Mboup, Souleymane; Jaye, Assan; Nyanzi, Emily; Mbidde, Edward K.; Kaleebu, Pontiano; Mpendo, Juliet; Kimani, Joshua; Birungi, Josephine; Muyindike, Winnie; Kambugu, Andrew; Sebastian, Hachizovu; Ray, Handema; Mike, Chaponda; Bertin, Kabuya J.; Modest, Mulenga; Thiam, Moussa; Janha, Omar; Davis, Alberta; Amambua-Ngwa, Alfred; Nwakanma, Davis C.; Mboup, Souleymane; Jaye, Assan; Jespersen, Sanne; Hønge, Bo L.; Esbjornsson, Joakim; Medina, Candida; Te, David Da Silva; Correira, Faustino G.; Laursen, Alex L.; Ostergaard, Lars; Andersen, Andreas; Aaby, Peter; Erikstrup, Christian; Wejse, Christian; Dieye, Siry; Sarr, Moussa; Sy, Haby; Mbodj, Helene D.; Ndiaye, Marianne; Ndiaye, Amy; Moussa, Seydi; Jaye, Assan; Mboup, Souleymane; Nyombi, Balthazar M.; Shao, Elichilia R.; Chilumba, Innocent B.; Moyo, Sikhulile; Gaseitsiwe, Simani; Musonda, Rosemary; Datong, Pam; Inyang, Bucky; Osawe, Sophia; Izang, Abel; Cole, Chundung; Okolo, Felicia; Cameron, Bill; Rosenthal, Kenneth; Gray, Clive; Jaspan, Heather; Seraise, Boitumelo; Andrea-Marobela, Kerstin; Moyo, Sikhulile; Musonda, Rosemary; Makhema, Joseph; Essex, Max; Gaseitsiwe, Simani
    ENGLISH ABSTRACT: We are pleased to present peer reviewed forum proceedings of the 2nd synchronicity forum of GHRI/CHVIfunded Canadian and African HIV prevention and vaccine teams Forum objectives ∙GHRI-funded capacity building and HIV prevention research teams presented highlights of achievements ∙Teams discussed how to jointly build on achievements for sustainability ∙Provided an opportunity for inter-team collaboration, synchronize best approach to capacity building, mentoring of new researchers and building leadership ∙Provided opportunities for informal discussions and networking among the teams. ∙Teams learnt about recent advances in the area of African regulatory and ethics review process ∙The forum proceedings was a special supplement in an openaccess journal was produced
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    Common mental disorders and psychological adjustment among individuals seeking HIV testing : a study protocol to explore implications for mental health care systems
    (BioMed Central, 2018-04-10) Bantjes, Jason; Kagee, Ashraf
    Background: In an effort to promote greater access to voluntary counseling and testing for HIV, it has become practice in many countries, including South Africa, to establish non-medical testing sites and to de-couple HIV testing from other medical and mental health care services. While it is well established that HIV infection is associated with a range of psychopathology, much of the literature has assumed that it is receipt of an HIV positive diagnosis that causes people to become depressed, traumatized, or develop other psychiatric symptoms. Empirical data about the baseline psychiatric condition and mental health care needs of persons seeking HIV testing is scarce. Understanding the psychological health of persons seeking HIV testing and documenting how psychiatric symptoms develop over time following receipt of an HIV positive diagnosis, has important implications for mental health care systems. Methods: We describe a study protocol to investigate: (1) the level of psychological distress and the prevalence of common mental disorders among persons seeking HIV testing; (2) the longitudinal development of psychiatric symptoms among persons diagnosed with HIV; and (3) the recommendations that can be made for mental health care systems to support persons seeking HIV testing and those newly diagnosed with HIV. In this longitudinal study quantitative and qualitative data are collected to document participants’ psychiatric symptoms, to determine whether they meet diagnostic criteria for a common mental disorder, and to explore the lived experiences of persons receiving an HIV positive test result. Data are collected at three time points; before HIV testing, and then again at 6 and 12 months post-testing. Discussion: Documenting the prevalence of common mental disorders among persons seeking HIV testing, and tracking the psychosocial support needs, psychological adjustment and psychosocial experiences of persons newly diagnosed with HIV, has important implications for the delivery of mental health care services and the design of integrated mental health care systems.
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    Common mental disorders and psychological adjustment among individuals seeking HIV testing : a study protocol to explore implications for mental health care systems
    (BMC (part of Springer Nature), 2018) Bantjes, Jason; Kagee, Ashraf
    Background: In an effort to promote greater access to voluntary counseling and testing for HIV, it has become practice in many countries, including South Africa, to establish non-medical testing sites and to de-couple HIV testing from other medical and mental health care services. While it is well established that HIV infection is associated with a range of psychopathology, much of the literature has assumed that it is receipt of an HIV positive diagnosis that causes people to become depressed, traumatized, or develop other psychiatric symptoms. Empirical data about the baseline psychiatric condition and mental health care needs of persons seeking HIV testing is scarce. Understanding the psychological health of persons seeking HIV testing and documenting how psychiatric symptoms develop over time following receipt of an HIV positive diagnosis, has important implications for mental health care systems. Methods: We describe a study protocol to investigate: (1) the level of psychological distress and the prevalence of common mental disorders among persons seeking HIV testing; (2) the longitudinal development of psychiatric symptoms among persons diagnosed with HIV; and (3) the recommendations that can be made for mental health care systems to support persons seeking HIV testing and those newly diagnosed with HIV. In this longitudinal study quantitative and qualitative data are collected to document participants’ psychiatric symptoms, to determine whether they meet diagnostic criteria for a common mental disorder, and to explore the lived experiences of persons receiving an HIV positive test result. Data are collected at three time points; before HIV testing, and then again at 6 and 12 months post-testing. Discussion: Documenting the prevalence of common mental disorders among persons seeking HIV testing, and tracking the psychosocial support needs, psychological adjustment and psychosocial experiences of persons newly diagnosed with HIV, has important implications for the delivery of mental health care services and the design of integrated mental health care systems.
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    Declaration on mental health in Africa : moving to implementation
    (Co-Action Publishing, 2014-06-16) Daar, Abdallah S.; Jacobs, Marian; Wall, Stig; Groenewald, Johann; Eaton, Julian; Patel, Vikram; Dos Santos, Palmira; Kagee, Ashraf; Gevers, Anik; Sunkel, Charlene; Andrews, Gail; Daniels, Ingrid; Ndetei, David
    Urgent action is needed to address mental health issues globally. In Africa, where mental health disorders account for a huge burden of disease and disability, and where in general less than 1% of the already small health budgets are spent on these disorders, the need for action is acute and urgent. Members of the World Health Organization, including African countries, have adopted a Comprehensive Mental Health Action Plan. Africa now has an historic opportunity to improve the mental health and wellbeing of its citizens, beginning with provision of basic mental health services and development of national mental health strategic plans (roadmaps). There is need to integrate mental health into primary health care and address stigma and violations of human rights. We advocate for inclusion of mental health into the post-2015 Sustainable Development Goals, and for the convening of a special UN General Assembly High Level Meeting on Mental Health within three years.
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    Do disability grants influence adherence to antiretroviral therapy
    (AOSIS Publishing, 2014-04) Kagee, Ashraf
    Anecdotal data suggest that some South Africans living with HIV who receive disability grants from the state deliberately default on their antiretroviral medication in an attempt to lower their CD4 count to remain eligible for grants. No actual empirical data however exist to show that disability grants act as such perverse incentives and are a valid reason for non-adherence. This article examines some of the complexities of antiretroviral adherence in the context of a resource-constrained environment. The multitude of structural barriers, including sometimes difficult patient-doctor conversations about the renewal of disability grants, shape patients’ experiences of the clinic environment and influence their adherence to care.
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    Efficacy of enhanced HIV counseling for risk reduction during pregnancy and in the postpartum period : a randomized controlled trial
    (PLoS, 2014-05-13) Maman, Suzanne; Moodley, Dhayendre; McNaughton-Reyes, Heathe Luz; Groves, Allison K.; Kagee, Ashraf; Moodley, Prashini
    Introduction: Pregnancy and the postpartum period present important intervention opportunities. Counseling can leverage the motivation women have during this time to change behaviors that may negatively affect their health and the heath of their infants. Methods: Pregnant women attending an antenatal clinic in South Africa were randomly allocated to treatment (n = 733) and control arms (n = 747). Treatment arm participants received enhanced HIV pre- and post-test counseling, legal support and access to support groups at baseline, which occurred at the first antenatal visit, and then six and ten weeks postpartum. Control arm participants received standard HIV testing and counseling (HTC) and two postpartum attention control sessions. Outcomes were incidence of sexually transmitted infection (STI) by 14 weeks postpartum and past 30-day inconsistent condom use at 14 weeks and 9 months postpartum. Results: There were no intervention effects on incident STIs for either HIV-negative (adjusted risk ratio (aRR) 1.01, 95% CI 0.71–1.44) or HIV-positive participants (aRR 0.86, 95% CI 0.61–1.23). The intervention was associated with a 28% decrease in risk of past 30-day inconsistent condom use at nine-months among HIV-negative women (aRR 0.72,95% CI 0.59–0.88), but did not affect inconsistent condom use among HIV-positive women (aRR1.08; 95% CI 0.67–1.75). Discussion: An enhanced counseling intervention during pregnancy and the postpartum period can lead to reductions in inconsistent condom use among HIV-negative women. Results underscore the importance of the counseling that accompanies HIV HTC. More work is needed to understand how to promote and sustain risk reduction among HIV-positive women.
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    Evaluation of the beck anxiety Inventory in predicting generalised anxiety disorder among individuals seeking HIV testing in the Western Cape province, South Africa
    (AOSIS, 2019) Saal, Wylene L.; Kagee, Ashraf; Bantjes, Jason
    Background: Routine anxiety screening is needed among HIV test seekers, given the lack of health-care professionals with the ability to identify individuals with generalised anxiety. Aim: The aim of this study was to determine the effectiveness of the Beck anxiety inventory (BAI) in predicting caseness for generalised anxiety disorder (GAD) among persons seeking HIV testing, using the structured clinical interview for the DSM-5 (SCID-5) as the gold standard. Setting: Five HIV testing sites in the Western Cape region of South Africa. Method: We recruited 500 persons seeking HIV testing from five non-medical testing sites in the Western Cape, South Africa. We used receiver operating curve analysis to determine the optimal cut-off point on the BAI to discriminate between GAD caseness and non-caseness. Results: 3.4% of the sample met the DSM-5 criteria for a diagnosis of GAD. Using an optimal cut-off point of 21.5, the sensitivity and specificity of the BAI were 82% and 80%, respectively. The positive predictive value was 13%, while the negative predictive value was 99%. Conclusion: Our data suggest that while the BAI may be used to screen for GAD, it is likely to yield a high number of false positives. A two-tiered method may be useful to mitigate against case over-identification. Thus, in a public health setting, persons screening positive on the BAI should receive a diagnostic interview to determine whether they are true cases for GAD. Within resource-constrained communities in South Africa, referral trajectories should be integrated with routine screening and HIV testing.
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    HIV prevalence in three predominantly Muslim residential areas in the Cape Town metropole
    (Health & Medical Publishing Group, 2005) Kagee, Ashraf; Toefy, Y.; Simbayi, L.; Kalichman, S.
    Objective. To report on the results of a random and representative household survey of HIV prevalence in 3 predominantly Muslim areas in the Cape Town metropole. Method. A cross-sectional representative community household survey was conducted in 3 residential areas. Aerial photographs were used in the selection of a random sample of 548 households, with the objective of obtaining an oral fluid sample and behavioural data from 2 inhabitants per household. Phase 1 of the study involved preparing the communities and notifying the household residents of the study. In phase 2, trained nurses collected oral fluid specimens for HIV testing and administered a confidential and anonymous behavioural questionnaire to household inhabitants aged 15 years and older. Results. A total of 717 people completed a behavioural interview and 512 were tested for HIV, yielding response rates of 65% and 47% respectively. The specimens of 503 respondents were correctly matched with behavioural data; 352 of these respondents indicated that they were Muslim. Of these oral fluid specimens 9 were reactive and 341 were non-reactive. We therefore calculated HIV prevalence among Muslims living in the three areas at 2.56% (95% confidence interval (CI): 1.18 - 4.80%). None of the individuals who tested HIV-positive had been previously tested for HIV. There were no HIV infections in the remainder of the sample. Conclusion. The results indicate that HIV prevalence among Muslims living in the 3 targeted residential areas of the Cape Town metropole, while not trivial, is significantly lower than the national prevalence for South Africa. These results imply the need for ongoing prevention and education programmes specifically targeting Muslim youth and adults and support and assistance for Muslims infected with and affected by HIV.
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    Living under siege: resilience, hopelessness, and psychological distress among Palestinian students in the Gaza Strip
    (Cambridge University Press, 2021-10) Veronese, Guido; Pepe, Alessandro; Diab, Marwan; Jamey, Yasser Abu; Kagee, Ashraf
    Background. Moving from an approach oriented to adaptation and functioning, the current paper explored the network of cumulative associations between the effects of the siege and resilience on mental health. Methods. We sought to explore the impact of the siege on psychological distress (anxiety, depression, and stress) and the moderating effect of resilience and hopelessness in a sample of 550 Palestinian university students. We hypothesized that the siege effect would impact psychological distress so that the more people were affected by the siege, the more mental symptoms of common mental disorders they would report. We also expected that the siege would negatively impact both resilience and participants’ hopelessness. Results. Findings showed that higher scores on the scale measuring effect of the siege were associated with hopelessness. Furthermore, living under siege compromised participants’ resilience. The more the siege affected individuals, the lower resilience were protecting participants mental health and the more hopelessness was exposing them to anxiety, stress, and depression. Conclusion. Our findings draw attention to how the ongoing violation of human rights influences people’s mental health in Gaza. Implications for clinicians and policymakers are discussed.
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    Mental health and physical health (Including HIV/AIDS)
    (Elsevier, 2008) Kagee, Ashraf; Freeman, Melvyn
    INTRODUCTION: According to the World Health Report 2001, over the past 20 years a fundamental and inseparable connection between mental and physical health has been convincingly established (WHO, 2001). Both mental and physical health are influenced by a combination of biological, psychological, and social factors. Thoughts, feelings, and behaviour have a major impact on physical health. Conversely, physical health has an important influence on mental health and wellbeing. The report notes two critical pathways through which this occurs: Physiological systems such as neuro-endocrine and immune functioning and health behaviour. These pathways are not independent: Behaviour may affect physiology, while physiological functioning may in turn affect health behaviour. In this article, we examine the historical shift that has occurred from a dualistic conception of health and illness to the bio-psychosocial model that emphasizes an integration of mind and body. We explore this interrelationship using the examples of somatoform disorder, chronic pain, HIV/AIDS, cardiovascular disease, cancer, and diabetes. Finally, we focus on some of the somatic manifestations of mental illness.
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    Paediatric HIV/AIDS disclosure : towards a developmental and process-oriented approach
    (Taylor & Francis, 2007) Lesch, A.; Swartz, L.; Kagee, Ashraf; Moodley, Keymanthri; Kafaar, Z.; Myer, L.; Cotton, M.
    As antiretroviral therapy becomes more widely available in low-resource settings and children with HIV/AIDS live for longer periods, disclosure of HIV diagnosis to infected children is becoming increasingly important. This article reviews the current literature on HIV-related disclosure in light of theories of cognitive development, and argues for the adoption of a process-oriented approach to discussing HIV with infected children. Disclosure presents unique challenges to healthcare workers and caregivers of children with HIV/AIDS that include controlling the flow of information about the child's HIV status to him/her and deciding on what is in his/her best interest. Health care workers' and caregivers' views regarding disclosure to children may often be contradictory, with healthcare workers likely to support disclosing the diagnosis of HIV/AIDS to children and caregivers more reluctant to discuss the disease with them. There is a clear need for practical interventions to support paediatric HIV disclosure which provide children with age-appropriate information about the disease. © 2007 Taylor & Francis.
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    Perspectives of patients and caregivers on the logistical barriers to providing mental health services in Uganda
    (Stellenbosch University, 2016) Twesigye, Justus; Kagee, Ashraf
    ENGLISH ABSTRACT: Mental disorders contribute substantially to the global burden of disease. Although mental disorders can be treated effectively, logistical barriers constrain the provision of evidence-based treatment in low- and middle-income countries. However, little is known about these barriers to treatment of patients in Uganda. We interviewed patients and care providers about their views on logistical barriers to the provision of mental health services. Results indicate that inadequate staffing, irregular medical supplies and the use of inferior medication constrained the delivery and utilisation of mental health services. Implications of these barriers include burnout among care providers and non-adherence to medical treatment among patients.
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    The perspectives of users of antiretroviral therapy on structural barriers to antiretroviral therapy adherence in South Africa
    (Medpharm Publications, 2012) Kagee, Ashraf; Nothling, Jani; Coetzee, Bronwyne
    Background: The effectiveness of antiretroviral therapy (ART) and the importance of adherence to treatment regimens are widely known. Yet, suboptimal adherence to ART and retention in care of patients still persists and, by many accounts, is fairly widespread. The aim of this study was to identify the structural barriers that influenced adherence among patients who were enrolled in the national ART programme in South Africa. Method: In this qualitative study, semi-structured interviews were conducted with a sample of 10 patients receiving ART at a public hospital in South Africa. Results: The results of the interviews were categorised according to poverty-related, institution-related and social barriers to clinic attendance and pill-taking, which collectively formed the structural barriers to adherence. The chief structural barriers to clinic attendance were time away from work, transport expenses, long waiting times and negative experiences with clinic staff. The chief barriers to pill-taking were food insecurity, stigma and discrimination. Conclusion: The barriers to adherence are discussed. Attention is called to the extraindividual factors that influenced ART adherence. We conclude that contextual factors, such as a healthcare-enabling environment, might play an important role in influencing healthcare-promoting behaviour among patients.
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    Predictors of burnout among HIV nurses in the Western Cape
    (AOSIS Publishing, 2017-06-28) Roomaney, Rizwana; Steenkamp, Jeanette; Kagee, Ashraf
    Background: Burnout has been implicated as one of the reasons for key healthcare personnel, such as nurses, leaving their profession, resulting in insufficient staff to attend to patients. Objective: We investigated the predictors of three dimensions of burnout, namely emotional exhaustion, depersonalisation and personal accomplishment, among nurses in South Africa attending to patients living with HIV. Method: Participants were recruited at a large tertiary hospital in the Western Cape region, with the help of the assistant director of nursing at the hospital. They completed the Maslach Burnout Inventory, the Quantitative Workload Inventory, the Interpersonal Conflict at Work Scale, the Organisational Constraints Scale, the Death and Dying subscale of the Nursing Stress Scale, and the HIV and AIDS Stigma Instrument – Nurse. Results: We found elevated levels of burnout among the sample. Workload, job status and interpersonal conflict at work significantly explained more than one-third of the variance in emotional exhaustion (R² = 0.39, F(7, 102) = 9.28, p = 0.001). Interpersonal conflict, workload, organisational constraints and HIV stigma significantly explained depersonalisation (R² = 0.33, F(7, 102) = 7.22, p = 0.001). Job status and organisational constraints significantly predicted personal accomplishment (R² = 0.18, F(7, 102) = 3.12, p = 0.001). Conclusion: Factors such as workload, job status and interpersonal conflict in the work context, organisational constraints and stigma associated with HIV were found to be predictors of burnout in the sample of nurses. Our recommendations include developing and testing interventions aimed at reducing burnout among nurses, including reducing workload and creating conditions for less interpersonal conflict at work.
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    Psychology training directors’ reflections on evidence-based practice in South Africa
    (SA ePublications, 2012-03) Kagee, Ashraf; Lund, Crick
    Despite its importance in the international arena, the evidence-based movement appears to have had little impact among South African clinical and counseling psychologists. We interviewed 13 of the 18 directors of psychology training programmes to understand the extent to which these programmes were rooted in an evidence-based approach to psychological practice; how important directors thought it was to emphasise an evidence-based approach in psychology training; and how students were taught to use research to inform their ongoing practice as clinical or counselling psychologists. Directors expressed a range of positions including opposition to evidence-based practice (EBP), support for EBP, and equivocality about EBP. Those who were opposed to EBP based their opposition on a “critical” approach to evidence, epistemological and ontological differences with the notion of EBP, and the conflation of theoretical orientation with EBP. Concerns were also raised in relation to areas of psychological need that lacked a research base, cultural factors that did not fit well with EBP, and different viewpoints on what constituted evidence. However, among several training directors, EBP was considered essential, particularly in light of the need to offer cost-effective services in an under-resourced setting like South Africa. These results are discussed in the context of the international evidence-based movement in mental health. Three recommendations flow from our research, namely, that the Health Professions Council of South Africa engage formally and vigorously with EBP for psychological interventions; that the Psychological Society of South Africa (PSYSSA) place the matter of EBP squarely on the organisational agenda; and that a standardised accreditation of clinical and counselling psychology training programmes be developed according to locally developed criteria for assessing EBP.
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    Psychosocial humanitarian interventions in the global South : the potential contributions of social work and community psychology
    (Stellenbosch University, Department of Social Work, 2018) Kagee, Ashraf
    ENGLISH ABSTRACT: This article makes the case for the fields of social work and community psychology to contribute to psychosocial humanitarian interventions in the global South. Many countries in the majority world face humanitarian crises, including war, political turbulence and in some cases genocide. In this article I examine some of the interventions that have demonstrated some efficacy in ameliorating psychosocial problems associated with conflict and war; I examine the role of mental health professionals in preparing survivors of war crimes and human rights abuses for testimony in post-conflict truth commissions; and I examine the complementary role of community psychologists and social workers in the context of conflict-related work. In defining a role for social workers and community psychologists, I identify areas of common concern for psychosocial humanitarian aid workers, namely an awareness of power relations, the potential mismatch of cultural zeitgeists between the professions of social work and psychology and the populations they serve, and the cultural sensitivities associated with what is considered to be therapeutically appropriate.
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    School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents
    (Cochrane, 2016-11-08) Kagee, Ashraf; Mason-Jones, Amanda J.; Sinclair, David; Mathews, Catherine; Hillman, Alex; Lombard, Carl
    Background: School-based sexual and reproductive health programmes are widely accepted as an approach to reducing high-risk sexual behaviour among adolescents.Many studies and systematic reviews have concentrated onmeasuring effects on knowledge or self-reported behaviour rather than biological outcomes, such as pregnancy or prevalence of sexually transmitted infections (STIs). Objectives: To evaluate the effects of school-based sexual and reproductive health programmes on sexually transmitted infections (such as HIV, herpes simplex virus, and syphilis), and pregnancy among adolescents.
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    Shortcomings of adherence counselling provided to caregivers of children receiving antiretroviral therapy in rural South Africa
    (Taylor & Francis Online, 2016-07) Coetzee, Bronwyne; Kagee, Ashraf; Bland, Ruth
    In order to achieve optimal benefits of antiretroviral therapy (ART), caregivers of children receiving ART are required to attend routine clinic visits monthly and administer medication to the child as prescribed. Yet, the level of adherence to these behaviours varies considerably in many settings. As a way to achieve optimal adherence in rural KwaZulu-Natal, caregivers are required to attend routine counselling sessions at HIV treatment clinics that are centred on imparting information, motivation, and behavioural skills related to medication administration. According to the information-motivation-behavioural skills model, information related to adherence, motivation, and behavioural skills are necessary and fundamental determinants of adherence to ART. The purpose of the study was to observe and document the content of adherence counselling sessions that caregivers attending rural clinics in KwaZulu Natal receive. We observed 25 adherence counselling sessions, which lasted on average 8.1 minutes. Counselling typically consisted of counsellors recording patient attendance, reporting CD4 count and viral load results to caregivers, emphasising dose times, and asking caregivers to name their medications and dosage amounts. Patients were seldom asked to demonstrate how they measure the medication. They were also not probed for problems regarding treatment, even when an unsuppressed VL was reported to a caregiver. This paper calls attention to the sub-optimal level of counselling provided to patients on ART and the urgent need to standardise and improve the training, support, and debriefing provided to counsellors.
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    Task sharing of a psychological intervention for maternal depression in Khayelitsha, South Africa : study protocol for a randomized controlled trial
    (BioMed Central, 2014-11) Lund, Crick; Schneider, Marguerite; Davies, Thandi; Nyatsanza, Memory; Honikman, Simone; Bhana, Arvin; Bass, Judith; Bolton, Paul; Dewey, Michael; Joska, John; Kagee, Ashraf; Myer, Landon; Petersen, Inge; Prince, Martin; Stein, Dan J.; Thornicroft, Graham; Tomlinson, Mark; Alem, Atalay; Susser, Ezra
    Background: Maternal depression carries a major public health burden for mothers and their infants, yet there is a substantial treatment gap for this condition in low-resourced regions such as sub-Saharan Africa. To address this treatment gap, the strategy of “task sharing” has been proposed, involving the delivery of interventions by non-specialist health workers trained and supervised by specialists in routine healthcare delivery systems. Several psychological interventions have shown benefit in treating maternal depression, but few have been rigorously evaluated using a task sharing approach. The proposed trial will be the first randomised controlled trial (RCT) evaluating a task sharing model of delivering care for women with maternal depression in sub-Saharan Africa. The objective of this RCT is to determine the effectiveness and cost-effectiveness of a task sharing counseling intervention for maternal depression in South Africa. Methods/Design: The study is an individual-level two-arm RCT. A total of 420 depressed pregnant women will be recruited from two ante-natal clinics in a low-income township area of Cape Town, using the Edinburgh Postnatal Depression Scale to screen for depression; 210 women will be randomly allocated to each of the intervention and control arms. The intervention group will be given six sessions of basic counseling over a period of 3 to 4 months, provided by trained community health workers (CHW)s. The control group will receive three monthly phone calls from a CHW trained to conduct phone calls but not basic counseling. The primary outcome measure is the 17-Item Hamilton Depression Rating Scale (HDRS-17). The outcome measures will be applied at the baseline assessment, and at three follow-up points: 1 month before delivery, and 3 and 12 months after delivery. The primary analysis will be by intention-to-treat and secondary analyses will be on a per protocol population. The primary outcome measure will be analyzed using linear regression adjusting for baseline symptom severity measured using the HDRS-17. Discussion: The findings of this trial can provide policy makers with evidence regarding the effectiveness and cost-effectiveness of structured psychological interventions for maternal depression delivered by appropriately trained and supervised non-specialist CHWs in sub-Saharan Africa. Trial registration: Clinical Trials: (ClinicalTrials.gov): NCT01977326, registered on 24/10/2013; Pan African Clinical Trials Registry (http://www.pactr.org): PACTR201403000676264, registered on 11/10/2013.
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    Understanding the experience and manifestation of depression in adolescents living with HIV in Harare, Zimbabwe
    (Public Library of Science, 2018-01-03) Willis, Nicola; Mavhu, Webster; Wogrin, Carol; Mutsinze, Abigail; Kagee, Ashraf
    Background Studies have found that adolescents living with HIV are at risk of depression, which in turn affects adherence to medication. This study explored the experience and manifestation of depression in adolescents living with HIV in Zimbabwe in order to inform intervention development. Methods We conducted a body mapping exercise with 21 HIV positive 15–19 years olds who had been diagnosed with major depressive disorder. Participants created a painted map of their body to assist them in expressing their somatic and emotional experiences in qualitative interviews. The interviews were transcribed and thematically coded using NVivo 10. Results Participants attributed their experiences of depression to their relationships and interactions with significant people in their lives, primarily family members and peers. A sense of being different from others was common among participants, both due to their HIV status and the impact HIV has had on their life circumstances. Participants described a longing to be important or to matter to the people in their lives. A sense of isolation and rejection was common, as well as grief and loss, including ambiguous and anticipated loss. Participants’ idioms of distress included ‘thinking deeply’ (‘kufungisisa’), ‘pain’, darkness, ‘stress’ or a lack of hope and ambiguity for the future. Suicidal ideation was described, including slow suicide through poor adherence. Supportive factors were also relational, including the importance of supportive relatives and peers, clinic staff and psychosocial support programmes. Conclusions An understanding of HIV positive adolescents’ own narratives around depression can inform the development and integration of appropriate mental health interventions within HIV care and treatment programmes. Study findings suggest that family and peer-led interventions are potentially useful in the prevention and management of depression in adolescents living with HIV.