From Stop to Go! Overcoming barriers to healthcare utilisation for high-risk adolescent mothers and their children in Southern Africa.

Lead Research Organisation: University of Oxford
Department Name: Social Policy and Intervention

Abstract

This project will identify barriers and facilitators of healthcare utilization among high-risk adolescent mothers and their children in South Africa. Research questions and methods were co-developed by a South-North research team, policymakers, NGOs and an adolescent parents Advisory Group. We will build local capacity in adolescent health research among South Africa-based early-career academics, doctoral students and government officials. Together we have a proven track-record of ethical research with vulnerable adolescents and high-impact programmatic engagement.

WHO guidelines view adolescent healthcare utilization within a socio-ecological framework. But there are major evidence gaps for adolescent mothers and their children in Africa, where one in three adolescent mothers live. Little is known about how healthcare, family, school and economic factors block or promote use of antenatal, maternal and child health services, especially in the context of HIV. There is limited evidence on adolescent fathers: the potential merits of their involvement in antenatal and early childhood care. This study combines quasi-experimental cohort data with qualitative participatory research to address this pressing evidence gap. The findings will directly contribute to regional policy and programming.

Stage 1 (2017-18) CO-CREATION AND PILOTING. The study was co-created with policymakers, adolescents and healthcare workers. We conducted consultations and reviewed draft questionnaires with adolescent parents, UN, government partners and frontline workers. From April 2018, we will supplement this with preliminary qualitative fieldwork. With co-funding from UNICEF, we are currently piloting questionnaires and developmental assessment tools with adolescent mother-child dyads.

Stage 2 (2018-19) FIELDWORK. We will conduct primary research to determine predictors of maternal healthcare use amongst high-risk adolescents in South Africa. This new research will capitalise on existing cohort data from 1589 adolescents followed from 2015-2017, with high rates of HIV, TB and poverty. By 2019 this cohort will include 450 adolescent mothers, and 450 of their children receiving care in 72 healthcare facilities. This provides an unprecedented opportunity to test prior and current predictors of healthcare utilisation, and its impacts on maternal and child health. We will collect i) medical records for adolescent mothers and their children (including standardised child development assessments); ii) detailed service provision data from all healthcare facilities; iii) self-reported adolescent healthcare experiences, violence exposure, alcohol use, support, schooling, parenting, father involvement, poverty and social protection access; and iv) in-depth qualitative and ethnographic data from adolescent mothers and fathers.

STAGE 3 (2019-20) DATA ANALYSIS AND ALLOCATIVE EFFICIENCY MODELS. We will merge this new study with prior longitudinal adolescent data, and use techniques such as propensity-score matching, multi-level structural equation modelling and marginal effects modelling to examine barriers and facilitators to healthcare utilisation. Findings will identify solutions that are feasible within government and NGO-provided health and social services. With government partners, we will identify 'best buys' through cost-effectiveness analyses for combinations of effective provisions for optimal impact on health outcomes.

STAGE 4 (2021-22) CO-CREATION OF EVIDENCE-BASED SOLUTIONS. We will co-create high-impact dissemination materials with our policy and adolescent partners. Through our programming partner's training fora, we will conduct skills training with frontline workers with regional reach. We will engage in extensive impact strategies with international agencies, donors and national governments.

This project combines innovative partnership with rigorous evidence to promote survival and thriving for adolescent mothers and their children.

Technical Summary

Adolescent parents in Africa persistently under-utilise healthcare: antenatal care, PMTCT and child services. This increases maternal mortality and morbidity, birth complications, pre-term birth, neonatal and under-5 mortality, HIV-transmission, childhood illness and risk of developmental delay. Systematic reviews of African research find limited evidence of modifiable barriers or facilitators to healthcare utilisation in this group. There is no known research on potential impact of adolescent fathers. Policy partners have identified a need for high-quality research alongside cost-effectiveness models to inform programming.

This study combines new data from maternal-child dyads in South Africa with prior data from pre-conception to pregnancy. It is powered to examine moderated and mediated pathways to healthcare uptake through multilevel structural equation models. It allows testing of combinations of interventions through marginal effect and propensity-score models.

We will merge medical records, socio-economic surveys with standardised child developmental assessments from 450 mother-child dyads with service delivery information collected at 72 healthcare facilities. This complex multi-year dataset will be analysed using multi-level models to account for repeated measures and nested effects within facilities. After identification of facilitators (and potential interactive/additive effects), allocative efficiency analysis will compute the cost of these provisions under different budgetary models. Findings will be informed by qualitative research, by adolescent and policy advisory groups.

Targeted activities will maximise ODA impact. The study was co-created with high-level policymakers at international and national level, and fills a clearly identified need in the Global South. Findings will be integrated into policies, programming and health facilities via a training module for healthcare practitioners delivered through our implementation partners.

Planned Impact

Who will benefit from this research?

1. Adolescent parents and their children, through findings that lead directly to policy change and improved programming for their healthcare needs.
2. Policymakers in government departments within Africa, specifically Ministries of Health, Social Development/Welfare, Women and Children and Education, through presentations and policy briefs.
3. International and regional agencies: the World Health Organisation, UNICEF, UNAIDS, UNFPA and UNDP, through joint creation and dissemination of findings within agencies and the Inter-agency Task Team for Social Protection, Care and Support.
4. Donors and implementing organisations: The Global Fund, USAID-PEPFAR and Save the Children, through advisory positions held by PIs, webinars and policy briefs
5. Scientific community: academics and students in adolescent health, maternal and child health and HIV, through peer-reviewed publications and conference presentations.
6. Frontline healthcare providers and healthcare managers through an in-service training module on adolescent mothers and children, delivered through our partner Paediatric Adolescent Treatment for Africa.
7. Early-career researchers in South Africa, through mentoring, methodological training and leading peer-reviewed publications.

How will they benefit from this research?

In our consultations, governments in South Africa, Kenya, Tanzania, Zambia, Sierra Leone and Liberia have requested evidence to inform the development of adolescent-friendly health services. UN agencies and the World Health Organisation, as well as donors - the Global Fund and USAID-PEPFAR - have asked the research team for evidence to develop more effective programs. The findings of this study will therefore directly benefit national and international policy-leaders in their goals of improving health service uptake for adolescent mothers and their children. The inclusion of allocative efficiency analysis will allow cost-effectiveness information to aid decision-making. These benefits will be primarily during the impact stage of the project, through knowledge exchange and direct support in policy and programming development.
Tailored healthcare provision that is based on the best evidence will directly benefit adolescent mothers and their children in the region. This means substantive impact on a population level: with Africa's youth explosion, the UN estimates 435 million adolescents and 60 million adolescent mothers in the next 30 years (UNPD 2017). Increased healthcare uptake has been shown to reduce child morbidity and mortality. Improved maternal health will have both direct impacts, and indirect impacts via parenting capacity, on their current and future children. These impacts are likely to take place beyond the timescale of the grant.

Frontline healthcare providers and healthcare managers will benefit directly from evidence-based training to support their work with adolescent mothers and their children. Qualitative work with providers reveals frustration and sadness at adolescent late uptake of antenatal care, high birth complications and delays in healthcare access for childhood illness. In 2020, we will deliver an in-service training module through an intercontinental forum, with follow-up support from our implementing partner Paediatric Adolescent Treatment for Africa.

Early career investigators and doctoral students based in South Africa will benefit from leadership roles within an innovative project. They will develop methodological skills through training and ongoing mentoring by senior PIs. They will be actively supported to lead first-authored papers, give presentations at conferences and to policymakers. The whole research team will benefit from capacity-building by our early-career academics, who have extensive experience in high-level government, nursing training and health systems and in reproductive health programming. This will take place throughout the project.
 
Title Breakthrough on HIV adolescence: Prof. Mark Orkin 
Description SABC Digital News, Johannesburg, SA 
Type Of Art Film/Video/Animation 
Year Produced 2019 
Impact National reach, general public, estimated 38,000, SABC Digital News, Johannesburg, SA 
URL https://www.youtube.com/watch?v=BeXfH7MFs30&feature=youtu.be
 
Title HEY BABY Logo 
Description The research team co-created a logo for the study. The fieldwork team organised a mini-competition, where several teams were given time to design a logo for the HEY BABY. The team put forward 15 drawings which the research team at Oxford and Cape Town voted on. A graphic designer was then provided the favoured drawings which produced the HEY BABY logo. 
Type Of Art Image 
Year Produced 2018 
Impact Having a study logo allows the research team to enhance recognisability and branding for the teams work and dissemination activities. 
URL http://www.youngcarers.org.za/hey-baby
 
Title IAS 2018: Elona Toska 
Description Dr Elona Toska was interviewed by International AIDS Society at AIDS 2018. This interview was video-recorded and is available on YouTube and at www.accessHIV.org. During the interview Dr Elona Toska describes her work as a post-doctoral researcher on the study. 
Type Of Art Film/Video/Animation 
Year Produced 2018 
Impact This short interview creates opportunity for the research team to disseminate information about the study to public audience. 
URL https://youtu.be/OL64wrn5umE
 
Description Draft South African Department for Basic Education National Policy On The Prevention And Management Of Learner Pregnancy
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
URL http://www.governmentpublications.lib.uct.ac.za/news/draft-dbe-national-policy-prevention-and-manage...
 
Description Invitation for Lucie Cluver to join the WHO Adolescent Service Delivery Working Group (ASDWG)
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a advisory committee
 
Description Policy Brief: HIV Sensitive Social Protection. 'Leaving no-one behind'
Geographic Reach Africa 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact This policy brief outlines WFP's role in ensuring social protection systems are inclusive of people living with, at risk of and affected by HIV. The research team co-drafted a policy brief outlining the role WFP can play in ensuring social protection systems are inclusive of people living with, at risk of or affected by HIV at the policy, programme and intervention levels. It highlights pieces of evidence on the impact of HIV-sensitive social protection; it identifies potential entry points, and opportunities in the development and implementation of national HIV response, poverty-reduction and development plans; and it speaks to broader social policies, programmes and schemes. It further highlights relevant partnerships to complement WFP approaches. The policy brief accessible on the WFP website and has been disseminated to 20 country offices ((Angola, Burundi, Congo, Democratic Republic of the Congo, Djibouti, Eswatini, Ethiopia, Kenya, Lesotho, Madagascar, Malawi, Mozambique, Namibia, Rwanda, Somalia, South Sudan, Uganda, United Republic of Tanzania, Zambia, Zimbabwe) in the Eastern and Southern Africa Region.
URL https://www.wfp.org/publications/leaving-no-one-behind-how-wfps-approach-hiv-sensitive-social-protec...
 
Description Policy Impact recommendations by Prof. Lucie Cluver, at UNAIDS PCB, Geneva, Switzerland (December, 2019)
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
URL https://www.unaids.org/sites/default/files/media_asset/28112019_UNAIDS_PCB45_Thematic-Segment-Backgr...
 
Description South African MRC - Social Impact Bond
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
Impact The research team participated in a workshop to develop the South African Medical Research Council's (SAMRC) Social Impact Bond programme. The SAMRC Social Impact Bond aims to design and then test an affordable optimal package of interventions that will improve the quality of life and health of adolescent girls and young women through knowledge management and new knowledge generation (accelerated learning) and the use of innovative financing mechanisms that drive results. The package of interventions include the full spectrum of biological, behavioural and structural interventions in addressing HIV, reproductive health, sexual and gender based violence, economic and educational strengthening and mental health for adolescent girls and you women. Dr Elona Toska attended the workshop to advocate for the importance of addressing the unique needs of adolescent mothers.
 
Description Workshop at National Department of Health - South Africa - Pediatrics' and Adolescent (0-19 years olds)
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Ask, Boost, Connect, Discuss for HIV+ adolescent mothers _GCE R20
Amount $100,000 (USD)
Funding ID OPP1190719 
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 04/2018 
End 12/2019
 
Description CIPHER Grant Programme
Amount $150,000 (USD)
Funding ID 2018/625/TOS 
Organisation International AIDS Society (IAS) 
Sector Charity/Non Profit
Country Switzerland
Start 10/2018 
End 09/2020
 
Description Research England GCRF QR Fund
Amount £140,500 (GBP)
Funding ID 0006071 
Organisation Higher Education Funding Council for England 
Sector Public
Country United Kingdom
Start 11/2018 
End 07/2019
 
Description UCT Conference hosting grant
Amount R 25,000 (ZAR)
Organisation University of Cape Town 
Sector Academic/University
Country South Africa
Start 09/2019 
End 08/2020
 
Description UCT Enabling Grant-seekers Excellence Award (2019)
Amount R 100,000 (ZAR)
Organisation University of Cape Town 
Sector Academic/University
Country South Africa
Start 09/2019 
End 08/2020
 
Description UCT University Research Committee Start-Up grant (2019)
Amount R 20,000 (ZAR)
Organisation University of Cape Town 
Sector Academic/University
Country South Africa
Start 09/2019 
End 08/2020
 
Description Untransmittable: reducing HIV transmission among young women living with HIV, their partners and children in South Africa
Amount $487,453 (USD)
Funding ID K43TW011434 
Organisation Fogarty International Centre 
Sector Public
Country United States
Start 08/2019 
End 04/2024
 
Title Adapted version of the Mullen Scales of Early Learning 
Description A simple and child-friendly observational tool to document child physical and cognitive development will be used to measure development of adolescents' children across five domains: gross motor skills, fine motor skills, receptive language, expressive language, and visual reception. This involves a series of game-like tasks which have been adapted to the study context. For example the list of age-appropriate words a child should know was translated into the local language - Xhosa - and unfamiliar toys were replaced with substitutes available in the study area. 
Type Of Material Model of mechanisms or symptoms - human 
Year Produced 2018 
Provided To Others? No  
Impact This tool is currently being used to to measure motor and cognitive development in children of young mothers participating in the study. During baseline data collection, over 1100 motor and cognitive development assessments were administered to children over 3 months old. This tool will be implemented during follow-up data collection among all child in the sample to allow examining of child outcomes longitudinally. 
 
Title Adolescent Health & Wellbeing questionnaire 
Description The adolescent health & wellbeing questionnaire was drafted over several consultations with health practitioners and adolescents who are part of the study's Teen Advisory Group. Participants choose the site of their interviews to allow for maximum privacy. The adolescent health questionnaire includes items to assess socio-demographics, healthcare service access (i.e. transport, costs, waiting times, distance and satisfaction of health services), self-reported health outcomes, and risk factors hypothesized to influence adolescent ART adherence and sexual reproductive service uptake. Measures use (where available) tools validated in Southern Africa. The adolescent health and wellbeing self-report questionnaire is administered through tablets. The questionnaire includes teen-friendly images and language designed to engage youth. 
Type Of Material Model of mechanisms or symptoms - human 
Year Produced 2014 
Provided To Others? Yes  
Impact This questionnaire was used to collect real-life data for the world's largest longitudinal cohort of adolescents living with HIV. This has created unique opportunity to investigate risk and resilience promoting factors among adolescents living with HIV in South Africa. The study has already had major impact on policy, UN guidelines and programming for adolescents living with HIV. The team has presented findings in nearly 60 presentations at over twenty-five conferences and workshops. Findings and research priorities have been shared with several hundred of stakeholders engaged in adolescent health and HIV/AIDS policy and programming. The study has to date resulted in 42 peer-reviewed publications in journals including the Lancet Child and Adolescent Health, AIDS, Journal of the International AIDS Society and PloS One. This questionnaire is now also being used to investigate predictors of maternal healthcare use amongst high-risk adolescents in South Africa. During baseline data collection, the fieldwork team have conducted 1027 surveys with adolescent mothers aged 10-19 who have at least one child. In 2020-21, the data collection team will trace the full cohort of adolescent mother-child dyads and administer the survey. 
URL https://static1.squarespace.com/static/54e3c4b3e4b02a415877e452/t/5dc952e3e8290d7830fee50d/157347508...
 
Title Adolescent Parent Questionnaire 
Description The Adolescent parent questionnaire was drafted over several months in consultation with health practitioners and young mothers in the Eastern Cape. The questionnaire was pre-piloted with teen mothers and fathers who are part of the study's Teen Advisory Group. The adolescent parent questionnaire measures adolescent's parenting experiences, parenting stress, pregnancy experiences and assesses their child's health, nutrition and care. Measures use (where available) tools validated in Southern Africa. After pilot testing the questionnaire was further adapted so that research assistants are able to collect information about the child's care from the child's primary caregivers (usually maternal grandmothers) instead of adolescent parents. Pilot testing revealed that adolescent parents were often not able to recall or answer questions about their children's care, nutrition and health. In the study context, childcare is often provided by the adolescent parent's caregivers or extended family to ensure that the adolescent parent can return to school or to reduce stigma of associated with being an adolescent parent. By asking the primary caregiver of these children to respond to questions about childrens' health, nutrition and care we are able to collect data that is prone to biases. The adolescent parent questionnaire is administered through tablets. Participants choose the site of their interviews to avoid unnecessary transport and associated child-minding costs. The questionnaire includes teen-friendly images and language designed to engage youth. 
Type Of Material Model of mechanisms or symptoms - human 
Year Produced 2018 
Provided To Others? Yes  
Impact During baseline data collection, the fieldwork team have conducted 1027 adolescent-parent self-report surveys with adolescent mothers aged 10-19 who have at least one child. In 2020-21, the data collection team will trace the full cohort of adolescent mother-child dyads and administer the survey. 
URL http://www.youngcarers.org.za/s/HEY-BABY-Adolescent-Primary-caregiver-Questionnaire_2018_Reducedsize...
 
Title HEY BABY Dataset 
Description The research team is currently implementation data collection that will contribute to building a complex two-wave data including over 1000 adolescent parent and child dyads. Variables collected from self-report questionnaire as well as extraction from participants health records will allow the research team to identify barriers and facilitators of healthcare utilisation amongst high-risk adolescent mothers and their children. A team of early career researchers and doctoral candidates and research assistants (Saal, Langwenya, He, Anquandah, Carlqvist, Shenderovich, Wittesaele, Zhou, Jochim and Roberts) have led ambitious data cleaning activities for complex relational data collected as part of HEY BABY baseline. In the end, this dataset will include baseline data containing (1) self-report data from adolescent mothers about their experiences and access to health services, school, mental health, well-being, access to services and parenting experiences; (2) self-report data about children of adolescent mothers; (3) data extracted from home-based Road To Health Immunization cards and (4) cognitive development and motor skills assessment data for children. This will build a unique and complex dataset that will allow us to determine predictors of maternal healthcare use amongst high-risk adolescents in South Africa. 
Type Of Material Database/Collection of data 
Year Produced 2018 
Provided To Others? No  
Impact This dataset will be there the first known primary research in Africa examining predictors of adolescent maternal healthcare use. Initiating data cleaning of baseline data will allow us to conduct preliminary analysis and inform adaptations for follow-up data collection. 
 
Description Collaboration between University College London, the University of Cape Town and the University of Oxford 
Organisation University College London
Country United Kingdom 
Sector Academic/University 
PI Contribution Since inception of the project, the research team at the University of Oxford has entered into a tripartite collaboration agreement with the University of Cape Town and University College London. This collaboration continues to support a long-standing and established research collaboration between researchers at the University of Cape Town and Oxford. This joint research team actively engages and collaborates to academically conceptualise research design, support data collection activities, produce high-impact research and engage closely with local, national and international partners. This collaboration supports mixed-methods research lead by Dr Elona Toska (co-PI) and Dr Rebecca Hodes (quantitative co-Investigator) at the AIDS and Society Research Unit, University of Cape Town. Co-Principal Investigators (Professor Lucie Cluver & Dr Elona Toska) also provide strategic and conceptual oversight for the team and co-Investigators at the University of Cape Town. This award contributes £247,553 to this inter-disciplinary team of researchers and project & data management capacity at the University of Cape Town (Dr Hodes, Rebecca Maughan-Brown, Nontokozo Langwenya, Lameez Mota, Akhona Mfeketo and Marius Coqui). In the upcoming grant period, the research team will also identify a cost-effectiveness and allocative efficiency analysis researcher and coordinate Sr N Bungane based at University of Fort Hare. This collaboration creates opportunity for early-career researchers based in South Africa to lead in ground-breaking research that will impact social and health policy in South Africa and the region. The research team has also entered into collaboration with Professor Lorraine Sherr at University College London. The collaboration will contribute resulting data to enable high-impact research lead by Professor Lorraine Sherr and doctoral candidate Kathryn Roberts. In addition, Prof Sherr has regularly contributed to review of quantitative research tools, specifically including review of measures on child development and health outcomes as well as mental health measures for adolescent mothers.
Collaborator Contribution Firstly, the research team at the University of Cape Town and Professor Sherr have been instrumental in the development of the research design, sampling strategy and data collection tools. This has been repeated in preparation and planning activities related to follow-up data collection for the study and will continue as the research team proceeds with follow-up data collection activities in 2020-21. This included overseeing literature reviewing and designing and testing of research tools. Dr Elona Toska has maintained oversight of baseline data collection activities with support of Professor Cluver. Dr Rebecca Hodes has lead qualitative research activities. Qualitative research took place between May and November 2018. Qualitative research focused exploring intergenerational adversity, experiences of service delivery and fatherhood. The University of Cape Town also manages partnerships with South-African based partners including PATA, University of Stellenbosch and Sr N Bungane at the University of Fort Hare. In this capacity, lead researchers at the University of Cape Town also provide skills building for early career researchers such as doctoral candidate Siyanai Zhou and Director-General Conny Nxumalo at the National Department of Social Development and post-doctoral students Dr Wylene Saal. Through this collaboration, University of Cape Town also provides project management to ensure smooth running of fieldwork operations and successful data collection. This has led to successful recruitment of adolescent-parent (n=1027) and child (n=1124) dyads completing multiple data points. The research team at the University of Cape Town is also contributing to data cleaning of complex adolescent-parent and child dataset. As co-Investigator Professor Lorraine Sherr, has been highly involved since the initial phase of the project. Professor Sherr has provided her expertise to conceptualise the sampling and recruitment strategy of highly vulnerable young mothers. During early engagement, Professor Sherr also supervised literature reviews that were used to inform design of research tools and provided consultation about implementation of child cognitive development assessments. Professor Sherr has subsequently maintained active engagement with lead investigators by providing expert advice on use of child development outcome measures for follow-up data collection. Throughout baseline data collection, collaborators have provided extensive oversight on research, data collection and data management activities. In addition, researchers have provided feedback on ethical quandaries that arose during baseline data collection and challenges related to ambitiously recruiting a large small of vulnerable adolescent mothers and their children.
Impact This tripartite collaboration has been crucial for successful inception of the study and unique opportunity to establish data collection activities sooner than planned. We are delighted to report major outputs and outcomes. Set-up and implementation of HEY BABY baseline data collection 2018-19. The research team successfully secured funding through a UNICEF-ESARO Small-Scale Funding Agreement (SSFA) with partners at UNICEF-ESARO (US$45,000) and through Higher Education Funding Council for England (HEFCE) from Research England (£187,000). These funds were awarded during completion of the Mzantsi Wakho data collection. Having secured these funds allowed us to set-up HEY BABY data collection earlier than planned. The research team took advantage of established infrastructure and a highly-trained team of local researchers to support the pilot and baseline data collection for the HEY BABY study. This involved piloting new research tools, delivering additional training to the research team about new data collection tools, developing sampling strategy and engaging with local stakeholders and partners to support recruitment efforts. Design and piloting of research tools for two rounds of data collection. The research team based at Oxford, University of Cape Town and University College London developed two additional research tools: 1) adolescent parent questionnaires and 2) adapted Mullen Scales of Early Learning tool. The adolescent parent questionnaire was piloted with adolescent mums who provided feedback on priority concerns of young mothers and framing of questions. For example, young mums felt it was important to include questions about access and quality of creches and day-care. In consultation with researchers at Stellenbosch University, the Mullen Scales of Early Learning was adapted to improve contextual relevance and feasibility of implementation. For example, items that would not be easily recognised by children in the Eastern Cape would be replaced with more appropriate objects. Recruitment of young adolescent mothers (n=1027) and their children (n=1124): The research team developed a sampling strategy that would enable us to include adolescent mothers aged 10-19 who both engaged and did not engage in formal services. This led to the successful recruitment of 1027 adolescent mothers and 1124 of their children. Between March 2018 and July 2019, we interviewed N=1,712 adolescent girls and young women. We utilised seven parallel sampling strategies to reach adolescent girls (including mothers) and adolescents girls living with HIV (10-19 years) who were both engaged and not engaged in services, and that we reached comparison adolescent girls with matched demographic profiles. Through each sampling strategy we collected details of adolescent girls, who were then traced to their communities and interviewed in their homes. First, we included all ART-initiated adolescent girls, irrespective of whether they were engaged in care, in all district health facilities providing HIV services (n=73) between March 2014 to September 2015. This group was re-traced for follow-up interviews in 2018 with 94% retention in the study. Second, we identified all maternity obstetric units (n=9) in the health district and used case files to identify all adolescent mothers. Third, we interviewed neighbouring adolescent girls of those approached through clinic files. Fourth, secondary schools were randomly selected per municipal area (n=43) within the study's catchment area (n=43) within the study's catchment area. Fifth, we used referrals by social workers and NGO service providers to identify adolescent mothers. Sixth, we included community referrals by adolescent mothers themselves. Finally, an advisory group of adolescent mothers devised recruitment methods for especially hard-to-reach adolescent mothers. For each sampling channel, we recorded refusals and consenting adolescents. Through this methodology, research participants included in the sample will report on variable experiences of health services use/access and parenting experiences which will in turn allow the research team to conduct analysis that is both rigorous and policy-relevant. Data cleaning for baseline data: A team of early career researchers and doctoral candidates and research assistants (Saal, Langwenya, He, Anquandah, Carlqvist, Shenderovich, Wittesaele, Zhou, Jochim and Roberts) have led ambitious data cleaning activities for complex relational data collected as part of HEY BABY baseline. In the end, this dataset will include baseline data containing (1) self-report data from adolescent mothers about their experiences and access to health services, school, mental health, well-being, access to services and parenting experiences; (2) self-report data about children of adolescent mothers; (3) data extracted from home-based Road To Health Immunization cards and (4) cognitive development and motor skills assessment data for children. This will build a unique and complex dataset that will allow us to determine predictors of maternal healthcare use amongst high-risk adolescents in South Africa. Engagement with local stakeholders: Since inception of our previous study (Mzantsi Wakho) the team has engaged closely with policy-makers and implementers at local, national and international levels. This has resulted in close collaboration with local stakeholders such as the Departments of Basic Education and Health. These collaborations have been instrumental in supporting pilot and baseline data collection activities for this project. Meetings with district hospital and healthcare workers have helped us identify key research priorities that will support service delivery that will meet the needs of young parents and their children. Additionally, collaboration with the Department of Basic Education led to meeting opportunities with Learner Support Agents and schools to support research activities and also provide input into on priority research questions regarding attendance of young mothers at schools. These collaborations as well as working closely with local NGOs has also supported recruitment activities allowing us to successfully recruit over 1000 adolescent parents and child dyads. As follow-up data collection activities get underway, onsite fieldwork managers will liaise closely with local stakeholders to facilitate next wave of data collection activities due to start in early 2020. Early dissemination and abstract submissions: Due to concerted effort of data cleaning team, lead investigators and early career researchers have been able to conduct preliminary analysis of HEY BABY baseline data in order to respond to urgent policy questions. In December 2019, on behalf of Dr Toska, Camille Wittesaele presented preliminary HEY BABY baseline data analysis focusing on adolescent mother living with HIV and their child who are HIV exposed at the 20th International Conference on AIDS and STIs in Africa (ICASA) Kigali, Rwanda. In addition, several abstracts have been submitted for IAS 2020.
Start Year 2018
 
Description Collaboration between University College London, the University of Cape Town and the University of Oxford 
Organisation University of Cape Town
Country South Africa 
Sector Academic/University 
PI Contribution Since inception of the project, the research team at the University of Oxford has entered into a tripartite collaboration agreement with the University of Cape Town and University College London. This collaboration continues to support a long-standing and established research collaboration between researchers at the University of Cape Town and Oxford. This joint research team actively engages and collaborates to academically conceptualise research design, support data collection activities, produce high-impact research and engage closely with local, national and international partners. This collaboration supports mixed-methods research lead by Dr Elona Toska (co-PI) and Dr Rebecca Hodes (quantitative co-Investigator) at the AIDS and Society Research Unit, University of Cape Town. Co-Principal Investigators (Professor Lucie Cluver & Dr Elona Toska) also provide strategic and conceptual oversight for the team and co-Investigators at the University of Cape Town. This award contributes £247,553 to this inter-disciplinary team of researchers and project & data management capacity at the University of Cape Town (Dr Hodes, Rebecca Maughan-Brown, Nontokozo Langwenya, Lameez Mota, Akhona Mfeketo and Marius Coqui). In the upcoming grant period, the research team will also identify a cost-effectiveness and allocative efficiency analysis researcher and coordinate Sr N Bungane based at University of Fort Hare. This collaboration creates opportunity for early-career researchers based in South Africa to lead in ground-breaking research that will impact social and health policy in South Africa and the region. The research team has also entered into collaboration with Professor Lorraine Sherr at University College London. The collaboration will contribute resulting data to enable high-impact research lead by Professor Lorraine Sherr and doctoral candidate Kathryn Roberts. In addition, Prof Sherr has regularly contributed to review of quantitative research tools, specifically including review of measures on child development and health outcomes as well as mental health measures for adolescent mothers.
Collaborator Contribution Firstly, the research team at the University of Cape Town and Professor Sherr have been instrumental in the development of the research design, sampling strategy and data collection tools. This has been repeated in preparation and planning activities related to follow-up data collection for the study and will continue as the research team proceeds with follow-up data collection activities in 2020-21. This included overseeing literature reviewing and designing and testing of research tools. Dr Elona Toska has maintained oversight of baseline data collection activities with support of Professor Cluver. Dr Rebecca Hodes has lead qualitative research activities. Qualitative research took place between May and November 2018. Qualitative research focused exploring intergenerational adversity, experiences of service delivery and fatherhood. The University of Cape Town also manages partnerships with South-African based partners including PATA, University of Stellenbosch and Sr N Bungane at the University of Fort Hare. In this capacity, lead researchers at the University of Cape Town also provide skills building for early career researchers such as doctoral candidate Siyanai Zhou and Director-General Conny Nxumalo at the National Department of Social Development and post-doctoral students Dr Wylene Saal. Through this collaboration, University of Cape Town also provides project management to ensure smooth running of fieldwork operations and successful data collection. This has led to successful recruitment of adolescent-parent (n=1027) and child (n=1124) dyads completing multiple data points. The research team at the University of Cape Town is also contributing to data cleaning of complex adolescent-parent and child dataset. As co-Investigator Professor Lorraine Sherr, has been highly involved since the initial phase of the project. Professor Sherr has provided her expertise to conceptualise the sampling and recruitment strategy of highly vulnerable young mothers. During early engagement, Professor Sherr also supervised literature reviews that were used to inform design of research tools and provided consultation about implementation of child cognitive development assessments. Professor Sherr has subsequently maintained active engagement with lead investigators by providing expert advice on use of child development outcome measures for follow-up data collection. Throughout baseline data collection, collaborators have provided extensive oversight on research, data collection and data management activities. In addition, researchers have provided feedback on ethical quandaries that arose during baseline data collection and challenges related to ambitiously recruiting a large small of vulnerable adolescent mothers and their children.
Impact This tripartite collaboration has been crucial for successful inception of the study and unique opportunity to establish data collection activities sooner than planned. We are delighted to report major outputs and outcomes. Set-up and implementation of HEY BABY baseline data collection 2018-19. The research team successfully secured funding through a UNICEF-ESARO Small-Scale Funding Agreement (SSFA) with partners at UNICEF-ESARO (US$45,000) and through Higher Education Funding Council for England (HEFCE) from Research England (£187,000). These funds were awarded during completion of the Mzantsi Wakho data collection. Having secured these funds allowed us to set-up HEY BABY data collection earlier than planned. The research team took advantage of established infrastructure and a highly-trained team of local researchers to support the pilot and baseline data collection for the HEY BABY study. This involved piloting new research tools, delivering additional training to the research team about new data collection tools, developing sampling strategy and engaging with local stakeholders and partners to support recruitment efforts. Design and piloting of research tools for two rounds of data collection. The research team based at Oxford, University of Cape Town and University College London developed two additional research tools: 1) adolescent parent questionnaires and 2) adapted Mullen Scales of Early Learning tool. The adolescent parent questionnaire was piloted with adolescent mums who provided feedback on priority concerns of young mothers and framing of questions. For example, young mums felt it was important to include questions about access and quality of creches and day-care. In consultation with researchers at Stellenbosch University, the Mullen Scales of Early Learning was adapted to improve contextual relevance and feasibility of implementation. For example, items that would not be easily recognised by children in the Eastern Cape would be replaced with more appropriate objects. Recruitment of young adolescent mothers (n=1027) and their children (n=1124): The research team developed a sampling strategy that would enable us to include adolescent mothers aged 10-19 who both engaged and did not engage in formal services. This led to the successful recruitment of 1027 adolescent mothers and 1124 of their children. Between March 2018 and July 2019, we interviewed N=1,712 adolescent girls and young women. We utilised seven parallel sampling strategies to reach adolescent girls (including mothers) and adolescents girls living with HIV (10-19 years) who were both engaged and not engaged in services, and that we reached comparison adolescent girls with matched demographic profiles. Through each sampling strategy we collected details of adolescent girls, who were then traced to their communities and interviewed in their homes. First, we included all ART-initiated adolescent girls, irrespective of whether they were engaged in care, in all district health facilities providing HIV services (n=73) between March 2014 to September 2015. This group was re-traced for follow-up interviews in 2018 with 94% retention in the study. Second, we identified all maternity obstetric units (n=9) in the health district and used case files to identify all adolescent mothers. Third, we interviewed neighbouring adolescent girls of those approached through clinic files. Fourth, secondary schools were randomly selected per municipal area (n=43) within the study's catchment area (n=43) within the study's catchment area. Fifth, we used referrals by social workers and NGO service providers to identify adolescent mothers. Sixth, we included community referrals by adolescent mothers themselves. Finally, an advisory group of adolescent mothers devised recruitment methods for especially hard-to-reach adolescent mothers. For each sampling channel, we recorded refusals and consenting adolescents. Through this methodology, research participants included in the sample will report on variable experiences of health services use/access and parenting experiences which will in turn allow the research team to conduct analysis that is both rigorous and policy-relevant. Data cleaning for baseline data: A team of early career researchers and doctoral candidates and research assistants (Saal, Langwenya, He, Anquandah, Carlqvist, Shenderovich, Wittesaele, Zhou, Jochim and Roberts) have led ambitious data cleaning activities for complex relational data collected as part of HEY BABY baseline. In the end, this dataset will include baseline data containing (1) self-report data from adolescent mothers about their experiences and access to health services, school, mental health, well-being, access to services and parenting experiences; (2) self-report data about children of adolescent mothers; (3) data extracted from home-based Road To Health Immunization cards and (4) cognitive development and motor skills assessment data for children. This will build a unique and complex dataset that will allow us to determine predictors of maternal healthcare use amongst high-risk adolescents in South Africa. Engagement with local stakeholders: Since inception of our previous study (Mzantsi Wakho) the team has engaged closely with policy-makers and implementers at local, national and international levels. This has resulted in close collaboration with local stakeholders such as the Departments of Basic Education and Health. These collaborations have been instrumental in supporting pilot and baseline data collection activities for this project. Meetings with district hospital and healthcare workers have helped us identify key research priorities that will support service delivery that will meet the needs of young parents and their children. Additionally, collaboration with the Department of Basic Education led to meeting opportunities with Learner Support Agents and schools to support research activities and also provide input into on priority research questions regarding attendance of young mothers at schools. These collaborations as well as working closely with local NGOs has also supported recruitment activities allowing us to successfully recruit over 1000 adolescent parents and child dyads. As follow-up data collection activities get underway, onsite fieldwork managers will liaise closely with local stakeholders to facilitate next wave of data collection activities due to start in early 2020. Early dissemination and abstract submissions: Due to concerted effort of data cleaning team, lead investigators and early career researchers have been able to conduct preliminary analysis of HEY BABY baseline data in order to respond to urgent policy questions. In December 2019, on behalf of Dr Toska, Camille Wittesaele presented preliminary HEY BABY baseline data analysis focusing on adolescent mother living with HIV and their child who are HIV exposed at the 20th International Conference on AIDS and STIs in Africa (ICASA) Kigali, Rwanda. In addition, several abstracts have been submitted for IAS 2020.
Start Year 2018
 
Description Collaboration between University of Oxford and the Paediatric Adolescent Treatment Africa (PATA) 
Organisation Paediatric AIDS Treatment for Africa
Country South Africa 
Sector Charity/Non Profit 
PI Contribution Our collaboration with the Paediatric Adolescent Treatment Africa (PATA) involves: 1) knowledge exchange and 2) financial contribution of £22,500. Knowledge exchange: the research team regularly meets with PATA to share relevant analysis and provide recommendations to inform PATA's implementation activities. Financial contribution: A contribution is costed towards the 2020 PATA healthcare provider intercontinental summit. This forum will be held to review and finalise the adolescent parent module with providers. This will support that attendance of 30 front-line healthcare providers from 23 countries in Africa.
Collaborator Contribution The Paediatric Adolescent Treatment Africa (PATA) contributes to this project by providing access to 258-strong network of frontline healthcare providers. PATA will lead in hosting the 2020 PATA healthcare provider intercontinental summit. This will allow the research team to maximise impact of research findings by building capacity amongst healthcare providers from 24 countries in South, East, West and Central Africa.
Impact No outputs or outcomes yet.
Start Year 2018
 
Description Collaboration between the University of Oxford and Stellenbosch University 
Organisation University of Stellenbosch
Country South Africa 
Sector Academic/University 
PI Contribution The research team has collaborated with Professor Mark Tomlinson at Stellenbosch University's Department of Psychology in the conceptual planning and design of the HEY BABY study. The no-funds collaboration is formally governed by a no-fund collaboration agreement between Oxford University and the Stellenbosch University.
Collaborator Contribution Professor Mark Tomlinson has been involved in the conceptual planning and design of the HEY BABY study, specifically through expertise on investigating early child development. Marguerite Marlow, a doctoral-candidate, supervised by Professor Tomlinson, was highly involved in piloting and training the research team in early child development research tools. In 2018, Marguerite Marlow delivered two week-long training session to 40 members of the fieldwork team in South Africa's Eastern Cape. Marguerite Marlow's engagement also involved supporting the adaptation and translation of a research tool that measures motor skills and cognitive development among children of the adolescent mothers involved the study. Baseline early child development data was successfully collected for all but two children (out of 1200 children) of adolescent mothers participating in the HEY BABY study. Since completion of baseline data collection, the research team at Stellenbosch has provided advice about considerations for cleaning and analysis of this data for the study. In addition, in preparation for HEY BABY follow-up data collection, Dr Marlow and Professor Tomlinson's team continue to provide expert advice and training support for early child development research tools and measures.
Impact This collaboration has resulted in the training of 40 data collectors in the South Africa. The fieldwork team in South Africa has to do conducted nearly 1200 child development assessments which will analysed as part of HEY BABY baseline data. Through this collaboration, the research team has additionally received feedback on additional literature reviews conducted on early childhood development measures for use in comparable cohorts and settings. This informed and lead to revisions and further adaptation of research tools to be used for follow-up data collection.
Start Year 2018
 
Description Collaboration with UNICEF ESARO 
Organisation UNICEF
Country United States 
Sector Public 
PI Contribution In November 2018 the research team based at Oxford University and the University of Cape Town entered into a Programme Cooperation Agreement with UNICEF Eastern and Southern Africa Regional Office (ESARO). The UNICEF-ESARO Programme Cooperation Agreement aims to build relevant and robust evidence to identify factors affecting adolescent programming and inform provision of services and support. It will also provide expert capacity building to programme implementers, UNICEF country teams and UNICEF partners to provide differentiated services for adolescents. The research team's contribution for the duration of this the UNICEF-ESARO Programme Cooperation Agreement totals US$1,059,304. This includes costs of: cleaning the research data; ongoing training of local research teams in South Africa; ongoing engagement with policymakers; engaging annually with adolescent advisory groups to ensure that the research is adolescent-relevant and adolescent-friendly; and contribution into the dissemination of findings, reviews of evidence, and training of UNICEF staff and partners. This Programme Cooperation Agreement will also make use of two research studies which involved 5 years of data collection, training local research teams in South Africa, and engagement with policymakers in planning the research. This includes 3 years for Mzantsi Wakho data ($2,514,165) and 1 year for HEY BABY data ($793,113).
Collaborator Contribution UNICEF-ESARO will contribute US$400,000 towards 1) staff costs, workshop expenses and travel for the research team and 2) access to evidence-sharing and capacity-building opportunities for UNICEF ESARO country partners. Contributions from the research team and UNICEF-ESARO will support three main programme outputs: (1) generating real-life high-quality evidence on programming for better adolescent health and wellbeing outcomes, (2) provide expert-level knowledge exchange with ESARO country partners to strengthen the provision of differentiated adolescent programmes and (3) build the capacity of UNICEF Eastern and Southern African Regional Country Offices to engage in research and translate evidence into impactful programming. Activities corresponding to these outputs are described below. This contribution will support existing Mzantsi Wakho study and provide co-funding for data cleaning and 2 publications for this project. Programme output 1: data cleaning, merging and analysis on key programming-related research questions conducted on two major studies, manuscript drafting and policy briefs. Programme output 2: webinars, regional meetings, conferences or workshops to disseminate evidence with UNICEF and country partners and allow evidence building on programming for good health and HIV outcomes among adolescents and young people. Programme output 3: capacity building research clinics with priority countries to implement evidence-building tools to strengthen programming for good health and HIV outcomes among adolescents.
Impact Several outputs within three distinct collaboration objectives have resulted from this collaboration. ========================================================================================================= 1) Generating real-life high-quality evidence on programming for better adolescent health outcomes ========================================================================================================= 1a) Publication of three peer-reviewed articles and high-quality evidence shared to support programming for better adolescent health outcomes Paper 1: The systematic review provides an evidence update on interventions designed to improve antiretroviral therapy adherence and retention among adolescents (10-19) and youth (15-24) living with HIV. This reviewed empirical evidence published between January 2016 and June 2018. A search of 11 health and humanities databases generated 2425 citations and 10 relevant studies, the large majority conducted in sub-Saharan Africa. These include six clinic-level interventions, one individual-level m-Health trial, and three community- or household-level interventions. Findings highlight the need to further develop and test multi-faceted interventions that go beyond health facilities, to address broader social barriers to adherence and retention. Casale, C., et al. "Recent Interventions to Improve Retention in HIV Care and Adherence to Antiretroviral Treatment Among Adolescents and Youth: A Systematic Review." AIDS Patient Care and STDs, vol. 33, no. 6, Mary Ann Liebert, Inc., publishers, June 2019, pp. 237-52, doi:10.1089/apc.2018.0320. Paper 2: This analysis examined pathways in HIV care. Pathways were identified by tracing movements across facility and care types. Associations between transition pathways and viral failure, mortality, loss to follow-up, and viral load change were tested in sequential multivariate regressions. Two main pathways were identified: classical transition to adult HIV care (43.3%) and down-referral transition to primary healthcare clinics (56.7%). Across pathways, 27.3% experienced cyclical transition, or repeated movement between paediatric and non-paediatric care. Adolescents who experienced down-referral transition were less likely to demonstrate viral failure. Mortality and loss to follow-up were not associated with either pathway. Median post-transition viral load change was not clinically significant or associated with transition pathways. Interviews with healthcare providers found that informal "protocols" are implemented to mitigate risk of negative post-transition HIV outcomes. These findings propose a contextually relevant model for transitions out of paediatric HIV care in South Africa. Feasible and scalable "protocols" may mitigate risk of worsening post-transition HIV outcomes. Haghighat, R., et al. "Transition Pathways Out of Paediatric Care and Associated HIV Outcomes for Adolescents Living With HIV in South Africa." JAIDS Journal of Acquired Immune Deficiency Syndromes, vol. 82, no. 2, 2019. Key findings and policy messages in the recently published article on adolescent transition pathways by Roxanna Haghighat et al. will be summarised in a policy brief. This will extend the impact of these highly relevant findings to reach programme implementers as well as adolescent healthcare service providers. This policy brief will present newly identified patterns of transitions in care amongst adolescents living with HIV. Draft is currently in review. This policy brief will be disseminated to UNICEF Eastern and Southern Africa Country Offices who deliver programming and services for adolescents living with HIV. Furthermore, the policy brief will be disseminated more widely to policymakers and programme implementers. Paper 3: This paper examines differences in educational outcomes for adolescents living with HIV, in order to i) identify educational markers for targeting HIV testing, counselling and linkages to care, and ii) to identify essential foci of educational support for adolescents living with HIV. Living with HIV was associated with poorer attendance and educational delay. Key school-based markers for identifying unreached adolescents living with HIV may be low attendance, frequent sickness, low mood and slow learning. Toska, E., et al. "Educational Experiences and Needs of Adolescents Living with HIV in a South African Cohort." BMC Public Health, vol. 19, no. 1, 2019, p. 272, doi:10.1186/s12889-019-6580-0. 1b) Dataset cleaning activities: In preparation for the planned analysis to take place the research team has reached final stages of finalising a three-wave dataset using data collected from the world's largest longitudinal cohort study of adolescents living with HIV. 1c) Regular meetings held to discuss ongoing analysis and updates on activities between the research team and UNICEF-ESARO ========================================================================================================= 2) Expert-level knowledge exchange with UNICEF Eastern & Southern Africa Region country partners to strengthen the provision of differentiated adolescent programmes ========================================================================================================= 2a) Webinar Series: Evidence & Solutions for Adolescents in Eastern & Southern Africa The first webinar of the planned series was successfully held in September 2019. The webinar series provides an opportunity for UNICEF Eastern & Southern Africa Regional Country Offices to learn about the latest evidence and solutions to strengthen their programming and services for adolescents. The webinar was attended by 14 participants from UNICEF Eastern & Southern Africa Regional Country Offices. The webinar presentation slides, and recording were disseminated and shared to all 21 UNICEF Eastern & Southern Africa Regional Country Offices. The first webinar was titled: Beyond the Third 90: Supporting Adolescents Living with HIV To Remain Engaged in Care as They Transition to Adulthood. During the webinar findings were presented from two recent publications: 1. Dr Marisa Casale introduced the webinar by presenting results from a systematic review of Interventions to improve retention in HIV care and adherence to antiretroviral treatment among adolescents and youth. 2. This was followed by a presentation by doctoral researcher Roxanna Haghighat, presenting newly identified transition trajectories for adolescents living with HIV. Participants highlighted that was the first they have considered the complexity of transitions in adolescent HIV care and treatment. 2b) Review of evidence for UNICEF Eastern & Southern Africa countries The first review of evidence has been conducted and published in the Journal of Acquired Immune Deficiency Syndromes. This systematic review provides an evidence update of empirically evaluated interventions that keep adolescents in HIV treatment and care. Key messages were presented to UNICEF Eastern & Southern Africa Country Offices during a webinar in September 2019. This included identification of clinic and home-based interventions that show promise in improving adherence outcomes. The systematic review also highlights evidence gap and need to further develop and test multi-faceted interventions that go beyond health facilities. These may be important to address broader social barriers to adherence and retention. ========================================================================================================= 3) Build the capacity of UNICEF ESARO country offices to engage in research and use evidence-building tools in programme implementation ========================================================================================================= Oxford-UCT team provided feedback on a study protocol developed for research by UNICEF Zimbabwe: Prof Lucie Cluver and Dr Elona Toska provided feedback on the strengths of a study protocol drafted by UNICEF Zimbabwe. This included feedback on both the strengths of data collection tools as well as study design. Further feedback was provided in a follow-up meeting which allowed the Oxford -UCT team to provide expert knowledge exchange. The discussion from this meeting supported the implementation of research tools that would enhance the country office's (Zimbabwe) capacity to implement evidence-building tools. Oxford-UCT team provided feedback on a study protocol developed for research by UNICEF Tanzania: In early April 2019, the collaborators met with UNICEF Tanzania to discuss a study on adolescents living with HIV and education. Feedback on this study protocol allowed the country office to ensure that research aims are feasible to answer and applied appropriate research design. This consultation provided the country office with feedback that enhances the country to office to successfully implement evidence-building activities.
Start Year 2018
 
Description National Health Laboratory Services of South Africa 
Organisation National Health Laboratory Services, South Africa
Country South Africa 
Sector Public 
PI Contribution Since the study started, the research team has built a collaboration with Professor Gayle Sherman at the National Health Laboratory Services (NHLS) of South Africa. Through this partnership, we will match - using an algorithm developed and tested by the NHLS team - adolescent parent and child laboratory outcomes (HIV test results, viral load, TB tests) to their interview data in 2018-2021. The research will collect secondary data to link adolescent and child medical records to adolescent interviews in collaboration with the National Health Laboratory Service of South Africa. Most adolescent parents and their children access public health services in one of the 79 health facilities with whom our research team works closely. These facilities collect and store health information such as access to PMTCT (prevention of mother to child transmission of HIV) care, child HIV testing and results, and child immunisation records. The study has asked consent from all adolescent parents and caregivers to access this information from their medical files. Upon completion of baseline data collection in July 2019, lead investigator (Dr Toska) and a team of early career researchers (Nontokozo Langwenya, Eda He, Roxanna Haghighat, Dr Anna Carlqvist, Siya Zhou & Silinga Dzumbunu) will prepare a dataset to facilitate matching of up to 1500 adolescents living with HIV (including adolescent mothers and their children). Facilitated through a formal collaboration agreement with the NHLS team, data will be transferred for matching to take place from mid-2020 onwards. The team of researchers leading this endeavour are in the final stages of finalising the dataset required for the NHLS team to run matching algorithms. The first round of matching results is set to be completed by mid-2020.
Collaborator Contribution Professor Gayle Sherman at the National Health Laboratory Services (NHLS) of South Africa will use participant information collected by the research team to match study participants to data stored at the NHLS repository. Professor Sherman's team has provided consultation about type of information the research team should collect from participants - for example, variations in name spellings - in order to maximise possibility of accurately matching research participants to data sorted at the NHLS.
Impact This will enable us to use social science data and methods to identify what can help with health outcomes measured through rigorous biomedical tests. The collaboration with NHLS extends the existing medical records data collection that the team has been already conducting, by ensuring that data available from health facilities outside the catchment area are included in the dataset, with adolescent patient and caregiver consent.
Start Year 2018
 
Description Paediatric AIDS Treatment for Africa (PATA) 
Organisation Petroc
Country United Kingdom 
Sector Academic/University 
PI Contribution Knowledge Exchange
Collaborator Contribution long established NGO that is supporting our research on adolescent adherence by advising on recruitment and relationships with local government and clinics
Impact None
Start Year 2014
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation African School of Economics
Country Benin 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation African Union Development Agency
Country South Africa 
Sector Charity/Non Profit 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation Agency for Research and Development Initiative
Country South Sudan 
Sector Charity/Non Profit 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation Busara Center for Behavioral Economics
Country Kenya 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation London School of Hygiene and Tropical Medicine (LSHTM)
Country United Kingdom 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation National Institute for Medical Research, Tanzania
Department Mwanza Intervention Trials Unit (MITU)
Country Tanzania, United Republic of 
Sector Public 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation North-West University
Country South Africa 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation University College London
Country United Kingdom 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation University of Cape Town
Country South Africa 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation University of Dodoma
Country Tanzania, United Republic of 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation University of Edinburgh
Country United Kingdom 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation University of Ibadan
Country Nigeria 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation University of KwaZulu-Natal
Country South Africa 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation University of Stellenbosch
Country South Africa 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation University of Zambia
Country Zambia 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation University of the Western Cape
Country South Africa 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub Research Partnership 
Organisation Wellcome Trust
Department KEMRI-Wellcome Trust Research Programme
Country Kenya 
Sector Academic/University 
PI Contribution The Accelerate Hub has made research grants available to the research partners listed above. We also provide coordination, support, capacity building and administrative support available to the partners.
Collaborator Contribution Research partners are contributing to the development of individual trials and studies. They are also contributing to the overall development of our thinking and understanding about accelerators.
Impact This collaboration is multi-disciplinary. The collaboration covers social science, economics, psychology, health sciences, english and humanities.
Start Year 2019
 
Description Young Carers; HEY BABY; Mzantsi Wakho & Sinovuyo Teen Study: Lifeline South Africa 
Organisation Lifeline South Africa
Country South Africa 
Sector Private 
PI Contribution The research team pays for counselling services for our most vulnerable research participants and local fieldwork staff. The research team also provides knowledge exchanges by reporting on relevant research findings to partners at Lifeline South Africa.
Collaborator Contribution We provide referral of participants and local staff to counselling services. Lifeline South Africa provides counselling for all of our local staff who may have experienced vicarious trauma throughout conducting fieldwork activities. Lifeline also provides counselling to our young research participants.
Impact Access to Lifeline allows us to refer research participants to counselling services. During interviews participants may disclose traumatic events they have experienced and ask research assistants support for accessing local services to support mental health and wellbeing. In addition, we have found this service useful to refer team members to who may experience vicarious trauma.
Start Year 2014
 
Description AAAS 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Lead investigator Dr Elona Toska, Prof Lucie Cluver and Dr Rebecca Hodes were invited to attend the American Association for the Advancement of Science (AAAS) 2019 conference in Washington DC.

Dr Elona Toska presented to an audience of 40 policy-makers and multi-disciplinary academics. The session was titled: Innovations in Effective Infection Control and Prevention: Lessons for the Future. Dr Toska presented on Reducing Life-threatening Infections: Innovative Social Science Approaches on behalf of the extended research team. She shared findings from the qualitative and quantitative findings, and received questions on parenting programmes, interventions that support ART adherence among adolescents living with HIV, and the future of sexual and reproductive health interventions among young people.
Year(s) Of Engagement Activity 2019
 
Description AIDSImpact conference, London, UK - Aug 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Various presentations at the 14th AIDS Impact conference July 29th - 31st 2019, London, United Kingdom - given by members of the Hub team.

Conference looking at HIV/AIDS prevention, treatment and care, focusing both globally and on specific communities and countries hardest hit by the HIV/AIDS epidemic.
Year(s) Of Engagement Activity 2019
URL http://www.aidsimpact.com/
 
Description Article by E. Toska in the Times Select, a South African Publication 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Article title : Hunger stalks adolescent mothers already under strain. https://select.timeslive.co.za/news/2019-10-16-hunger-stalks-adolescent-mothers-already-under-strain/
Year(s) Of Engagement Activity 2019
 
Description Brown University Guest Lecture 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact Lead investigators Dr Elona Toska, Prof Lucie Cluver and Dr Rebecca Hodes were invited to present a guest lecture for the Sociology of Medicine course at Brown University's Department of Sociology.

The presentation was titled: Addressing the Unique Health Needs of Adolescents through a Lifecourse Approach: The Socio-ecological Model.
Year(s) Of Engagement Activity 2019
 
Description Capacity sharing and building workshop for Early Career Researchers at the annual Hub meeting in Cape Town in January 2020 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Study participants or study members
Results and Impact The Hub organised a full day capacity sharing and building workshop for early career researchers at its annual meeting, held in Cape Town in January 2020. This included sessions on research methods, research mentoring, communication skills, and policy engagement and influencing. 23 ECRs from DAC and other countries participated in the workshop. The majority of these were female (15); eight males also participated in the workshop.

This workshop emphasised the importance of networking and established and launched a community of practice on the Basecamp online platform, where all researchers are connected and can discuss common issues affecting them and their work with their peers.

Career development and sustainability are also important to the Hub's understanding of 'equitable partnerships' and ECRs were therefore engaged in discussions regarding mentorship and explored future opportunities to identify mentors and mentees using the African Academy of Sciences (AAS) mentorship platform.

Policy engagement is obviously crucial to achieving research impact, as well as to ensuring that early career researchers are able to establish fulfilling and sustainable careers. The session on policy engagement was therefore designed to build confidence and skills in this area. Participants considered the wide range of activities involved in policy engagement and wrote and presented short elevator pitches for policy makers. The workshop was accompanied by a handout, 'An introduction to policy engagement' which contained advice on how to get started, links to further resources, and case-studies of Hub staff and researchers involved in policy engagement.
Year(s) Of Engagement Activity 2020
URL https://www.acceleratehub.org/resources
 
Description Consultation with the Coalition for Children Affected by AIDS, November 2019 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact The Coalition is a partnership of global donors, United Nations agencies, NGOs, and experts to support youth and children affected by HIV and AIDS. They are planning a new focus on adolescent mothers affected by HIV and will partner with the research study for knowledge exchange. The consultancy was on advocacy and evidence for adolescent mothers affected by and infected by HIV and resulted in a plan to work together with HEY BABY study initiative.
Year(s) Of Engagement Activity 2019
 
Description Development and dissemination of information sheet on medicines taking to Small Projects Foundation for sharing at schools served by the NGO 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Development and dissemination of information sheet on medicines taking to Small Projects Foundation for sharing at schools served by the NGO
Mzantsi Wakho project with Small Projects Foundation, East London, SA
Year(s) Of Engagement Activity 2019
 
Description EGPAF Webinar 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Online webinar, scientific community
Year(s) Of Engagement Activity 2019
 
Description Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) Webinar February 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) invited the research team to present a webinar in February 2019. Dr Elona Toska, Roxanna Haghighat and Prof Lucie Cluver co-presented a webinar session titled, From Clinics to Community: Supporting Adolescents Living with HIV.

The webinar was attended by EGPAF staff from nearly half a dozen countries, including Democratic Republic of Congo, Eswatini, Lesotho, South Africa, Kenya and Zimbabwe. The two main areas of focus were transition in care and supporting young people achieve their sexual and reproductive health goals, particularly when they are living with HIV. Through collaborating with EGPAF on their transition toolkit, the research team has significantly shaped how EGPAF has conceptualises non-Western and non-Northern pathways of transition in health for young people living with HIV.
Year(s) Of Engagement Activity 2019
 
Description HIV Transmission and Prevention for Adolescents in Southern and Eastern Africa 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Evidence for HIV Prevention in Southern Africa (EHPSA), Cape Town, South Africa
Year(s) Of Engagement Activity 2018
 
Description ICASA 2019 Oral presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact Presentation of preliminary HEY BABY baseline data analysis focusing on adolescent mother living with HIV and their child who are HIV exposed. In collaboration with International AIDS Society. Audience: ~90 people, conference attendees (policy makers, practitioners). Location: Kigali, Rwanda.
Year(s) Of Engagement Activity 2019
 
Description Implementation Science Working Group, University of California San Francisco 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact In February 2019, doctoral candidate Roxanna Haghighat presented at to the Implementation Science Working Group at University of California San Francisco. Roxanna Haghighat presented research examining the transition of adolescents living with HIV out of paediatric care. 13 members of the Group attended the meeting and demonstrated a lot of interest in the work of the research team. The group also communicated considerable appreciation for the amount of work that has gone into the data collection and unpacking of the complex data.
Year(s) Of Engagement Activity 2019
 
Description Lucie Cluver Research Group & University of Cape Town - Eastern Cape Dissemination Week, to institutions and recruitees - May 2019 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Eastern Cape Dissemination Week
Year(s) Of Engagement Activity 2019
 
Description Newsletter on website of Department of Social Policy and Intervention "Ground-breaking report aims to STACK the odds for adolescents living with HIV and reach the Sustainable Development Goals" 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Newsletter on an Oxford University departmental website entitled "Ground-breaking report aims to STACK the odds for adolescents living with HIV and reach the Sustainable Development Goals"
Year(s) Of Engagement Activity 2019
URL https://www.spi.ox.ac.uk/article/ground-breaking-report-aims-to-stack-the-odds-for-adolescents-livin...
 
Description Plenary session presentation: Paediatric AIDS Treatment for Africa (PATA) Youth Summit 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Patients, carers and/or patient groups
Results and Impact In November 2018, Dr Elona Toska presented at the 2018 PATA Youth Summit in Dar Es Salaam, Tanzania. The presentation was tiled: #DATADRIVEN Advocacy For Our Adolescent And Young People In HIV Response What Are The Priorities?

The presentation was attended by about 200+ PATA network members from 40 teams from 13 Eastern and Southern African countries, including nurses, counsellors, peer supporters, and national/ regional/ international networks of young people living with HIV.
Year(s) Of Engagement Activity 2018
URL http://teampata.org/summits-and-forums/
 
Description Policy meeting - UNICEF HQ (Sept 2019) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Meeting on HEY BABY to UNICEF Adolescent participation team in New York.
Year(s) Of Engagement Activity 2019
 
Description Presentation (October, 2019) in Cape Town, South Africa for GCRF Hub colleagues and NGO partners 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Supporters
Results and Impact Presentation "Development Accelerators - A Game-changer for Africa's Adolescents"
Year(s) Of Engagement Activity 2019
 
Description Presentation (online) - Johnson & Johnson (Sept 2019) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact Online presentation sharing results from mixed methods quantitative and participatory research activities on use and experience of injectables among adolescent girl and boys.
Year(s) Of Engagement Activity 2019
 
Description Presentation - 2gether 4SRHR project (Feb 2020) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Dr Elona Toska and Nontokozo Langwenya presented to representatives of five country teams implementing 2gether 4SRHR project (SIDA funded, implemented by UNICEF, UNFPA, UNAIDS & WHO). Presentation title: Opportunities in HIV & SRHR Programming for the Second Decade of Life in East and Southern Africa.
Year(s) Of Engagement Activity 2020
 
Description Presentation and discussion to the UNAIDS Programme Coordinating Board, on 12 Dec, Geneva 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Professor Lucie Cluver was invited to speak to the UNAIDS Programme Coordinating Board in Geneva about the UKRI's GCRF Accelerate Hub's recent findings. This was an opportunity to present the 'accelerator' concept in relation to HIV and adolescents and the very low rates of adherence to antiretroviral medication. The Hub's results show that simple social and economic solutions (cash transfers, safe schools and parenting support) can improve retention in HIV care for vulnerable adolescents, and that they also improve multiple other Sustainable Development Goals. This provides real opportunities to capitalise on the SDG agenda, and also to provide services to adolescents living with HIV that allow them to reach their wider goals.

The PCB is a high-level advisory group that advises the United Nations on policy and programming. It includes the UNAIDS representatives of 22 countries, UNFPA, UNICEF, WFP, UNESCO, ILO, WHO, World Bank, UNDP, UNHCR and UNODC, and meets at the World Health Organisation. Lucie spoke at the 'children and adolescents' thematic day on Thursday 12 December, which then makes clear plans for UNAIDS actions. Afterwards, she said: "We are really honoured that the Accelerate Hub was invited to speak at the UNAIDS Planning Coordination Board. We presented our new findings, showing that parenting support, cash transfers and safe schools can improve HIV care and also multiple SDGs for adolescents living with HIV. After our talk, the US Ambassador for the AIDS response, the Deputy Executive Director of UNAIDS and DFID all highlighted that these findings are informing the design of their programmes to fight the AIDS epidemic."
Year(s) Of Engagement Activity 2019
URL https://www.spi.ox.ac.uk/article/accelerator-interventions-at-unaids
 
Description Presentation at 2nd International Workshop on HIV Adolescence, Cape Town, South Africa 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Presentation at conference - "Teens Just Want to Have Fun: Association between Substance use and weekend adherence amongst adolescents living with HIV in South Africa"
Year(s) Of Engagement Activity 2018
 
Description Presentation at AIDS Impact, July 2019 - London, UK - Respondent @ Lunchtime satellite Youth at Risk HSRC 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Lucie Cluver - Respondent @ Lunchtime satellite Youth at Risk HSRC
Year(s) Of Engagement Activity 2019
 
Description Presentation at AIDS Impact, July 2019, London, UK - "'I used to hate myself when I first knew, but there was a thing that whispered in my ears': Young HIV-positive masculinities throughout the life course" 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Presentation - 'I used to hate myself when I first knew, but there was a thing that whispered in my ears': Young HIV-positive masculinities throughout the life course
Year(s) Of Engagement Activity 2019
 
Description Presentation at AIDS Impact, July 2019, London, UK - "Interventions to prevent and reduce gender-based violence (GBV) among young people living with, or most affected by, HIV and AIDS in low-and middle income countries (LMICs): A systematic review and meta-analysis  " 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Presentation - Interventions to prevent and reduce gender-based violence (GBV) among young people living with, or most affected by, HIV and AIDS in low-and middle income countries (LMICs): A systematic review and meta-analysis 
Year(s) Of Engagement Activity 2019
 
Description Presentation at AIDS Impact, July 2019, London, UK - "Medical pluralism among children and adolescents in South Africa: methodological findings from mixed methods research " 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Presentation - Medical pluralism among children and adolescents in South Africa: methodological findings from mixed methods research 
Year(s) Of Engagement Activity 2019
 
Description Presentation at AIDS Impact, July 2019, London, UK - "Predictors of adherence to ART among adolescents in South Africa: Supportive family relationships" 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Presentation - Predictors of adherence to ART among adolescents in South Africa: Supportive family relationships
Year(s) Of Engagement Activity 2019
 
Description Presentation at AIDS Impact, London, UK - "Adolescent Pregnancy and Mental Health: Does the impact of pregnancy differ according to HIV status?" 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Presentation - Adolescent Pregnancy and Mental Health: Does the impact of pregnancy differ according to HIV status? 
Year(s) Of Engagement Activity 2019
 
Description Presentation at AIDS Impact, London, UK - "Adolescent hormonal contraception use and childbearing ideation in the era of HIV - findings from a large community-based study in South Africa " 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Presentation : Adolescent hormonal contraception use and childbearing ideation in the era of HIV - findings from a large community-based study in South Africa 
Year(s) Of Engagement Activity 2019
 
Description Presentation at AIDS Impact, London, UK - "Can we harness the Sustainable Development Goals to reach viral suppression for adolescents living with HIV?" 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Can we harness the Sustainable Development Goals to reach viral suppression for adolescents living with HIV? 
Year(s) Of Engagement Activity 2019
 
Description Presentation at AIDS Impact, London, UK - "Dreams of an AIDS-free generation: Which supportive factors delay exposure to HIV risk in early adolescence"  
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Presentation at AIDS Impact, London, UK - "Dreams of an AIDS-free generation: Which supportive factors delay exposure to HIV risk in early adolescence" 
Year(s) Of Engagement Activity 2019
URL http://www.aidsimpact.com/
 
Description Presentation at AIDS Impact, London, UK - "Mental wellbeing amongst caregivers of HIV-affected children in South Africa: predictors of positive mental health and its implications for child wellbeing" 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Presentation at Conference - Mental wellbeing amongst caregivers of HIV-affected children in South Africa: predictors of positive mental health and its implications for child wellbeing 
Year(s) Of Engagement Activity 2019
URL http://www.aidsimpact.com/
 
Description Presentation at AIDS Impact, London, UK - "Tackling shame for a stronger HIV response: Systematic review of interventions to address self-stigma among people living with and affected by HIV " 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Presentation - Tackling shame for a stronger HIV response: Systematic review of interventions to address self-stigma among people living with and affected by HIV 
Year(s) Of Engagement Activity 2019
 
Description Presentation at AIDS Impact, London, UK - "Young leaders left behind: challenges and new solutions for adolescents living with HIV" 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Presentation: Young leaders left behind: challenges and new solutions for adolescents living with HIV 
Year(s) Of Engagement Activity 2019
 
Description Presentation at Gugulethu Community 'Research Day', South Africa 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Gugulethu Community 'Research Day'
Year(s) Of Engagement Activity 2019
 
Description Presentation at UKRI for International Women's Day, November 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Supporters
Results and Impact This was an opportunity to share, with UKRI staff, on advocacy and evidence for adolescent mothers affected by and infected by HIV. They will partner with the research study for knowledge exchange and further collaboration.
Year(s) Of Engagement Activity 2019
 
Description Presentation at the UN Inter-Agency Task Team for Social Protection, Care and support, October 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact The presentation was on advocacy and evidence for adolescent mothers affected by and infected by HIV. The Task team will partner with the research study for knowledge exchange and further collaboration.
Year(s) Of Engagement Activity 2019
 
Description Presentation by Janina Jochim at Oxford, Green Templeton College 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact presentation on Adolescent Motherhood & School Outcomes in South African Girls and Young Women .
Year(s) Of Engagement Activity 2019
 
Description Presentation by Janina Jochim at the Department of Social Policy and Intervention, University of Oxford 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Presentation on "Teenage Mothers and Schooling - Going from "door-to-door" to collect primary data in South Africa"
Year(s) Of Engagement Activity 2019
 
Description Presentation by Yulia Shenderovich at Department of Social Policy and Intervention, Oxford University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Presentation on "Mental health and anti-retroviral adherence in a cohort of adolescents in South Africa: Analysis plan"
Year(s) Of Engagement Activity 2020
 
Description Presentation for Academics by Janina Jochim, in Cape Town, South Africa 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Presentation HEY BABY - A mixed-methods study on resilience factors in adolescent mothers in the Eastern Cape, South Africa" - dissemination of doctoral research findings by Janina Jochim.
Year(s) Of Engagement Activity 2019
 
Description Presentation for Gates Foundation, July 2018 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Supporters
Results and Impact The presentation informed partners at the Gates Foundation on importance of social protection to support improved health outcomes for young people living with HIV. We also shared importance of examining the needs of young families and their children. This paved the way for future collaboration on evidence.
Year(s) Of Engagement Activity 2018
 
Description Presentation for South African Department of Social Development, June 2018 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Presentation informed South Africa's Department of Social Development on the importance of social protection to support the needs of young people living with HIV and promote adherence to medication. This paved the way for future collaboration on evidence.
Year(s) Of Engagement Activity 2018
 
Description Presentation for UNICEF ESARO on "Africa's Adolescents: New Evidence on Preventing Infections and Supporting Adherence", June 2018 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact The presentation informed UNICEF ESARO on the importance of social protection to support improved health outcomes for young people living with HIV. This paved the way for future collaboration on evidence and led to Programme Cooperation Agreement.
Year(s) Of Engagement Activity 2018
 
Description Presentation in Johanesburg, South Africa (Oct, 2019) to PATA Teams (from Cameroon, DRC, eSwatini, Kenya, Malawi, Mozambique, South Africa, Tanzania, Uganda, Zambia and Zimbabwe) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact presentation - Resilient Relationships for Adolescents & Young People Living with HIV. What can we do in clinics and communities? (18/10/19)
Year(s) Of Engagement Activity 2019
 
Description Presentation of MW Findings and HEY BABY introduction 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Eastern Cape AIDS Council (ECAC), Conference on HIV, TB & STIs prevention policy implementation in schools, Regent Premier Hotel in East London
Year(s) Of Engagement Activity 2018
 
Description Presentation of MW Findings and HEY BABY introduction 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Planning and Research Committee Members of the Eastern Cape AIDS Council (ECAC) at the Eastern Cape Socio-Economic Consultative Council (ECSECC) offices, Eastern Cape, South Africa
Year(s) Of Engagement Activity 2018
 
Description Presentation of MW Findings and HEY BABY introduction 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Inaugural 2018/19 Eastern Cape Department of Education Research Seminar, Eastern Cape, South Africa
Year(s) Of Engagement Activity 2018
 
Description Presentation on Mzantsi Wakho & HEY BABY at 9th Southern African AIDS Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Presentation on Mzantsi Wakho & HEY BABY at 9th Southern African AIDS Conference, held at the Foundation for Professional Development (FPD)_Durban, South Africa
Year(s) Of Engagement Activity 2019
URL http://www.saaids.co.za/
 
Description Report contribution by E. Toska and L. Cluver with the University of Cape Town and Western Cape Department of Health, South Africa 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Request for input on cash transfers/social grants for Western Cape Burden of Disease review. Reported on with Director of the Centre for Infectious Disease Epidemiology and Research (CIDER) at the University of Cape Town and a Public Health Medicine Specialist in the Western Cape Department of Health
Year(s) Of Engagement Activity 2019
 
Description Report posted on Nuffield Foundation website "Identifying psychosocial, family and service mechanisms to improve anti-retroviral adherence amongst adolescents living with HIV in Southern Africa" 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Title of report "Identifying psychosocial, family and service mechanisms to improve anti-retroviral adherence amongst adolescents living with HIV in Southern Africa". This report summarises the study findings and impact of the Mzantsi Wakho research project implemented jointly by the Universities of Oxford and Cape Town.
Year(s) Of Engagement Activity 2019
 
Description Seminar at University of Cape Town Centre for Social Science Research, Cape Town, SA - 'Devil's medicine or complementary care? Biomedical beliefs and practices amongst traditional health practitioners in South Africa' 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Seminar - presentation on 'Devil's medicine or complementary care? Biomedical beliefs and practices amongst traditional health practitioners in South Africa'
Year(s) Of Engagement Activity 2019
 
Description Skills-building session: Paediatric AIDS Treatment for Africa (PATA) Youth Summit 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact In November 2018, Camille Wittesaele facilitated two skills-building workshops to 40 nurses and counsellors. This session was titled: Empowered with Evidence: Using research and data to improve services for adolescent and young people living with HIV. These participatory skills-building sessions focused on understanding approaches to integrating HIV & sexual & reproductive health services to meet adolescent and young people living with HIV. Participants also explored ways to document and measure successes and areas for improvement of integration using routinely collected data at their health facilities.

Participants provided feedback that interactive activities and group discussions were useful to understand concepts and apply them to real-world examples from their own health facilities. In addition, the group noted that is was helpful to understand how integrating healthcare can help to address the specific needs of young people and maximise retention in care and improve service delivery.
Year(s) Of Engagement Activity 2018
URL http://teampata.org/summits-and-forums/
 
Description South African Medical Research Council (SA MRC) Social Impact Bond Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Dr Elona Toska attended workshop meeting at the South African Medical Research Council (SA MRC) to provide consultation on the design of packages included in the Social Impact Bond attended by nearly 30 leading South Africa-based social and biomedical HIV scientists.

The Social Impact Bond aims to address HIV and sexual and gender-based violence in adolescent girls and young women though innovative financing and accelerated learning by focusing on improving access to sexual and reproductive health products and services through school-based programming and reducing unintended adolescent pregnancies. The research team advocated for inclusion of post-birth support for adolescent girls returning to school, improved parental-adolescent relationships, and better training of existing auxiliary nurses and social workers.
Year(s) Of Engagement Activity 2018
 
Description Symposium, July 2019 - Durban, South Africa - for audience of Higher Education, Practitioners, Students, Academics 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Sex, Sexuality and Education in South Africa: A symposium
Year(s) Of Engagement Activity 2019
 
Description Teen Advisory Group South Africa - Western Cape & Eastern Cape (2019) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Study participants or study members
Results and Impact 2019 brought to a close ten years of our Teen Advisory Group in Cape Town, South Africa. This group has been central to the team's success by co-developing protocols for Young Carers, Mzantsi Wakho and HEY BABY. In order to reflect on the progress and celebrate the contributions of our adolescent co-researchers, we ran a graduation programme for them. Adolescents were provided with a menu of methodologies to choose from as a way of reflecting on their engagement to date and as part of closing this particular group. They chose to share their insights via a focus group discussion, theatre production and a participatory mural development and painting. These interactive and collaborative methodologies were implemented successfully over the course of 2019.

In addition to the graduation programme, our team established a new Teen Advisory Group in the Eastern Cape in June 2019. The adolescents in this cohort were recruited from existing studies, including Mzantsi Wakho. At our first engagement with this group, we focused on building a relationship, creating a safe space for interaction, dialogue and sharing, as well as to exploring the different ways the adolescents would like to interact and work with the Teen Advisory Group. This successful meeting was followed up by a storytelling workshop in November 2019. We look forward to ongoing collaboration with this group.
Year(s) Of Engagement Activity 2019
 
Description UN Women + Accelerating Achievement for Africa's Adolescents Hub 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Prof Lucie Cluver and Dr Elona Toska presented a session titled: Transforming the Potential of Africa's Adolescent Demographic Boom.

This talk was presented to 10 attendees primarily consisting of representative from UN agencies: UNWomen, UNFPA, and UNDP. The presentation focused on presenting preliminary findings from the HEY BABY study and presenting the research team's recently awarded UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub. Feedback focused on how we can integrate HEY BABY and team's findings in the International Conference on Population Development's 25th anniversary. The research team is in touch with UNFPA headquarters and Eastern and Southern Africa Region to provide additional webinars, capacity sharing and evidence translation support for adolescent sexual and reproductive health.
Year(s) Of Engagement Activity 2019
 
Description UNICEF HIV Newsletter Issue 2: Special edition on ICASA 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The ICASA satellite session titled: The Drive to Thrive: How are the children and adolescents HIV-exposed yet uninfected doing? was highlighted in the UNICEF HIV Newsletter Issue: Special edition on ICASA. Camille Wittesaele, presented on behalf of Dr Elona Toska and HEY BABY team on outcomes of HIV-exposed and uninfected children in the HEY BABY cohort data. This presentation shared preliminary analysis of HEY BABY baseline data.
Year(s) Of Engagement Activity 2020
 
Description USAID + FHI360 February 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Dr Elona Toska was invited to attend present at a meeting at USAID in Washington DC. This presenting was co-organised with partners the research team's partners at FHI360. The meeting was attended by Orphans and Vulnerable Children-focused staff.

The presentation was titled: HIV Prevention (Primary and Secondary) Among Adolescents in Southern Africa: What Works? The focus was on which provisions support young people to delay/ avoid exposure to HIV risk. Findings suggest that early consistent access to 4 provisions is critical.
Year(s) Of Engagement Activity 2019
 
Description Webinar for UNAIDS Tanzania Office, November 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Third sector organisations
Results and Impact The webinar informed attendees on importance of social protection to support adherence and improved health outcomes for young people living with HIV and paved the way for future collaboration on evidence.
Year(s) Of Engagement Activity 2019
 
Description Webinar: Beyond The Third 90: Supporting Adolescents Living With HIV To Remain Engaged In Care As They Transition To Adulthood 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Marisa Casale (PhD) and Roxanna Haghighat (DPhil Candidate) presented webinar in collaboration with UNICEF-ESARO. Presented (1) systematic review of interventions to improve adolescent retention in care and (2) adolescent transition pathways.
Attended by 14 attendees from across UNICEF ESAR country offices and slides and recording of the webinar will be shared to all 21 UNICEF Eastern-Southern Africa Region Country Offices (Angola, Botswana, Burundi, Comoros, Eritrea, Eswatini (Swaziland), Ethiopia, Kenya, Lesotho, Madagascar, Malawi, Mozambique, Namibia, Rwanda, Somalia, South Africa, South Sudan, Tanzania, Uganda, Zambia, Zimbabwe)

Impact: some country offices highlighted that this is the first they have ever considered the complexity of transitions in adolescent HIV care and treatment.
Year(s) Of Engagement Activity 2019
 
Description World Food Programme Webinar, November 2018 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Informing attendees on the importance of social protection for improving health outcomes for young people in Southern Africa.
Year(s) Of Engagement Activity 2018