Publications

2025 - BMJ Global Health

Authors: Cluver L, Jochim J, Sidloyi L, Armstrong A, Gulaid L, Banougnin B, et al.

Background 30% of girls in Africa are mothers, facing high risk for negative health and educational outcomes. We aimed to identify services with the potential to reduce multiple simultaneous risks for adolescent mothers, described by the UN as ‘development accelerators’.

Methods Adolescent mothers (n=1044) from South Africa completed questionnaires between 2017/2019 and 2020/2023, assessing mental health, HIV risks, violence victimisation, education access and hypothesised ‘accelerators’. We used multivariable random effects regression models, adjusting for covariates. Predicted probabilities (marginal effects) were estimated to determine how each identified accelerator, and their combinations, influence the probability of each outcome, offering improved interpretability into the impact of the accelerators.

Results Three ‘accelerators’ showed protective associations against multiple risks: Food security was associated with reductions in age disparate/transactional sex (OR 0.56, 95% CI (0.42, 0.74)); no contraception use (OR 0.42, 95% CI (0.29, 0.60)); no school enrolment or work engagement (OR 0.46, 95% CI (0.32, 0.67)) and low self-efficacy (OR 0.62, 95% CI (0.46, 0.83)). Non-violent parenting was associated with reductions in suicidality (OR 0.20, 95% CI (0.10, 0.39)); mental health distress (OR 0.44, 95% CI (0.31, 0.64)); transactional/age disparate sex (OR 0.62, 95% CI (0.45, 0.87)); intimate partner violence (OR 0.27, 95% CI (0.14, 0.52)); and sexual violence (OR 0.21, 95% CI (0.10, 0.44)). Respectful clinics were associated with reductions in mental health distress (OR 0.65, 95% CI (0.46, 0.92)); low self-efficacy (OR 0.43, 95% CI (0.33, 0.58)) and condomless sex (OR 0.46, 95% CI (0.35, 0.61). When all three accelerators—compared with none—were provided, risks were greatly lowered. For example, suicidality from 13% to 2%; intimate partner violence from 22% to 5% and sexual violence from 11% to 1%.

Conclusions This real-world, longitudinal cohort design study identifies services with accelerator impacts that protect adolescent mothers against multiple risks. These can be realised through improved reach of existing services to include adolescent mothers: economic support including government cash transfers, parenting programmes and adolescent-responsive healthcare.

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2025 - Child Neuropsychology, 1–16

Authors: Morse, K., Tatham, C., Saliwe, B., Gwampi, B., Sidloyi, L., Sherr, L., & Toska, E.

There are significant challenges for research on child cognitive development in resource-scarce environments including the need for contextually appropriate assessments that accommodate diverse age cohorts or span multiple years or rounds of data collection in longitudinal studies. In such cases, combining two cognitive assessments may be necessary to maximize age and assessment item coverage. The Mullen Scales of Early Learning (MSEL) is developed for children aged 2–60 months, while the Kaufman Assessment Battery for Children (KABC-II) is administered to children aged 3–18 years. Understanding the relationship between these scales is essential for drawing valid conclusions across age cohorts and study periods where children may age out of the MSEL. This correlational study examines the relationship between MSEL subscales and KABC-II subtests in a sample of 59 children aged 4–5 years in the Eastern Cape, South Africa using data collected in March–June 2024. Intra-class correlations and paired t-tests demonstrate agreement between the two assessments indicating that the selected subtests are measuring similar underlying constructs. In post-hoc factor analysis the combined subscales had an alpha of 0.86 demonstrating strong agreement between the MSEL and KABC-II. These findings support the comparability of outcomes across different cognitive assessments, enabling researchers to identify risk and resilience pathways for children in low- and middle-income settings.

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2025 - BMJ Open

Authors:Steventon Roberts K, Smith C, Cluver LD, et al.

Background Fathers are intricately bound to the experience of adolescent mothers and their children. Yet, fathers of children born to adolescent mothers, particularly within the context of HIV, remain neglected in the literature. These exploratory analyses provide insight into the characteristics of fathers of children born to adolescent mothers affected by HIV in South Africa.

Setting Eastern Cape Province, South Africa.

Design Cross-sectional data from a prospective cohort study.

Participants Young mothers (10–24 years of age) and their children (0–68 months). All mothers completed detailed study questionnaires, including standardised and study-specific measures, relating to their self, their children and the fathers of their children. Summary statistics are presented based on maternal self-report of father characteristics. χ2 tests and t-tests (Fisher’s exact/Kruskal-Wallis tests, where appropriate) were additionally used to explore sample characteristics (including father characteristics, maternal experience and child characteristics) according to paternal age and father involvement in childcare (defined by responses to four maternal self-report questions). Father characteristics were also explored according to maternal HIV status and maternal mental health status.

Results 40% of fathers were adolescents (10–19 years) at the birth of their children. Overall, father involvement was low (19.5%). Compared with noninvolved fathers, involved fathers were more likely to be older when their child was born (21 years vs 20 years, t=4.30, p=0.04), to be in a relationship with the mothers of their children (74.8% vs 47.2%, χ2=40.8, p≤0.0001), to reside with their children and their mothers (14.7% vs 3.7%, χ2=49.3, p≤0.0001) and to attend the first antenatal appointment (4.3% vs 1.5%, χ2=5.21, p=0.02). A quarter (25.4%; 227/894) of the adolescent mothers in the sample were living with HIV. The prevalence of maternal HIV was found to be higher among adolescent mothers of children born to older fathers compared with adolescent fathers (31.7% vs 15.9%, χ2=28.3, p≤0.001). Likewise, depressive symptoms were more prevalent among adolescent mothers of children born to older fathers compared with adolescent fathers (9.9% vs 5.3%, χ2=6.08, p=0.01). Adolescent mothers reporting poor mental health were less likely to be in a relationship with the fathers of their children (41.8% vs 54.1%, χ2=7.32, p=0.03) and more likely to experience domestic violence perpetrated by the fathers of their children (8.2% vs 3.3%, χ2=6.07, p=0.01) and to engage in arguments about finances with the fathers of their children (30.0% vs 17.0%, χ2=10.8, p=0.001). While some differences in individual subscales were identified, overall composite scores of child cognitive development did not differ according to father age or father involvement.

Conclusions Analyses provide the first preliminary description of the fathers of children born to adolescent mothers affected by HIV in South Africa. Fathers are inherently tied to the experiences of adolescent mothers and their children. Father involvement with their children was low. Further research is required to explore the potential barriers to father involvement and pathways to overcome these. Efforts to bolster father engagement, such as the inclusion of fathers within maternal and child service provision, may have benefits for fathers, adolescent mothers and their children. There was a high prevalence of adolescent fatherhood in the study. Adolescent fathers may have specific needs requiring tailored intervention for adolescent parent families. The need for the inclusion of fathers within policy, programming and research remains.

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2025 - Front. Reprod. Health

Authors: Chen-Charles J, Bekker L-G, Jochim J, Wittesaele C, Cluver L and Toska E

Introduction:

Pregnant or parenting adolescent girls and young women (PPYW) are at greater risk of sexual exposure to HIV than their peers, yet tailored HIV prevention efforts for PPYW remain limited.

Methods:

We analysed cross-sectional data (2020–2023) from a sample of PPYW (median age 21.5, IQR = 20.3–22.5) in the Eastern Cape, South Africa.

Results:

Approximately 88% of PPYW who were HIV-negative (n = 646) had a HIV test in the last few years. Of these—58% knew about PrEP (n = 328). Of those who knew about PrEP, 31% had ever been offered PrEP (n = 100; 15% of HIV-negative PPYW), and 62% of those who were offered PrEP had ever taken PrEP (n = 62; 10% of HIV-negative PPYW). Compared to PPYW who have not had a HIV test in the last few years, PPYW who had accessed HIV testing were more likely to be aware of PrEP (aOR = 2.39, 95% CI:1.44–3.97, p = 0.001), have been offered PrEP (aOR = 2.96, 95% CI:1.16–7.55, p = 0.023), and taken PrEP (aOR = 4.57, 95% CI:1.09–19.16, p = 0.038).

Conclusions:

This study highlights missed opportunities in PrEP delivery and offers recommendations to enhance PrEP awareness and uptake among PPYW. Despite high HIV testing rates in this key population, awareness of PrEP, its offer, and uptake remain low.

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2‍025 - ‍BMJ Global Health

Authors: Sherr L, Haag K, Steventon Roberts K, Cluver L, Jochim J, Saal W, et al.

Background Globally, adolescent mothers and their children have poorer health outcomes. However, little is known regarding having multiple children as an adolescent. Analyses explore associations between having multiple versus single children on young mothers’ mental health and having a sibling and child development outcomes for their children. Furthermore, maternal age when having a second child (eg, multipara adolescent or multipara adolescent–adult pregnancy) is examined in relation to maternal and child outcomes.

Methods Data are drawn from a cohort of young mothers (n=1017; 10–24 years) and their children (0–68 months) residing in the Eastern Cape Province, South Africa. Effects of having multiple versus single children on maternal mental health and child cognitive outcomes (assessed using the Mullen Scales of Early Learning) were explored using hierarchical regression models. We examined associations among primipara adolescent motherhood, multipara adolescent motherhood and multipara adolescent–adult motherhood, and child cognitive development scores.

Results Poor maternal mental health was elevated among multipara mothers. Multipara mothers were more likely to report higher parental stress scores and lower social support scores (p=0.002–0.038). Child cognitive development scores were higher in children born to multipara mothers (those with a sibling (B=6.75, 95% CI 1.00 to 12.51, p=0.021)); younger child age (B=−0.56, 95% CI −0.68 to –0.44, p=<0.001) and formal childcare attendance (B=3.58, 95% CI 0.03 to 7.13, p=0.048) were also identified as positive predictors of higher cognitive development scores. First-born children of multipara adolescent mothers appeared to perform equally well to children born to primipara mothers (children without siblings), while first-born children of multipara adolescent–adult mothers seemed to benefit strongly from having siblings (B=14.31, 95% CI 4.18 to 24.44, p=0.006).

Conclusions Having multiple children was associated with poorer maternal mental health. Delaying a second pregnancy until adulthood may have benefits, as sibling effects were found to be positively associated with child cognitive development scores. Formal childcare support was associated with positive child outcomes. Findings highlight the need to focus on repeat adolescent pregnancy, improve social, psychological and family planning support among young mothers with a focus on birth timing and spacing, early childhood care provision and support for young families.

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2025 - AIDS Behav

Authors: Zhou, S., Laurenzi, C., Tolmay, J. et al.

Adolescent girls living with HIV are at higher risk of poor HIV treatment outcomes than older women living with HIV. However, little is known about how age at first birth influences their adherence to antiretroviral treatment (ART). Using South African data from a cross-sectional study of 311 young mothers living with HIV (N = 311, mean age 19.7 ± 1.92 years, follow-up = 2017–2018), we examined the association between age at first birth (< 18 versus 18+ years), all hypothesized factors and self-reported past-week ART adherence, adjusting for known covariates. We computed adjusted probability estimates conditional on the presence of none, one, or all factors significantly associated with ART adherence in the final regression model. Overall, 45% (N = 140) of participants had their first birth before the age of 18. ART adherence rates differed significantly by age at first birth (< 18 years: 67.9% vs. 18+ years: 80.1%, p = 0.013). Age-at-first birth (< 18 years) (aOR 0.45, 95% CI 0.26–0.78, p = 0.005) and internalized HIV stigma (aOR 0.33, 95% CI 0.17–0.62, p = 0.001) were associated with lower odds of past-week adherence, while psychosocial support (aOR 2.39, 95% CI 1.20–4.74, p = 0.013) and availability of a caregiver for the participant (aOR 2.74, 95% CI 1.37–5.52, p = 0.005) were associated with higher odds of past-week adherence. Combined psychosocial support and caregiver presence improved ART adherence among young mothers, with stronger effects in those reporting internalized HIV stigma. Efforts to support young mothers to improve their adherence to ART are urgently needed at scale, including strategies to reduce the impact of HIV-related stigma, including family psychosocial support.

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2024 - JIAS

Authors: Elona Toska, Siyanai Zhou et al.

Adolescent girls and young women (AGYW) living with HIV face poor HIV outcomes and high rates of unintended pregnancies, with little known about optimal healthcare provisions. This study surveyed 774 AGYW aged 12-24 from 61 South African health facilities, analyzing associations between HIV outcomes and seven healthcare provisions, comparing results between mothers and non-mothers. Findings showed poor HIV outcomes, particularly for mothers, with two key provisions—safe and affordable facilities, and kind and respectful staff—significantly improving outcomes. These results underscore the importance of accessible, adolescent-responsive healthcare to enhance HIV-related outcomes and reduce morbidity and mortality among AGYW, especially mothers.

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2024 - Health Education Journal

Authors: Jane Kelly, Maya Low et al.

This study investigated nurses' perspectives on providing sexual and reproductive health (SRH) services to adolescents and young people in Eastern Cape, South Africa, particularly following the COVID-19 pandemic. Semi-structured interviews with 20 nurses revealed that while nurses empathize with the challenges faced by young patients and wish to engage and educate them, they also face difficulties due to patients' shame and perceived attitudes. The study highlights that internal and social biases can hinder nurses' motivation and willingness to support young patients effectively. To improve these interactions, the study suggests practical and participatory interventions to enhance patient-provider relationships.

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2024 - Journal of Adolescent Health

Authors: Nontokozo Langwenya, Elona Toska, Heidi Stöckl, Lucie Cluver

The study examines the heightened risk of intimate partner violence (IPV) among South African adolescent mothers, particularly those living with HIV (LHIV), before and during the COVID-19 pandemic. Analyzing data from 834 adolescent mothers, the study found that IPV prevalence, especially physical and psychological IPV, increased significantly during the pandemic, with those living with HIV facing higher levels of IPV both prepandemic and during COVID-19. The findings highlight the need for targeted initiatives to reduce IPV among adolescent mothers, especially those living with HIV, to address their increased economic and social vulnerabilities.

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2024 - Vaccine

Authors: Camille Wittesaele, Elona Toska et al.

Children born to adolescent mothers, particularly those with HIV, are more vulnerable to infant mortality and have lower antibody protection against vaccine-preventable diseases. This study estimated vaccination coverage and timeliness for 1,080 children of adolescent mothers in Eastern Cape, South Africa. The findings showed that vaccination coverage was below national targets, with lower rates among children of mothers living with HIV. Vaccination timeliness also declined significantly over time. The study suggests that more research is needed to identify factors contributing to incomplete and delayed vaccinations and emphasizes the need for enhanced vaccination campaigns for children of adolescent mothers.

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2024 - HSRC Social Security Volume 2

Authors: Claire Tatham, Janina Jochim et al.

Exposure to adversities is a strong predictor of early childbearing among adolescent girls and young women, with early motherhood negatively affecting children's developmental outcomes. This study analyzed data from 1,046 mother-child dyads in Eastern Cape, South Africa, highlighting the Child Support Grant (CSG) as a potential support avenue. Findings revealed that adolescent and young mother recipients took longer to secure the CSG, which was linked to lower children's cognitive scores. The study underscores the need for "cash-plus" interventions that address the specific needs of adolescent mothers and their children, especially post-COVID-19, to improve child development outcomes.

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2023 - Oxford-UCT

Title: Generating evidence and capacity building for scalable solutions to improve wellbeing of adolescents living with HIV and adolescent HIV affected mothers in Eastern and Southern Africa .

This report summarises activities conducted by the Oxford-UCT team in collaboration with UNICEF.

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2023 - UNICEF

This synthesis report reflects a comprehensive review of the body of research undertaken through the Evidence-to-Action partnership. It identifies common themes and new insights to answer the following questions:

• What common factors were found to put adolescents, including adolescents living with HIV and young mothers, at risk of poor health and well-being outcomes?

• What interventions – alone and in combination – can be implemented at scale to mitigate risk and improve health and well-being outcomes?

• What are the cross-cutting implications for policy and practice?

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2023 - AIDS and Behavior

Authors: Toska E, Zhou S, Chen-Charles J, Gittings L, Operario D, Cluver L

Long-acting injectable anti-retroviral therapy (LAART) may overcome barriers to long-term adherence and improve the survival of adolescents and young people living with HIV (AYLHIV). Research on the acceptability of LAART for this age-group is limited. We asked 953 AYLHIV about their preferred (theoretical) ART mode of delivery (pill, injectable, or other) in 2017–2018, before LAART was available or known to AYLHIV in South Africa. One in eight (12%) AYLHIV preferred LAART over single or multiple pill regimens.

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2023 - AIDS

Authors: Cluver L, Zhou S, Orkin M, Rudgard W, Meinck F, Langwenya N, Vicari M, Edun O, Sherr L, Toska E

We are failing to reach 95–95–95 for adolescents living with HIV (ALHIV). Sexual abuse and intimate partner violence (IPV) may impact antiretroviral therapy (ART) adherence, with high rates of 17.4 and 29.7%, respectively, across the southern sub-Saharan African region. However, evidence on their associations with adolescent ART adherence remains limited, with only three cross-sectional studies globally.

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2023 - AIDS and Behavior

Authors: Zhou S, Toska E, Langwenya N, Edun O, Cluver L, Knight L

The timely identification of ART non-adherence among adolescents living with HIV presents a significant challenge, particularly in resource-limited settings where virologic monitoring is suboptimal. Using South African adolescent cohort data (N = 933, mean age 13.6 ± 2.89 years, 55.1% female, follow-up = 2014–2018), we examined the association between elevated viral load (VL ≥ 1000 copies/mL) and seven self-reported adherence measures on missed doses, and clinic appointments –with varying recall timeframes.

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2023 - AIDS and Behavior

Authors: Cluver L, Shenderovich Y, Seslija M, Zhou S, Toska E, Armstrong A, Gulaid LA, Ameyan W, Cassolato M, Kuo C, Laurenzi C, Sherr L

Brief tools are necessary to identify adolescents at greatest risk for ART non-adherence. From the WHO’s HEADSS/HEADSS+ adolescent wellbeing checklists, we identify constructs strongly associated with non-adherence (validated with viral load). We conducted interviews and collected clinical records from a 3-year cohort of 1046 adolescents living with HIV from 52 South African government facilities.

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2023 - CSSR Working Paper

Authors: Kelly J, Ornellas A, Coakley C, Jochim J, Mangqalaza H, Cluver L, Zelmanovitz Axelrod I, Sidloyi L, Price Y, Thabeng M, Dipa Y, Toska E

In South Africa, one third of women have been pregnant during adolescence, with the last four years (2017-21) seeing a staggering increase of 48.7% in births amongst 10- to 14-year-olds and 17.9% amongst 15- to 19-year-olds. Adolescent motherhood can have a negative impact on the education, livelihoods, and health of adolescents and their children. Enabling adolescent mothers’ return to school is essential, given the profound impact that school dropout has on psychological, physical, social and economic health.

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2023 - Global Public Health

Authors: Jochim J, Cluver L, Sidloyi L, Kelly J, Ornellas A, Mangqalaza H, Coakley C, Nogoduka C, Pillay M, Nokama B, George G, Toska E, Teen Advisory Group Eastern Cape

Adolescent mothers face numerous challenges. This study aimed to address the operationalisation of the new South African national policy for young mothers by testing the associations of potential protective provisions with three policy goals: School return, grade promotion, and pregnancy/HIV prevention.

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2023 - Child: Care, Health and Development

Authors: Cluver L, Jochim J, Mapukata Y, Wittesaele C, Shenderovich Y, Mafuya S, Steventon Roberts K, Banougnin B, Sherr L, Toska E

Forty percent of adolescent girls in Africa are mothers. Increasing evidence shows positive impacts of formal childcare use for adult women, but no known studies in the Global South examine associations for adolescent mothers and their children. This study aims to investigate associations of formal childcare with maternal and child outcomes in a large sample of adolescent mothers.

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2023 - Infant and Child Development

Authors: Steventon Roberts K, Smith C, Toska E, Cluver L, Wittesaele C, Langwenya N, Shenderovich Y, Saal W, Jochim J, Chen-Charles J, Marlow M, Sherr L

This study explores the cognitive development of children born to adolescent mothers within South Africa compared to existing reference data, and explores development by child age bands to examine relative levels of development. Cross-sectional analyses present data from 954 adolescents (10–19 years) and their first-born children (0–68 months).

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2022 - PLOS ONE

Authors: Toska E, Saal W, Chen-Charles J, Wittesaele C, Langwenya N, Jochim J, Steventon Roberts KJ, Anquandah J, Banougnin BH, Laurenzi C, Sherr L, Cluver L

We mapped 35 SGD-related targets among 1,046 adolescent mothers and their oldest child (n = 1046). Understanding progress and gaps in meeting the SDGs among highly vulnerable groups is critical, particularly for adolescent mothers and their children. These complex vulnerabilities suggest that programming for adolescent mothers must address their unique needs.

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2022 - Psychology, Health & Medicine

Authors: Jochim J, Meinck F, Steventon Roberts KJ, Wittesaele C, Langwenya N, Toska E, Cluver L

This study aimed to better understand the factors that render some adolescent mothers vulnerable to school non-enrollment, and how to reduce these risks. Using latent class analysis, we explored emerging latent groups and their relationship to mothers’ enrollment in school, college, or tertiary education.

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Online resource

Authors: The Accelerating Achievement for Africa’s Adolescents (Accelerate) Hub

SDG accelerators are actions (e.g., interventions: cash transfers, parenting support) that will take us forward more quickly across a broad range of interlinked goals. This resource provides a step-by-step guide and a Stata syntax (do. file) which will take you through how to best conduct accelerator analyses with observational data. The guide will help you choose your accelerators and outcomes, and identify synergies across accelerators through a motivating example on child violence.

Read the guide here

Download the Stata syntax here

2022 - Health Promotion International

Authors: Gittings L, Medley S, Logie C, Ralayo N, Petersen N, Chen-Charles J, Toska E.

This paper presents empirical and methodological findings from an art-based, participatory process with a group (n = 16) of adolescent and young advisors in the Western Cape Province of South Africa. In a weekend workshop, participants reflected on their participation in 12 years of health and development-related research through theatre, song, visual methodologies and semi-structured interviews.

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2021 - South African Health Review

Authors: Kelly J F, Glinski C D, Laurenzi C A, Mangqalaza H, Toska E, Gittings L, Langwenya N, Sidloyi L, Mbiko A, Taleni B, Saliwe B.

This study qualitatively explores the experiences, challenges and responses of nurses based in public healthcare facilities in the Eastern Cape, South Africa during the first wave of the COVID-19 pandemic. In-depth, semi-structured telephonic interviews were conducted with nurses (n=13) from public healthcare facilities in a mixed urban-rural health district.

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2021 - International Journal of Education Development

Authors: Jochim J, Cluver L, Meinck F.

An early pregnancy often puts an end to a girls’ education. However, few studies have investigated which factors affect adolescents’ school discontinuation during pregnancy. This study interviewed 1,046 adolescent mothers from the Eastern Cape province in South Africa.

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2021 - AIDS and Behaviour

Authors: Roberts K, Smith C, Cluver L, Toska E, Zhou S, Boyes M, Sherr L.

These analyses aim to identify the prevalence of probable common mental disorder among adolescent mothers and, among adolescents experiencing the syndemic of motherhood and HIV.

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2021 - AIDS online

Authors: Cluver L, Shenderovich Y, Toska E, et al.

This paper concludes that adolescents living with HIV need to be safe at home and feel safe from stigma in an accessible clinic. This will require active collaboration between health and child protection systems, and utilization of effective violence prevention interventions.

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2021 - AIDS and Behavior

Authors: Roberts K, Smith C, Cluver L, Toska E, Sherr L

This systematic review sought to identify (1) the prevalence/occurrence of common mental disorder amongst adolescents who are living with HIV and have experienced pregnancy, (inclusive of adolescent fathers) in sub-Saharan Africa (2) risk and protective factors for common mental disorder among this group, and (3) interventions (prevention/treatment) for common mental disorder among this group.

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2020 - South African Medical Journal

Authors: Jochim J, Groves A, Cluver L

While adolescent mothers' postpartum return to school offers long-term benefits, returning too early in the absence of sufficient support may impede the healthy development of their children. This study assessed the rates of adolescent mothers' return to school in South Africa (SA) and examined how many months after birth school-aged girls resumed schooling.

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2020 - Global Public Health

Authors: Toska E, Laurenzi C, Roberts K, Cluver L, Sherr L.

While adolescents have received increasing attention in the global HIV response and international strategies and commitments, adolescent mothers and their children remain largely overlooked in research, funding and, programming for health-related outcomes. We conducted an extensive scoping review of current evidence on the experiences of adolescent mothers affected by HIV and their children in this region.

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2020 - Journal of the International AIDS Society

Authors: Toska E, Cluver L, Laurenzi C, Wittesaele C, Sherr L, Zhou S, Lanwenya N.

There is a growing interest in adolescent motherhood and HIV among policymakers and programme implementers. To better shape services and health outcomes, we need evidence on reproductive aspirations and contraception use in this high‐risk group, including the effect of motherhood and HIV status. We report data from a large survey of adolescent girls and young women conducted in a mixed rural‐urban district in South Africa.

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2019 - Lancet Child Adolescent Journal

Authors: Cluver L, Orkin M, Campeau L, Toksa E, Webb D, Carlqvist A, Sherr L.

Low-income and middle-income countries (LMICs) face major challenges in achieving the UN's Sustainable Development Goals (SDGs) for vulnerable adolescents. We aimed to test the UN Development Programme's proposed approach of development accelerators—provisions that lead to progress across multiple SDGs—and synergies between accelerators on achieving SDG-aligned targets in a highly vulnerable group of adolescents in South Africa.

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2018 - Journal of the International AIDS Society

Authors: Cluver L, Pantelic M, Toska E, Orkin M, Casale M, Bungane N, Sherr L.

There are two million HIV‐positive adolescents in southern Africa, and this group has low retention in care and high mortality. There is almost no evidence to identify which healthcare factors can improve adolescent self‐reported retention. This study examines factors associated with retention amongst antiretroviral therapy (ART)‐initiated adolescents in South Africa.

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2018 - Journal of Development Economics

Authors: Steinart J, Cluver L, Meinckac F, Doubt J, Vollmer S.

Using data from a randomized field experiment with 552 households, nested within 40 villages and townships in South Africa, we examine the impact of a brief financial literacy training that was integrated into a broader psychosocial parenting intervention. Based on self-reported measures, we document significant improvements in financial behaviors, including higher saving and lower borrowing rates.

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2018 - BMC Public Health

Authors: Rudgard W, Carter D, Scuffell J, Cluver L, Fraser-Hurt N, Boccia D.

The World Health Organization prioritises a more holistic global response to end the tuberculosis (TB) epidemic by 2030. Based on experiences in the HIV response, social protection, and in particular cash transfers, show promise for contributing to this. Currently, individual-level evidence for the potential of cash transfers to prevent TB by addressing the structural social determinants of disease is lacking. To identify priority actions for the TB research agenda, we appraised efforts by the HIV response to establish the role of cash transfers in preventing HIV infection.

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2018 - Prevention Science

Authors: Shenderovich Y, Eisner M, CLuver L, Doubt J, Berezin M, Majokweni S, Murray AL.

Parenting programs are a promising approach to improving family well-being. For families to benefit, programs need to be able to engage families actively in the interventions. Studies in high-income countries show varying results regarding whether more disadvantaged families are equally engaged in parenting interventions. In low- and middle-income countries (LMICs), almost nothing is known about the patterns of participation in parent training. This paper examines group session attendance and engagement data from 270 high-risk families enrolled in the intervention arm of a cluster-randomized controlled trial in South Africa.

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