Publications
Evidence generated from the hey baby study provide robust evidence to inform health and social policy and programming supporting young families. Findings are published in high-impact peer-reviewed publications and policy briefs.
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2018-2023 UNICEF-Oxford-UCT Final Narrative Report
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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Identifying Drivers and Mitigators of Adolescent HIV and Sexual and Reproductive Health Risk: A synthesis of evidence-to-action research
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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Factors Associated with Preferences for Long-Acting Injectable Antiretroviral Therapy Among Adolescents and Young People Living with HIV in South Africa
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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Impacts of intimate partner violence and sexual abuse on antiretroviral adherence among adolescents living with HIV in South Africa
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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Exploring Self-reported Adherence Measures to Screen for Elevated HIV Viral Load in Adolescents: A South African Cohort Study
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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Identifying adolescents at highest risk of ART non-adherence, using the World Health Organization endorsed HEADSS and HEADSS+ checklists
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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Investing in our future: supporting pregnant and mother learners’ return to school
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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Improving educational and reproductive outcomes for adolescent mothers in South Africa: A cross-sectional analysis towards realising policy goals
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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Associations of formal childcare use with health and human capital development for adolescent mothers and their children in South Africa: A cross-sectional study
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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Exploring the cognitive development of children born to adolescent mothers in South Africa
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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Achieving the health and well-being Sustainable Development Goals among adolescent mothers and their children in South Africa: Cross-sectional analyses of a community-based mixed HIV-status cohort
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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Which factors affect postpartum educational enrollment of adolescent mothers in South Africa? A latent class analysis
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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SDG accelerator analyses: A step by step guide on what to do with observational data
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.
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Art-based reflections from 12 years of adolescent health and development-related research in South Africa
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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Reflections of public healthcare nurses during the first wave of the COVID-19 pandemic in the Eastern Cape Province of South Africa
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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Learner pregnancy in South Africa’s Eastern Cape: The Factors affecting adolescent girls' school withdrawal during pregnancy
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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Adolescent Motherhood and HIV in South Africa: Examining Prevalence of Common Mental Disorder
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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Clinic and care: associations with adolescent antiretroviral therapy adherence in a prospective cohort in South Africa.
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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Understanding Mental Health in the Context of Adolescent Pregnancy and HIV in Sub-Saharan Africa: A Systematic Review Identifying a Critical Evidence Gap
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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Adolescent mothers affected by HIV and their children: A scoping review of evidence and experiences from sub-Saharan Africa
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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Adolescent mothers affected by HIV and their children: A scoping review of evidence and experiences from sub-Saharan Africa
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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Reproductive aspirations, contraception use and dual protection among adolescent girls and young women: the effect of motherhood and HIV status.
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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Improving Lives by Accelerating Progress towards the UN Sustainable Development Goals for Adolescents Living with HIV: a Prospective Cohort Study.
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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STACKing the Odds for Adolescent Survival: Health Service Factors Associated with Retention in Care and Adherence amongst Adolescents Living with HIV in South Africa.
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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Household Economic Strengthening through Saving and Budgeting: Evidence from a Field Experiment in South Africa.
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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Cash Transfers to Enhance TB Control: Lessons from the Global HIV Response.
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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What Affects Attendance and Engagement in a Parenting Program in South Africa?
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.