Mosa Moshabela

University of KwaZulu-Natal | ukzn · School of Nursing and Public Health

We explored why people may not reveal their antiretroviral therapy (ART) status when presenting for HIV care, and how a linked electronic system may help address this phenomenon. Data were collected from March to October 2023 from people who presented to clinics for an HIV test in KwaZulu-Natal, South Africa but found to be on ART, as well from sta...

Background Antenatal care (ANC) is an essential platform to improve maternal and newborn health (MNH). While several articles have described the content of ANC in low- and middle-income countries (LMICs), few have investigated the quality of detection and management of pregnancy risk factors during ANC. It remains unclear whether women with pregnan...

Background In 1978, the World Health Organization (WHO) adopted primary health care (PHC) as the most effective strategy to meet the healthcare needs of communities. This raises the question as to the extent and nature of the training that undergraduate (UG) medical students receive in medical schools regarding PHC, following this statement. Aim T...

Primary health care (PHC) is central to attainment of the Sustainable Development Goals, yet comparable cross-country data on key aspects of primary care have not been widely available. This study analysed data from the People's Voice Survey, which was conducted in 2022 and 2023 in 14 countries. We documented usual source of care across countries a...

Population confidence is essential to a well functioning health system. Using data from the People's Voice Survey—a novel population survey conducted in 15 low-income, middle-income, and high-income countries—we report health system confidence among the general population and analyse its associated factors. Across the 15 countries, fewer than half...

Objectives Treatment for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is increasingly transitioning from hospital-centred to community-based care. A national policy for decentralised programmatic MDR/RR-TB care was adopted in South Africa in 2011. We explored variations in the implementation of care models in response to this c...

Background The definition of Primary Health Care (PHC) issued by the World Health Organisation in 1978 indicated that essential health care should be made accessible to individuals and their communities close to where they live and work. In 1992 Starfield articulated the four pillars of PHC: the patient’s first contact with healthcare, comprehensiv...

Todd Lewis and co-authors discuss development and use of the People's Voice Survey for health system assessment.

Digital technologies provide unprecedented opportunities for health and nutrition interventions among adolescents. The use of digital media and devices among young adolescents across diverse settings in sub-Saharan Africa is unclear. This cross-sectional study aimed to assess the use of digital media and devices and the socioeconomic determinants o...

In Sub-Saharan Africa (SSA), adolescents make up around one-quarter of the population who are growing up in a rapidly urbanizing environment, with its associated risks and benefits, including impacts on health, psychosocial development, nutrition, and education. However, research on adolescents' health and well-being in SSA is limited. The ARISE (A...

Background The mental and financial strain linked to unpaid caregiving has been amplified during the COVID-19 pandemic. In sub-Saharan Africa, carers of adolescents living with HIV (ALHIV) are critical for maintenance of optimum HIV treatment outcomes. However, the ability of caregivers to provide quality care to ALHIV is undermined by their abilit...

Objective Champions are recognised as important to driving organisational change in healthcare quality improvement initiatives in high-income settings. In low-income and middle-income countries with a high disease burden and constrained human resources, their role is highly relevant yet understudied. Within a broader study on policy implementation...

Background The definition of Primary Health Care (PHC) issued by the World Health Organisation in 1978 indicated that it is essential health care which should be made accessible to individuals and their communities, close to where they live and work. In 2010 Starfield introduced the four pillars of PHC: the patient’s first contact with healthcare,...

This study aimed to determine levels of health insurance coverage in low- and middle-income countries and how coverage varies by people's sociodemographic characteristics. We conducted a population size-weighted, one-stage individual participant data meta-analysis of health insurance coverage, using a population-based sample of 2,035,401 participan...

Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democra...

Background During the emergence of the COVID-19 pandemic in South Africa in March 2020, there was an urgent mobilization of healthcare workers (HCWs) who had to adapt quickly to a challenging health system. Therefore, this paper examines factors associated with HCWs’ perceptions of the South African health system’s capability for managing COVID-19...

The extent to which Omicron infection1-9, with or without previous vaccination, elicits protection against the previously dominant Delta (B.1.617.2) variant is unclear. We measured SARS-CoV-2 variant neutralization capacity in 39 Omicron sub-lineage BA.1 infected individuals in South Africa starting at a median of 6 (IQR 3-9) days post-symptoms ons...

Background: The mental and financial strain linked to unpaid caregiving has been amplified during the COVID-19 pandemic. In sub-Saharan Africa, carers of adolescents living with HIV (ALHIV) are critical for maintenance of optimum HIV treatment outcomes. However, the ability of caregivers to provide quality care to ALHIV is undermined by their abili...

Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democra...

The emergence of Omicron (Pango lineage B.1.1.529), first identified in Botswana and South Africa, may compromise vaccine effectiveness and lead to re-infections¹. We investigated whether Omicron escapes antibody neutralization in South Africans vaccinated with Pfizer BNT162b2. We also investigated if Omicron requires the ACE2 receptor to infect ce...

The 21st International Conference on HIV/AIDS and STI's in Africa (ICASA) was successfully held from the 6th to 11t h December 2021 in Durban, South Africa. Little did we know at the time of planning that COVID-19 could become such a formidable force in eroding the progress made to bring lifesaving therapies among vulnerable communities in Africa....

This is a policy brief emanating from our COVID surveys focussing on healthcare workers in South Africa in April-May 2020. We identify training gaps among healthcare workers. http://www.hsrc.ac.za/en/research-data/view/13642

Background Undergraduate medical students are trained to acquire a general medical practice overview on qualifying. This training forms a foundation for primary health care service or further training towards a specialty of choice. Objective The aim of the study was to determine the scope of published scientific literature on the training of under...

Background Widespread use of traditional medicine (TM), the issue of their safety, combined with progressive lobbying from both practitioner groups and the public have made regulation of traditional health practitioners (THPs) an important issue. While there are questions on whether the regulation of THPs are worthwhile endeavour, literature contin...

Accurate reporting of antiretroviral therapy (ART) uptake is crucial for measuring the success of epidemic control. Programs without linked electronic medical records are susceptible to duplicating ART initiation events. We assessed the prevalence of undisclosed ART use at the time of treatment initiation and explored its correlates among people pr...

Objective: To describe the medical, socio-economic and geographical profiles of patients with rifampicin-resistant TB (RR-TB) and the implications for the provision of patient-centred care. Setting: Thirteen districts across three South African provinces. Design: This descriptive study examined laboratory and healthcare facility records of 194...

Introduction People’s confidence in the health system's capability in managing the COVID-19 pandemic can determine public support, risk perceptions, and compliance to the required behaviors during the pandemic. Therefore, this paper investigated people’s perception of health system capability to manage the COVID-19 pandemic in different spatial are...

BACKGROUND: Increased co-ordination and co-operation between traditional and biomedical health systems in South Africa (SA) is a national priority. To improve care, practitioners in both systems must learn to recognise the value of their parallel counterparts, and such lessons should begin in medical school. However, there is little research regard...

We use a regression discontinuity design to estimate the causal effect of antiretroviral therapy (ART) eligibility according to national treatment guidelines of South Africa on two risk factors for cardiovascular disease, body mass index (BMI) and blood pressure. We combine survey data collected in 2010 in KwaZulu-Natal, South Africa, with clinical...

Background: Adequate information and knowledge about COVID-19 has been shown to induce the confidence and positive performance among healthcare workers (HCWs). Therefore, assessing the relationship between confidence in knowledge and associated factors among HCWs is vital in the fight against COVID-19. This paper investigates factors associated wit...

Background Regulations could create benefits and opportunities for traditional health practitioners (THPs) and traditional medicine (TM) users in this new era of traditional medicine systems (TMS) as the growing international popularity propels this. The 1978 International Conference on Primary Health Care played a significant role in recognising T...

There are estimated two million traditional healers in sub-Saharan Africa (SSA), with more than 10% (200,000) working in South Africa. Traditional healers in SSA are frequently exposed to bloodborne pathogens through the widespread practice of traditional ‘injections’, in which the healers perform dozens of subcutaneous incisions to rub herbs direc...

Letter by Venter et al. on editorial by Schoub (Dial down the rhetoric over COVID-19 vaccines. S Afr Med J 2021;111(6):522-523. https://doi.org/10.7196/SAMJ.2021.v111i6.15740).

Background Background: SARS-CoV-2 has resulted in the COVID-19 pandemic. Based on a nationally representative online survey conducted several weeks on the pandemic, this paper explores how South Africans responded to the compliance regulations laid down by the national government and factors associated with individuals’ confidence in their communit...

In 2011, the South African National TB Programme launched a policy of decentralized management of drug-resistant tuberculosis (DR-TB) in order to expand the capacity of facilities to treat patients with DR-TB, minimize delays to access care and improve patient outcomes. This policy directive was implemented to varying degrees within a rapidly evolv...

Background The abolition of the Witchcraft Suppression Act of 1957 and the declaration of the Traditional Health Practitioners (THPs) Act (No 22 of 2007) was key in efforts to recognise THPs. Concerns over the safety of products, practices and therapies used by THPs attracted calls for regulations, giving birth to the 2015 regulatory framework.

We explored women’s experiences of Option B+ in sub-Saharan African health facility settings through a meta-ethnography of 32 qualitative studies published between 2010 and 2019. First and second-order constructs were identified from the data and authors’ interpretations respectively. Using a health systems lens, third-order constructs explored how...

Universal antiretroviral therapy (ART) strategies have dramatically changed HIV programming across sub-Saharan Africa. We explored factors that influenced the development, adoption and implementation of universal ART policies in Tanzania, South Africa and Malawi. We conducted 26 key informant interviews and applied Kingdon's 'streams' model to expl...

Although integration of HIV and maternal health services is recommended by the World Health Organization, evidence to guide implementation is limited. We describe facility-level implementation of policies for integrating HIV care within maternal health services and explore experiences of service users and providers in rural Tanzania (Ifakara), Sout...

Background: We evaluated continuous quality improvement (CQI) targeting antenatal HIV care quality in rural South Africa using a stepped-wedge cluster-randomised controlled trial (Management and Optimisation of Nutrition, Antenatal, Reproductive, Child health, MONARCH) and an embedded process evaluation. Here, we present results of the process eva...

Background Evidence for the effectiveness of continuous quality improvement (CQI) in resource-poor settings is very limited. We aimed to establish the effects of CQI on quality of antenatal HIV care in primary care clinics in rural South Africa. Methods and findings We conducted a stepped-wedge cluster-randomised controlled trial (RCT) comparing C...

Little is known about how CD4 and viral load testing have evolved following implementation of universal test and treat (UTT) in African settings. We reviewed World Health Organization (WHO) guidance from 2013 to 2018, and compared it against national HIV policies in Malawi, Tanzania and South Africa. Three surveys rounds were conducted in 2013, 201...

We explored how strategies to promote male partner engagement influenced HIV care-seeking among men and women living with HIV. In-depth interviews were conducted with 25 health workers, 66 female service users and 10 male partners in Ifakara (Tanzania), Karonga (Malawi) and uMkhanyakude (South Africa) to elicit experiences of offering, providing or...

We explored how strategies to promote male partner engagement influenced HIV care-seeking among men and women living with HIV. In-depth interviews were conducted with 25 health workers, 66 female service users and 10 male partners in Ifakara (Tanzania), Karonga (Malawi) and uMkhanyakude (South Africa) to elicit experiences of offering, providing or...

Universal antiretroviral therapy (ART) for pregnant and postpartum women in sub-Saharan Africa has required adaptations to service delivery. We compared national policies on differentiated HIV service delivery with facility-level implementation, and explored provider and user experiences in rural Malawi, Tanzania and South Africa. Four national pol...

People’s confidence on the health system capability in managing COVID-19 outbreak can determine public support, risk perceptions and compliance behaviours during the pandemic. Therefore, this paper investigated people’s perception on health system capability using online survey data and current state of health system capacity to deal with COVID-19...

In 2015 and 2016, South Africa experienced a severe drought resulting in water restrictions and food price inflation. A year later, while the proportion of food secure households remained constant, the proportion of those experiencing severe food insecurity increased. This paper investigates the socioeconomic determinants of increasing food insecur...

Introduction Efficacious antiretroviral treatment (ART) enables people to live long and healthy lives with HIV but young people are dying from AIDS‐related causes more than ever before. Qualitative evidence suggest that various forms of HIV‐related discrimination and resulting shame act as profound barriers to young people’s engagement with HIV ser...

Objective: To assess and compare the association between household food insecurity and child nutritional status over two time-points taking into consideration the effects of a severe drought. Design: The study used two cross-sectional household surveys during and after a severe drought, consistent with a natural experiment design. Setting: The...

Background: Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency screening test is essential for malaria treatment, control, and elimination programs. G6PD deficient individuals are at high risk of severe hemolysis when given anti-malarial drugs such as primaquine, quinine, other sulphonamide-containing medicines, and chloroquine, which has recentl...

Background: The KwaZulu-Natal (KZN) Health Act of 2009 mandates the Provincial Health Research and Ethics Committee to develop health research priorities for the province. During 2013, the KZN Department of Health embarked on a research prioritisation process for the province. Priority research questions were generated by an inclusive process, in...

The effects of rainfall variability and droughts on food production are well established. However, in South Africa, the association between rainfall, droughts and household food insecurity is not well known. The aim of this paper was to measure and compare household food insecurity during and after a drought, and to assess the association between r...

Background and objectives Globally, contemporary legislation surrounding traditional health practitioners (THPs) is limited. This is also true for the member states of the Southern African Development Community (SADC). The main aim of this study is to map and review THP-related legislation among SADC countries. In order to limit the scope of the re...

SETTING: Thirteen districts in Eastern Cape (EC), KwaZulu-Natal (KZN) and Western Cape (WC) Provinces, South Africa. OBJECTIVE: To pilot a methodology for describing and visualising healthcare journeys among drug-resistant tuberculosis (DR-TB) patients using routine laboratory records. DESIGN: Laboratory records were obtained for 195 patients with...

BACKGROUND: Globally, the success of community-based health care teams varies between programmes, and their designs tend to be unique based on local needs and context. Whilst the body of knowledge on community-based health care teams is growing in sub-Saharan Africa, there is still a lack of evaluation studies designed from the perspective of servi...

Objectives We analysed mutually comparable surveys on adolescent attitudes and behaviours from nine sites in seven sub‐Saharan African countries, to determine the relationship between school enrolment and adolescent health outcomes. Methods Data from the Africa Research, Implementation Science, and Education Network cross‐sectional adolescent heal...

Food insecurity varies between urban and rural populations, as do their household characteristics and practices. The aim of the study was to compare the behaviours and practices households in rural and urban areas carry out during times of limited food in the district of iLembe, South Africa. Using a cross-sectional study design, household surveys...

HIV status awareness is a rate limiting step in HIV treatment and prevention initiatives aimed at addressing the global HIV epidemic. Uptake of HIV testing remains suboptimal despite global campaigns aimed at improving uptake. HIV self-testing (HIVST) displays the potential to increase uptake of HIV testing in public health care facilities, which a...

The World Health Organization recommends using HIV self-testing (HIVST) to improve HIV testing coverage by integrating self-testing for HIV into public domain primary healthcare (PHC) clinics in areas with a high burden of HIV. However, an understanding of the relationship and interaction between HIVST and the standard HIV counselling and testing (...

Objective: To assess adoption of World Health Organization (WHO) guidance into national policies for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) and to monitor implementation of guidelines at facility level in rural Malawi, South Africa and the United Republic of Tanzania. Methods: We summarized natio...

Repeat HIV testing is important in high HIV burden communities to enable sustainability of prevention initiatives; however, an understanding of repeat testing practices is limited. Additional HIV testing approaches may be required to increase testing. HIV self-testing is an additional testing approach, but knowledge on its potential for repeat test...

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