Mzantsi Wakho Adolescent Adherence Study

mzantsi wakho

Funded by: The Nuffield Foundation (UK), DFID and SIDA-Norad’s Evidence for HIV Prevention in Southern Africa programme (EHPSA) managed by Mott MacDonald, Johnson & Johnson Global Fund Programme, the European Research Council (ERC), the International AIDS Society through the CIPHER grant, the Philip Leverhulme Trust, the John Fell Fund, ELMA Philanthropies, the ESRC Impact Acceleration Account and the Clarendon-Green Templeton College Scholarship.

Start date: 2013

Data collection dates: 2014 - March 2018

Project outline

Mzantsi Wakho is a mixed-methods, longitudinal, community-traced study of ART adherence and sexual health practices among 1500 adolescents in South Africa. The study was established in mid-2013. This research collaborates with adolescents, frontline healthcare workers to improve adherence to medicine and access to sexual and reproductive health services amongst high-risk adolescents. We are generating evidence that informs social policy and intervention design that supports young people living in AIDS-affected communities in South Africa.

The study was designed and conceptualised by Oxford University and the University of Cape Town (Principal Investigators: Prof Lucie Cluver and Dr Rebecca Hodes; Co-Investigators: Dr Elona Toska, Dr Marija Pantelic, Lesley Gittings, Roxanna Haghighat) in collaborative planning with HIV-positive adolescents, UNICEF and South African National Departments of Health, Social Development and Basic Education, alongside the Eastern Cape Department of Health, Frere and Cecilia Makiwane hospitals, UNICEF, Paediatric-Adolescent Treatment for Africa (PATA), and community-based organisations (Kheth’Impilo, Raphael Centre, Small Projects Foundation and Keiskamma Trust).

In June 2019 a ground-breaking report was published summarising the findings of the Mzantsi Wakho study.


  1. Casale, M., Boyes, M., Pantelic, M., Toska, E., & Cluver, L. (2019). Suicidal thoughts and behaviour among South African adolescents living with HIV: Can social support buffer the impact of stigma? Journal of Affective Disorders, 245, 82-90. DOI: 10.1016/j.jad.2018.10.102
  2. Hodes, R., Cluver, L., Toska, E., & Vale, B. (2018). Pesky metrics: The challenges of measuring ART adherence among HIV-positive adolescents in South Africa. Critical Public Health, 1-12. DOI:
  3. Boyes, M. E., Cluver, L. D., Meinck, F., Casale, M., & Newnham, E. (2018). Mental health in South African adolescents living with HIV: Correlates of internalising and externalising symptoms. AIDS Care, 31, 95-104. DOI: 10.1080/09540121.2018.1524121
  4. Cluver, L., Pantelic, M., Toska, E., Orkin, M., Casale, M., Bungane, N., & Sherr, L. (2018). STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa. Journal of the International AIDS Society, 21, e25176. DOI: 10.1002/jia2.25176 
  5. Pantelic, M., Boyes, M., Cluver, L., & Meinck, F. (2017). HIV, violence, blame and shame: Pathways of risk to internalized HIV stigma among South African adolescents living with HIV. Journal of the International AIDS Society, 20, 21771. DOI: 10.7448/IAS.20.1.21771
  6. Natukunda, H. P. M., Cluver, L. D., Toska, E., Musiime, V., & Yakubovich, A. R. (2017). Beyond clinical trials: Cross-sectional associations of combination antiretroviral therapy with reports of multiple symptoms and non-adherence among adolescents in South Africa. South African Medical Journal, 107, 965-975. DOI: 10.7196/SAMJ.2017.v107i11.12405
  7. Romero, R., Cluver, L., Hall, J., & Steinert, J. (2017). Disadvantaged adolescents and educational delay in South Africa: Impacts of personal, family and school characteristics. Education as Change, 22.
  8. Hodes, R. (in press). Popular perspectives on teenage pregnancy in South Africa. In N. Mkhwanazi and D. Bhana, Young Families in the New South Africa.
  9. Hodes, R., & Morrell, R. (2018). Incursions from the epicentre: Southern theory, social science, and the global HIV research domain. African Journal of AIDS Research, 17, 22-31. DOI: 10.2989/16085906.2017.1377267
  10. Hodes, R., Price, I., Bungane, N., Toska, E., & Cluver, L. (2017). How front-line healthcare workers respond to stock-outs of essential medicines in the Eastern Cape Province of South Africa. South African Medical Journal, 107, 738-740. DOI: 10.7196/SAMJ.2017.v107i9.12476
  11. Cluver, L., Hodes, R., Toska, E., Kidia, K. K., Orkin, F. M., Sherr, L,. & Meinck, F. (2015). ‘HIV is like a tsotsi. ARVs are your guns’: Associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa. AIDS, 29, S57-65. DOI: 10.1097/QAD.0000000000000695
  12. Toska, E., Pantelic, M., Meinck, F., Keck, K., Haghighat, R., & Cluver, L. (2017). Sex in the age of HIV: A systematic review of prevalence and predictors of high-risk sexual practices, and programmes to reduce sexual risk-taking among HIV-positive adolescents and youth in Sub-Saharan Africa. PLoS One. DOI: 10.1371/journal.pone.0178106
  13. Mark, D., Cluver, L., Collins, C., Iorpenda, K., Taing, L., Andrade, C., & Hatane, L. (2017). What is it going to take to move youth-related HIV programme policies into practice in Africa? Journal of the International AIDS Society, 16. DOI: 10.7448/IAS.20.4.21491
  14. Hodes, R. (2017). Too many rights? Reproductive freedom in post-apartheid South Africa’. Centre for Social Science Research Working Paper, No. 401, University of Cape Town. 
  15. Cluver, L., Toska, E., Orkin, F. M., Meinck, F., Hodes, R., Yakubovich, A. R., & Sherr, L. (2016). Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa? AIDS Care, 28, 73-82. DOI: 10.1080/09540121.2016.1179008
  16. Gittings, L. (2016). When you visit a man you should prepare yourself’: Male community care worker approaches to working with men living with HIV in Cape Town, South Africa. Culture, Health and Sexuality, 18, 936-950. DOI: 10.1080/13691058.2016.1150513
  17. Linder, V., Goldswain, C., Adler, H., Carty, C., Harper, K., Jackson, V., & Boon, G. (2016). Lamivudine monotherapy: Experience of medium term outcomes in HIV- infected children unable to adhere to triple therapy. The Pediatric Infectious Disease Journal. DOI: 10.1097/INF.0000000000001156.
  18. Toska, E., Cluver, L., Boyes, M. E., Isaacsohn, M., Hodes, R., & Sherr, L. (2016). School, supervision and adolescent-sensitive clinic care: Combination social protection and reduced unprotected sex among HIV-positive adolescents in South Africa. AIDS and Behavior, 1-14. DOI: 10.1007/s10461-016-1539-y.
  19. Toska, E., Gittings, L., Hodes, R., Cluver, L., Govender, K., Chademana, K. E., & Gutiérrez, V. E. (2016). Resourcing resilience: Social protection for HIV prevention amongst children and adolescents in Eastern and Southern Africa. African Journal of AIDS Research, 15, 123-140. DOI: 10.2989/16085906.2016.1194299
  20. Hodes, R., Toska E., & Gittings, L. (2016). Babies for bling: Are teenage girls having children to access grants? HIV Nursing Matters, 7, 20-23.
  21. Nattrass, N., Hodes, R., & Cluver, L. (2016). Changing donor funding and the challenges of integrated HIV treatment. AMA Journal of Ethics, 18, 681. DOI: 10.1001/journalofethics.2016.18.07.ecas3-1607
  22. Hodes, R. (2016). The culture of illegal abortion in South Africa. Journal of Southern African Studies, 42, 79-93. DOI: 10.1080/03057070.2016.1133086
  23. Vale, B. (2016). Negotiations of blame and care among HIV‐positive mothers and daughters in South Africa's Eastern Cape. Medical Anthropology Quarterly. DOI: 10.1111/maq.12351
  24. Pantelic, M., Boyes, M., Cluver, L., & Thabeng, M. (2016). They say HIV is a punishment from God or from ancestors: Cross-cultural adaptation and psychometric assessment of an HIV stigma scale for South African adolescents living with HIV (ALHIV-SS). Child Indicators Research, 1-17. DOI: 10.1007/s12187-016-9428-5
  25. Vale, B. & Thabeng, M. (2016). Redeeming lost mothers: Adolescent antiretroviral treatment and the making of home in South Africa. Medical Anthropology, 35, 489-502. DOI: 10.1080/01459740.2016.1145218
  26. Cluver, L., Hodes, R., Sherr, L., Orkin, F. M., Meinck, F., Lim Ah Ken, P., & Vicari, M. (2015). Social protection: Potential for improving HIV outcomes among adolescents. Journal of the International AIDS Society, 18, 20299. DOI: 10.7448/IAS.18.7.2026
  27. Toska, E., Cluver, L., Hodes, R., & Kidia, K. K. (2015). Sex and secrecy: How HIV-status disclosure affects safe sex among HIV-positive adolescents. AIDS Care, 27, 47-58. DOI: 10.1080/09540121.2015.1071775
  28. Vale, B., & Thabeng, M. (2015). Mobilising AID(S)? Contesting HIV as a social and economic resource among youth in South Africa's Eastern Cape. Journal of Southern African Studies, 41, 797-813. DOI: 10.1080/03057070.2015.1041811