Mzantsi Wakho Adolescent Adherence Study

Project outline

Mzantsi Wakho is a mixed-methods, longitudinal, community-traced study based in the Amathole District of the Eastern Cape, South Africa. It seeks to answer several research questions about youth health, with a focus on long-term medication, contraception, and sexual and reproductive health. It uses multiple methods and data sources to identify and investigate risk and resilience-promoting factors, through linked qualitative and quantitative studies. The research team collaborates with adolescents, frontline healthcare workers and social service providers to design support tools to improve adherence to medicines and access to health services. The study generates evidence that informs social policy and intervention design that supports young people living in AIDS-affected communities in South Africa.

The Mzantsi Wakho study was designed and conceptualised in collaboration with the South African Departments of Health, Basic Education, and Social Development, UNICEF and UNAIDS, RIATT, REPSSI, Paediatric AIDS Treatment for Africa, and community-based organisations: the Keiskamma Trust, the Raphael Centre, Kheth’Impilo, and Small Projects Foundation.

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

1.    M. Pantelic,  M. Casale, L. Cluver,  E. Toska, M. Moshabela. Multiple forms of discrimination and internalized stigma compromise retention in HIV care among adolescents: findings from a South African cohort. Journal of the International AIDS Society, Volume23, Issue5, May 2020, e25488

2.    Hodes, R., Gittings, L. 2019. ‘Kasi curriculum’ What young men teach and learn about sex in a South African Township. Journal of Sex Education. 19(4): 436-454. DOI: 10.1080/14681811.2019.1606792

3.    Hodes, Rebecca, Beth Vale, Elona Toska, Lucie Cluver, Ros Dowse, and Mikael Ashorn, ‘“Yummy or Crummy?” The Multisensory Components of Medicines-Taking among HIV-Positive Youth’, Global Public Health, 14 (2019), 284–99

4.    Cluver, Lucie D, F Mark Orkin, Laurence Campeau, Elona Toska, Douglas Webb, Anna Carlqvist, and others, ‘Improving Lives by Accelerating Progress towards the UN Sustainable Development Goals for Adolescents Living with HIV: A Prospective Cohort Study’, The Lancet Child & Adolescent Health, 3 (2019), 245–54

5.    Haghighat, R., Toska, E., Cluver, L., Gulaid, L., Mark, D., Bains, A.. (2019) 'Transition Pathways Out of Pediatric Care and Associated HIV Outcomes for Adolescents Living With HIV in South Africa'.J Acquir Immune Defic Syndr. 2019 Oct 1;82(2):166-174. doi: 10.1097/QAI.0000000000002125.

6.    Toska, E., Campeau, L., Cluver, L., Orkin, M., Berezin, M., Sherr, L., Laurenzi, C., Bachman, G., (2019) 'Consistent Provisions Mitigate Exposure to Sexual Risk and HIV Among Young Adolescents in South Africa.  AIDS and Behavior, pp1-11. (

7.    Toska, E. Hodes, R. Cluver, L. Atujuna, M & Laurenzi, C. (2019). Thriving in the second decade: Bridging childhood and adulthood for South Africa’s adolescents. In Child Gauge 2019: Prioritising child and adolescent health - a call to action. Pp. 21-34. 20. The Children’s Institute, Cape Town.

8.    Toska, E., Cluver, L., Orkin, M., Bains, A., Berezin, M., Sherr, L., Gulaid, L. (2019). Screening and Supporting through Schools: educational experiences and needs of adolescents living with HIV in a South African cohort. BMC Public Health, 19, 272.

9.    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

10.    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:

11.    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

12.    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 

13.    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

14.    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

15.    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.

16.    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.

17.    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

18.    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

19.    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

20.    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

21.    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

22.    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. 

23.    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

24.    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

25.    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.

26.    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.

27.    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

28.    Hodes, R., Toska E., & Gittings, L. (2016). Babies for bling: Are teenage girls having children to access grants? HIV Nursing Matters, 7, 20-23.

29.    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

30.    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

31.    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

32.    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

33.    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

34.    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

35.    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

36.    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