Professor Lucie Cluver

Lucie Cluver
Professor of Child and Family Social Work
01865 280370
lucie.cluver@spi.ox.ac.uk

Lucie Cluver is a Professor of Child and Family Social Work, in the Centre for Evidence-Based Social Intervention in the Department of Social Policy and Intervention, and an Honorary Professor in Psychiatry and Mental Health at the University of Cape Town. She works closely with the South African government, USAID-PEPFAR, UNICEF, the World Health Organisation and with other international NGOs, to provide evidence that can improve the lives of children and adolescents affected by HIV/AIDS in Sub-Saharan Africa. 

Lucie is lucky to work with an incredible and dedicated team of PhD students, postdoctoral researchers, and colleagues. Together they lead large-scale longitudinal surveys and randomised controlled trials of interventions, combined with participatory qualitative research.

Lucie is a PI on several ongoing trials in Southern and Eastern Africa, all part of the Parenting for Lifelong Health Initiative – a collaboration between the World Health Organisation, UNICEF and academics to provide evidence-based non-commercialised child violence prevention programs for LMIC. These include the Sinovuyo Teen trial (with Dr Franziska Meinck and Dr Jenny Doubt) – a cluster randomised trial (n=1100, 40 sites) of a program for families with adolescents, the Sinovuyo Kids trial (with Prof Cathy Ward at University of Cape Town and Dr Jamie Lachman) for caregivers of 3-9 year olds, and the Mphatlalatsane trial (with Prof Mark Tomlinson and Prof Lorraine Sherr) for parents of toddlers in Lesotho. The PLH programmes are now being implemented in 16 countries in Africa, Asia and Eastern Europe.

Working with a dedicated team in close collaboration with policymakers, Lucie has pioneered research on ‘cash plus care’ – examining the impacts of social protection and psychosocial care on adolescent health.

Lucie leads the first community-based large panel of HIV-positive adolescents and community controls, including 1500 adolescents in South Africa (with Dr Elona Toska), which integrates qualitative research led by Dr Rebecca Hodes (University of Cape Town). Currently, she leads (with Dr Elona Toska) the first known longitudinal study in Africa to assess pathways to resilience amongst adolescent parent families living with and without HIV. This study will include 700 adolescent parents and child dyads.

Lucie has led three major longitudinal studies: the ‘Young Carers Study’ (2008-2012, with Dr Mark Boyes) was the world’s largest study of risk and resilience amongst AIDS-affected children, following 6000 children longitudinally in South Africa, the ‘Orphan Resilience Study’ (2005-2009 with Prof Frances Gardner) followed 1000 children over four years to identify impacts of orphanhood.
The team’s work has won a number of awards, including an ESRC Oxford University Excellence in Impact Award (2018), a University of Oxford Vice-Chancellor’s Innovation Award (2018), ESRC's Outstanding International Impact Prize (2017), the Philip Leverhulme Prize (2015), the International AIDS Society Young Investigator Award (2014), and the Discovery Clinical Excellence Award (2013). They have published over 100 papers in peer-reviewed journals including the Lancet Global Health, BMJ Global Health, AIDS, JAIDS, J Child Psychiatry and Psychology, Social Science and Medicine, AIDS Care and Prevention Science.

Funders: European Research Council Consolidator Grant, European Research Council 'Horizon 2020’, Medical Research Council, Research England, Janssen Pharmaceutica N.V., part of the Janssen Pharmaceutical Companies of Johnson & Johnson, The Nuffield Foundation, the Economic and Social Research Council, the Leverhulme Trust, the Evidence for HIV Prevention in Southern Africa (EHPSA), a UK aid programme managed by Mott MacDonald, the National Research Foundation (South Africa), UNICEF, USAID-PEPFAR, Ilifa Labantwana, the Claude Leon Foundation, the National Department of Social Development South Africa, the World Health Organisation, the John Fell Fund, the Oak Foundation, University of Oxford’s ESRC Impact Acceleration Account, RIATT-ESA, and the International AIDS Society through the CIPHER grant.

Cluver, L, Pantelic, M, Toska, E, Orkin, M, Casale, M, Sherr, L (in press). STACKing the odds for adolescent survival: Health service factors associated with retention in care and adherence amongst adolescents living with HIV in South Africa. Journal of the International AIDS Society. 

Rudgard, W, Carter, D, Scuffell, J, Cluver, L, Fraser-Hurt, N, Boccia, D (in press) Cash transfers to enhance TB control: Lessons from the global HIV response. BMC Public Health.

Hodes, R. Vale, B, Toska, E, Cluver, L, Dowse, R, Ashorn, M (in press). ‘Yummy or Crummy: The multisensory components of medicines-taking among HIV-positive youth. Global Public Health.

Steinert, J, Cluver, L, Meinck, F, Doubt, J, Vollmer, S (in press) Household Economic Strengthening through Saving and Budgeting: Evidence from a Field Experiment in South Africa. Journal of Development Economics.

Cluver, L. Meinck, F. Toska, E., Orkin, F. M. Hodes, R. Sherr, L. (2018). Violence exposure and adolescent antiretroviral non-adherence in South Africa. AIDS.

Cluver, L, Pantelic, M, Orkin, M, Toska, E, Medley, S, Sherr, L (2018) Sustainable Survival: Which SDGs protect against mortality risk for adolescents living with HIV? Journal of the International AIDS Society.

Cluver, L., Pantelic, M., Orkin, M., Toska, E., Medley, S., & Sherr, L. (2018). Sustainable Survival for adolescents living with HIV: do SDG-aligned provisions reduce potential mortality risk?. Journal of the International AIDS Society, 21 Suppl 1. doi:10.1002/jia2.25056

Cluver LD, Meinck F, Steinert JI, et al. Parenting for Lifelong Health: a pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa. BMJ Glob Heal 2018;3.http://gh.bmj.com/content/3/1/e000539.abstract

Cluver, L., Meinck, F., Steinert, J., Shenderovich, Y., Doubt, J., Herrero Romero, R., . . . Gardner, F. (n.d.). Parenting for Lifelong Health: A pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa. BMJ Global Health.

Cluver, L., & Sherr, L. (2017). Integrating disclosure support into family HIV care.. The Lancet. HIV, 4(12), e534-e535. doi:10.1016/s2352-3018(17)30153-4

Cluver, L. D., Lachman, J. M., Ward, C. L., Gardner, F., Peterson, T., Hutchings, J. M., . . . Redfern, A. A. (2017). Development of a Parenting Support Program to Prevent Abuse of Adolescents in South Africa: Findings From a Pilot Pre-Post Study. Research on Social Work Practice, 27(7), 758-766. doi:10.1177/1049731516628647

Cluver, L. D., Orkin, F. M., Yakubovich, A. R., & Sherr, L. (2016). Combination Social Protection for Reducing HIV-Risk Behavior Among Adolescents in South Africa.. Journal of Acquired Immune Deficiency Syndromes (1999), 72(1), 96-104. doi:10.1097/qai.0000000000000938

Cluver, L. D., Lachman, J. M., Ward, C. L., Gardner, F., Peterson, T., Hutchings, J. M., . . . Redfern, A. A. (2017). Development of a Parenting Support Program to Prevent Abuse of Adolescents in South Africa. Research on Social Work Practice, 27(7), 758-766. doi:10.1177/1049731516628647

Cluver, L, Orkin, M, Boyes, M, Yakubovich, A, Sherr, L (2016) Can Social Protection Improve Sustainable Development Goals for Adolescent Health?. PLOSOne. 11(10): e0164808 

Cluver, L, Meinck, F, Shenderovich, Y, Ward, C, Herrero Romero, R, Redfern, A, Lombard, C, Doubt, J, Steinert, J, Catanho, R, Wittesaele, C, De Stone, S, Salah, N, Mpimpilashe, P, Lachman, J, Loening, H, Gardner, F, Blanc, D, Nocuza, M, Lechowicz, M (2016). A parenting programme to prevent abuse of adolescents in South Africa: a study protocol for a pragmatic cluster randomized controlled trial. Trials. 17. 328.

Cluver, L, Meinck, F, Yakubovich, A, Doubt, J, et al (2016). Reducing child abuse amongst adolescents in low- and middle-income countries: A pre-post trial in South Africa. BMC Public Health. 13;16(1):567 

Cluver, L, Orkin, M, Yakubovich, A, Sherr, L (2016). Combination social protection for reducing HIV-risk behaviour amongst adolescents in South Africa. JAIDS. 72: 96-104    

Cluver, L, Orkin, M, Meinck, F, Boyes, M and Sherr, L (2016). Structural drivers and social protection: Mechanisms of HIV-risk and HIV-prevention for South African adolescents. Journal of the International AIDS Society (JIAS). 19. 2064-6.    

Cluver, L, Toska, E, Orkin, M, Yakubovich, A, Hodes, R, Sherr, L (2016). Achieving equity in HIV-treatment outcomes: Can social protection improve adolescent ART-adherence in South Africa? AIDS Care Equity Special Issue. Suppl  2 73-82

Cluver, L, Hodes, R, Toska, E, Kidia, K, Orkin, 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. Suppl 1. S57-65. 

Cluver, L, Orkin, M, Boyes, Ma, Sherr, L (2014) Cash plus care: social protection cumulatively mitigates HIV-risk behaviour among adolescents in South Africa. AIDS. S389-97

Cluver, L, Boyes, Ma, Orkin, M, Pantelic, Mc, Molwena, T & Sherr, L (2013) Child-focused state cash transfers and adolescent HIV-infection risks: A prospective multi-site study in South Africa. The Lancet: Global Health. 1. E362-70

Cluver, L, Orkin, M, Boyes, Ma, Sherr, L, Nikelo, J & Makhasi, D (2013). Pathways from parental AIDS to child psychological, educational and sexual risk: Developing an empirically-based interactive theoretical model. Social Science and Medicine, 87. 185-193

Cluver, L, Orkin, M, Boyes, Ma & Gardner, F (2012) ‘AIDS-orphanhood and caregiver HIV/AIDS sickness status: effects on psychological symptoms in South African youth’ Journal of Pediatric Psychology

Cluver, L, Orkin, M, Boyes,a M & Gardner, F (2012) Persisting mental health problems among AIDS-orphaned children in South Africa. Journal of Child Psychiatry & Psychology. 53 (4) 363-370.

Cluver, L, Orkin, M, Boyes, Ma, Gardner, F, & Meinck, Fc (2011) ‘Transactional Sex amongst AIDS-orphaned and AIDS-Affected Adolescents Predicted by Abuse and Extreme Poverty’. JAIDS 58 (3) 336-43   

Cluver, L, Bowes, L & Gardner, F (2010) Risk & protective factors for bullying victimisation amongst AIDS-affected & vulnerable children in S.Africa. Child Abuse & Neglect, 34 793-803 

Cluver, L, Gardner, F & Operario, D (2007). Psychological distress amongst AIDS-orphaned children in urban South Africa Journal of Child Psychiatry & Psychology & Allied Disciplines 48(8) 755-763

  • Behavioural health risks during early adolescence among perinatally HIV-infected South African adolescents and same-age, HIV-uninfected peers.

    2019
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    Journal article
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    AIDS care
    Behavioural health risks, including substance use, early sexual debut, bullying and suicidality, are common during adolescence, but may be complicated among perinatally HIV-infected adolescents. However, there are few data exploring these behaviours in sub-Saharan Africa. We compared behavioural health risks (any self-report of substance use, sexual activity, bullying others or suicidality, or a positive urine toxicology screen) among perinatally-infected adolescents ages 9-14 years to that of an HIV-uninfected comparator group; and explored the effect of behavioural health risks on adolescent and caregiver report of adolescent suboptimal adherence (missed antiretroviral therapy dose(s) on ≥1 day during the preceding 30 days) and elevated HIV viral load (≥50 and ≥1000 copies/mL in sensitivity analyses) in multivariable logistic regression models. Among 506 HIV-infected and 110 HIV-uninfected adolescents (median age overall: 12 years), 15% and 25% reported any behavioural health risk (p = 0.018), respectively. Tobacco and other drug use was uncommon, while alcohol use was reported by 8% of HIV-infected versus 12% of HIV-uninfected adolescents (p = 0.185). One HIV-infected (0.2%) and 3 HIV-uninfected adolescents (3%) reported any sexual activity (p = 0.019). Among HIV-infected adolescents, report of any behavioural health risk was more common among male adolescents [adjusted odds ratio (aOR): 1.78; 95% confidence interval (CI): 1.08-2.95] and was associated with adolescent report of suboptimal adherence (aOR: 1.66; 95% CI: 0.99-2.78) but not with caregiver report of suboptimal adherence or with elevated viral load. In this group of perinatally-infected youth entering early adolescence, the prevalence of behavioural health risks was lower than that among same-age, HIV-uninfected peers. Longitudinal data are needed to explore the reasons underlying these differences, for example the possibility of more protective caregiving and supportive family environments, or of emotional and physical immaturity, as well as the emergence of risk behaviours over time in this population.

  • Mental health in South African adolescents living with HIV: correlates of internalising and externalising symptoms.

    2019
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    Journal article
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    AIDS care
    Although declining in all other age groups, AIDS-related deaths among adolescents are increasing. In the context of HIV, mental health problems are associated with negative health outcomes, including non-adherence to life-saving ART. For effective programming it is essential to identify factors associated with psychological outcomes in this population. Adopting a socioecological perspective, we aimed to identify correlates of internalising and externalising symptoms in a large, representative sample of South African adolescents living with HIV. HIV-positive adolescents (n = 1060), who received care in public health facilities in South Africa's Eastern Cape, completed measures of internalising and externalising symptoms. Hypothesised correlates included HIV and health-related factors (physical health, mode of infection, medication side-effects, disclosure, stigma), health-service related factors (negative interactions with clinic staff, clinic support group), interpersonal factors (abuse, bullying victimisation, social support), parenting-related factors (orphanhood, positive parenting, parental monitoring, parent communication), as well as individual and demographic-related factors (self-efficacy, age, gender, urban/rural location, poverty). Correlates operating across a variety of contexts were identified. Bullying victimisation, self-efficacy, and positive parenting may be particularly salient intervention targets as they were associated with better outcomes on most or all mental health measures, can be addressed without directly targeting adolescents living with HIV (reducing the chances of accidental exposure and stigma), and are associated with better adolescent mental health in South Africa more generally.

  • Intimate partner violence and receptive syringe sharing among women who inject drugs in Indonesia: A respondent-driven sampling study.

    2018
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    Journal article
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    The International journal on drug policy
    BACKGROUND:Intimate partner violence (IPV) and HIV are overlapping public health problems that disproportionately affect women who inject drugs. Little is known about the relationship between IPV and HIV-related unsafe injecting practices among women in low- and middle-income settings. This study investigated whether IPV victimisation was associated with receptive syringe sharing among women who inject drugs in Indonesia. METHODS:Respondent-driven sampling (RDS) was used to recruit 731 women aged 18+ years, injecting drugs in the preceding 12 months, and residing in Greater Jakarta or Bandung, West Java. Population estimates were derived using the RDS-II estimator. Multivariate logistic regressions assessed relationships between different forms of past-year IPV (i.e. psychological abuse, physical and/or injurious assault, forced sex) and receptive syringe sharing, controlling for city differences and sociodemographic cofactors. RESULTS:Overall, 21.1% of participants reported engaging in past-month receptive syringe sharing. In multivariate analyses controlling for all forms of IPV, receptive syringe sharing was significantly positively associated with experiencing psychological abuse (OR = 1.86; 95% CI = 1.06,3.24; p = 0.030), physical and/or injurious assault (OR = 1.73; 95% CI = 1.04,2.89; p = 0.034), and several covariates: injecting pharmaceuticals only (versus heroin only) (OR = 3.58; 95% CI = 1.66,7.69; p = 0.001), experiencing unstable housing and/or homelessness (OR = 2.89; 95% CI = 1.41,5.95; p = 0.004), and residing in Bandung, West Java (versus Greater Jakarta) (OR = 2.33; 95% CI = 1.40,3.90; p = 0.001). CONCLUSION:IPV is a significant risk factor for HIV-related injecting risk among women who inject drugs in Indonesia. These findings indicate the urgent need to scale up harm reduction interventions and align existing programs with IPV prevention and support services, with specific efforts targeting the needs of female injectors.

  • Suicidal thoughts and behaviour among South African adolescents living with HIV: Can social support buffer the impact of stigma?

    2018
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    Journal article
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    Journal of affective disorders
    BACKGROUND:Adolescents living with HIV represent a high-risk population for suicidal ideation and attempts, especially in low-income settings. Yet little is known about risk and protective factors for suicide in this population. METHODS:A moderated mediation model was employed to test for potential (a) effects of stigma on suicidal ideation and attempts, both direct and mediated through depression and (b) direct and stress-buffering effects of social support resources on depression and suicidal ideation and attempts, among 1053 HIV-positive 10-19-year-old adolescents from a resource-scarce health district in South Africa. The survey data was collected using full community sampling of 53 clinics and tracing to over 180 communities. Effects of two support resources were tested: perceived support availability from the adolescents' social network and structured clinic support groups. Stigma was measured using the ALHIV-SS scale, depression through the CDI short form and social support through items from the MOS-SS. RESULTS:Stigma was a risk factor for depression (B = 0.295; p < 001) and for suicidal thoughts and behaviour (B = 0.185; p < .001). Only perceived support availability was directly associated with less depression (B = -0.182, p < .001). However, both perceived support availability and support group participation contributed to the overall stress-buffering effects moderating the direct and indirect relationships between stigma and suicidal thoughts and behaviour. LIMITATIONS:The data used in this study was self-reported and cross-sectional. CONCLUSIONS:Findings suggest that strengthening multiple social support resources for HIV-positive adolescents, through early clinic and community-based interventions, may protect them from experiencing poor mental health and suicidal tendencies.

  • Building resilient families: Developing family interventions for preventing adolescent depression and HIV in low resource settings.

    2018
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    Journal article
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    Transcultural psychiatry
    Depression contributes significantly to the global burden of disease in low- and middle-income countries. In South Africa, individuals may be at elevated risk for depression due to HIV and AIDS, violence, and poverty. For adolescents, resilience-focused prevention strategies have the potential to reduce onset of depression. Involving families in promoting adolescent mental health is developmentally appropriate, but few existing interventions take a family approach to prevention of adolescent depression. We conducted a qualitative investigation from 2013-2015 to inform the development of a family intervention to prevent adolescent depression in South Africa among families infected or at risk for HIV. Using focus groups with adolescents and parents (eight groups, n = 57), and interviews (n = 25) with clinicians, researchers, and others providing mental health and related services, we identified context-specific factors related to risk for family depression, and explored family interactions around mental health more broadly as well as depression specifically. Findings indicate that HIV and poverty are important risk factors for depression. Future interventions must address linguistic complexities in describing and discussing depression, and engage with the social interpretations and meanings placed upon depression in the South African context, including bewitchment and deviations from prescribed social roles. Participants identified family meetings as a context-appropriate prevention strategy. Family meetings offer opportunities to practice family problem solving, involve other family members in communal parenting during periods of parental depression, and serve as forums for building Xhosa-specific interpretations of resilience. This study will guide the development of Our Family Our Future, a resilience-focused family intervention to prevent adolescent depression (ClinicalTrials.gov #NCT02432352).

  • Intimate Partner Violence and HIV Sexual Risk Behaviour Among Women Who Inject Drugs in Indonesia: A Respondent-Driven Sampling Study.

    2018
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    Journal article
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    AIDS and behavior
    Women who inject drugs are disproportionately affected by HIV and intimate partner violence (IPV); however, the link between IPV and HIV remains under-researched among substance-using women in low- and middle-income countries. This study examined associations and additive effects of different forms of IPV victimization (psychological, physical and/or injurious, and sexual) on HIV sexual risk behavior among women who inject drugs in Indonesia. Respondent-driven sampling (RDS) was used to recruit 731 women from Greater Jakarta and Bandung, West Java. RDS-II weighted prevalence of any past-year IPV was 68.9% (95% CI 65.0, 72.6) in Jakarta and 55.9% (95% CI 48.0, 63.5) in Bandung. In separate logistic regressions controlling for socio-demographic covariates, all three forms of IPV showed statistically significant associations with sexual risk behavior. After adjusting for all IPV types, psychological (OR 1.87; 95% CI 1.17, 2.99; p = 0.009) and sexual (OR 1.98; 95% CI 1.22, 3.21; p = 0.006) IPV independently predicted women's sexual risk behavior. Marginal effects models suggested that co-occurrence of multiple forms of IPV had greater adverse consequences: sexual risk behavior was reported by 64.1% of women who did not experience any IPV, but increased to 89.9% among women exposed to all three types. Comprehensive harm reduction services that integrate IPV monitoring and prevention are urgently needed to reduce both HIV and IPV.
    Humans, HIV Infections, Substance Abuse, Intravenous, Prevalence, Logistic Models, Risk Factors, Cross-Sectional Studies, Risk-Taking, Sexual Behavior, Adolescent, Adult, Middle Aged, Sexual Partners, Indonesia, Female, Young Adult, Surveys and Questionnaires, Intimate Partner Violence

  • What Affects Attendance and Engagement in a Parenting Program in South Africa?

    2018
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    Journal article
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    Prevention science : the official journal of the Society for Prevention Research
    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. The trial evaluated a 14-week parenting intervention aiming to improve parenting and reduce maltreatment by caregivers. The intervention was delivered in 20 groups, one per study cluster, with 8 to 16 families each. Overall, caregivers attended 50% of group sessions and children, 64%. Using linear multilevel models with Kenward-Roger correction, we examined child and caregiver baseline characteristics as predictors of their attendance and engagement in the group sessions. Variables examined as predictors included measures of economic, educational, and social and health barriers and resources, as well as family problems and sociodemographic characteristics. Overall, the study yielded no evidence that the level of stressors, such as poverty, was related to attendance and engagement. Notably, children from overcrowded households attended on average 1.2 more sessions than their peers. Our findings suggest it is possible to engage highly disadvantaged families that face multiple challenges in parenting interventions in LMICs. However, some barriers such as scheduling, and alcohol and substance use, remain relevant.

  • 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

    2018
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    Journal article
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    JOURNAL OF THE INTERNATIONAL AIDS SOCIETY
    adolescent, HIV, delivery of healthcare, medication therapy management, adolescent health services, viral load

  • #A SYSTEMATIC REVIEW AND THEORY SYNTHESIS FOR THE IMPACT OF FOREIGN AID ON HIV/AIDS IN SUBSAHARAN AFRICA

    2018
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    Conference paper
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    JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH

  • Household economic strengthening through financial and psychosocial programming: Evidence from a field experiment in South Africa

    2018
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    Journal article
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    JOURNAL OF DEVELOPMENT ECONOMICS
    Financial literacy, Saving, Parenting, RCT, South Africa
    • More

Lucie Cluver - CV (July 2018)

For information about new project 'Hey Baby', please go here.

Lucie's previous DPhil students have gone on to be successful in academia, policy and practice:

  • Caroline Kuo (2010) - is an Assistant Professor of Behavioral and Social Sciences in the Center for Alcohol and Addiction Studies at Brown University
  • Lena Saleh (2012) - is the Director of Program Planning in HIV Prevention in the New York City Department of Health and Mental Hygiene
  • Tyler Lane (2013) - is a research fellow in the Institute for Safety, Compensation and Recovery Research at Monash University
  • Franziska Meinck (2014) - is a postdoctoral researcher in the Centre for Evidence-Based Interventions at Oxford
  • Beth Vale (2015) - is a researcher in humanities at the Mapungubwe Institute for Strategic Reflection (MISTRA)
  • Jamie Lachman (2016) - is a postdoctoral researcher in the Centre for Evidence-Based Interventions at Oxford
  • Elona Toska (2017) -  is a postdoctoral researcher at the University of Cape Town

Lucie would welcome applications for D.Phils from students who are committed to policy and programming-relevant research and to helping mitigate the impacts of HIV/AIDS and family distress on children in sub-Saharan Africa.

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