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, UNDP, USAID-PEPFAR, UNICEF, the World Health Organisation and with other international agencies, to provide evidence that can improve the lives of children and adolescents 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.

From February 2019, Lucie is the Principal Investigator for the new £20 million UKRI GCRF Accelerating Achievement for Africa's Adolescents Hub. Find out more here.

The UKRI GCRF Accelerate Hub

The goal of this new research programme is to promote success for Africa’s adolescents, and the children of adolescent parents. The Hub works in 34 countries across Africa to identify effective services with synergies across multiple Sustainable Development Goals: ‘Accelerators’. It responds to requests from policymakers for evidence that helps them to make the best, cost-effective policies for their adolescents. Partners include the African Union Development Agency, UNDP, UNICEF, WHO, UNFPA, UNAIDS, & UN Women, regional NGOs providing direct services, and is led by 11 African and 3 UK research institutions. It works closely with adolescents themselves as co-leaders in design and impact. The Hub has a particular focus on capacity-sharing for early-career African academics. (Co-Directors Prof Lorraine Sherr, Prof Chris Desmond)   

Supporting parents and preventing violence against children

Lucie co-leads the Parenting for Lifelong Health (PLH) Initiative – a collaboration between the World Health Organisation, UNICEF and academics to provide evidence-based non-commercialised child violence prevention programmes for LMIC. Since 2012, the PLH team has developed and tested programmes in randomised controlled trials in Southern Africa, Eastern Europe, the Philippines and Thailand. They are now being scaled up in 21 countries across Africa, Asia, Eastern Europe, India and Latin America. The PLH team is now working with implementing partners to pool data collected routinely across these locations so that we can better understand programme delivery and effectiveness at scale (co-leads Prof Cathy Ward, Prof Frances Gardner, Prof Mark Tomlinson, Dr Daniel Oliver, Dr Jamie Lachman, Dr Inge Wessels)

Cash plus care for adolescents in Africa

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. This has led to UNAIDS and UNICEF guidance and delivery of cash + care programs to millions of children and adolescents in Southern and Eastern Africa (with Prof Mark Orkin, Prof Lorraine Sherr, Dr Mark Boyes, Dr Franziska Meinck).

Supporting success for adolescents living with HIV (Mzantsi Wakho) and young parents (HEY BABY)

With Dr Elona Toska (University of Cape Town), Lucie co-leads the first community-based large panel of HIV-positive adolescents and community controls, including 1500 adolescents in South Africa over four years, and integrating qualitative research led by Dr Rebecca Hodes (University of Cape Town).

Also with Dr Elona Toska, Lucie co-leads the first known longitudinal study in Africa to assess pathways to resilience amongst adolescent parent families living with and without HIV. This ongoing study includes 900 adolescent parents and child dyads.

Previous work

Lucie has led 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, including 6000 children with longitudinal follow-up in South Africa, the ‘Orphan Resilience Study’ (2005-2009 with Prof Frances Gardner) followed 1000 children over four years to identify impacts of orphanhood.

Recognition

The team’s work has won a number of awards, including an European Union Council Conference Social Sciences and Humanities Impact Award (2019), ESRC Oxford University Excellence in Impact 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). Prof Cluver was included in UKRI’s ‘Women with Impact’ (2019) and in UNICEF’s ‘Women at the heart of the HIV response for Children’ (2018).

Working together and promoting early-career authorship, they have published over 150 papers in peer-reviewed journals including the Lancet Child and Adolescent Health, the Lancet Global Health, BMJ Global Health, AIDS, JAIDS, J Child Psychiatry and Psychology, Social Science and Medicine, AIDS Care and Prevention Science.

This research has been generously supported by:

UKRI Global Challenges Research Fund, Medical Research Council (MRC), UK Department for International Development (DFID), UK Department of Health and Social Care (DHSC) National Institutes of Health Research (NIHR), European Research Council (ERC), the Nuffield Foundation, Research England, Janssen Pharmaceutica N.V., part of the Janssen Pharmaceutical Companies of Johnson & Johnson, the Economic and Social Research Council (ESRC), the Leverhulme Trust, 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 (WHO), the John Fell Fund, the Oak Foundation, University of Oxford’s ESRC Impact Acceleration Account, Regional Inter-Agency Task Team for Children Affective by AIDS – Eastern and Southern Africa (RIATT-ESA), Gates Foundation, Wellspring Advisors, The Wellcome Trust, ELMA philanthropies, Rockefeller Foundation, HEARD at UKZN, the International AIDS Society through the CIPHER grant, FHI360, the University of Oxford’s’ Clarendon Scholarship Fund, HelpAge, Swedish International Development Cooperation Agency.

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

  • Final Report of a Project funded by the Nuffield Foundation: Pathways to Survival - Identifying psychosocial, family and service mechanisms to improve anti-retroviral adherence amongst adolescents living with HIV in Southern Africa

    2019
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    Report
    This report summarises the study findings and impact of a research project implemented jointly by the Universities of Oxford and Cape Town: Pathways to survival: identifying psychosocial, family and service mechanisms to improve anti-retroviral adherence amongst HIV-positive adolescents in Southern Africa (hereafter: Mzantsi Wakho – Your South Africa – its locally used name). The core source of funding for this high-impact and successful study came from the Nuffield Foundation. This study was also supported by supplementary co-funding. This study was the first to systematically examine potential causes of ART non-adherence and non-retention in HIV care amongst adolescents (10-19 years old) in Sub-Saharan Africa. Through additional funding awarded to the research team, additional research aims were also examined. The research project was implemented by a team of more than 50 researchers, including capacity-building for early-career academics and students in South Africa and the UK. In July 2015 – March 2018, this multi-disciplinary, mixed-methods team engaged with over 1,600 adolescents, 100 caregivers, and 120 healthcare providers through participatory workshops, in-depth interviews, ethnographic research, and three waves of quantitative surveys. In parallel, a clinic team engaged with over 79 public health facilities collecting data from clinic managers, healthcare providers, and patient files (with appropriate consent). With the essential support of the Nuffield Foundation, this study became the world’s largest longitudinal cohort of adolescents living with HIV. Mzantsi Wakho’s research team successfully followed up and maintained high retention rates across three time points, as research participants transitioned from early adolescence into youth. The study has already had major impact on policy, UN guidelines and programming for adolescents living with HIV.

  • Recent Interventions to Improve Retention in HIV Care and Adherence to Antiretroviral Treatment Among Adolescents and Youth: A Systematic Review.

    2019
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    Journal article
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    AIDS Patient Care STDS
    Adolescents represent a growing proportion of people living with HIV worldwide and the highest risk population group for treatment attrition and AIDS-related mortality. There is an urgent need to design, implement, and test interventions that keep young people in HIV treatment and care. However, previous systematic reviews show scarce and inconclusive evidence of effective interventions for this age group. Recent years have seen an increase in focus on adolescent health and a rapidly changing programmatic environment. This systematic review article provides an evidence update by synthesizing empirical evaluations of interventions designed to improve antiretroviral therapy adherence and retention among adolescents (10-19) and youth (15-24) living with HIV, published between January 2016 and June 2018. A search of 11 health and humanities databases generated 2425 citations and 10 relevant studies, the large majority conducted in sub-Saharan Africa. These include six clinic-level interventions, one individual-level m-Health trial, and three community- or household-level interventions. Implications of their findings for future programming and research with young adults are discussed, in relation to previous reviews and the broader empirical evidence in this area. Findings highlight the need to further develop and test multi-faceted interventions that go beyond health facilities, to address broader social barriers to adherence and retention. In particular, further intervention studies with adolescents (10-19) should be a priority, if we are to retain these young people in treatment and care and aspire to achieve the United Nation's Sustainable Development Goals and 90-90-90 targets.
    HIV treatment adherence, adolescents, retention in HIV care, systematic review, youth

  • Delivering a Parenting Program in South Africa: The Impact of Implementation on Outcomes

    2019
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    Journal article
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    Journal of Child and Family Studies
    © 2019, The Author(s). Objectives: Previous studies of parenting programs suggest that facilitator fidelity, participant attendance and engagement often influence treatment outcomes. While the number of parenting program evaluations has been growing in low- and middle-income countries, little is known about the implementation processes and their impact on participant outcomes in these settings. Methods: This study was nested within a cluster-randomised trial of a parenting program in South Africa. The paper aims to, first, describe the implementation of the intervention over 14 weeks. Second, using longitudinal multilevel analyses, the paper examines the impact of variation in observer-rated fidelity, attendance, and engagement on participant outcomes – parenting and maltreatment reported by caregivers and adolescents aged 10–18 (N = 270 pairs), 14 outcome constructs. Results: Fidelity, attendance and participant engagement rates were similar to those reported in high-income country studies. However, the participation and implementation characteristics did not predict participant outcomes. This may be due to limited variation in dosage as home visits were comprehensively provided when participants could not attend group sessions, and fidelity was monitored by the implementers and researchers. One statistically significant predictor after the multiple testing correction was higher fidelity predicting an increase in adolescent-reported maltreatment at follow-up, possibly due to an increase in reporting (incidence rate ratio 1.33, 95% CI [1.19, 1.49], p < 0.01). Conclusions: Our study confirms that a high quality of implementation can be achieved in a low-resource context. Suggestions for future research on parenting programs include examining therapeutic alliance alongside program fidelity and facilitator skill as well as systematically recording program adaptations.

  • Improving lives by accelerating progress towards the UN Sustainable Development Goals for adolescents living with HIV: a prospective cohort study.

    2019
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    Journal article
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    Lancet Child Adolesc Health
    BACKGROUND: 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. METHODS: We did standardised interviews and extracted longitudinal data from clinical records at baseline (2014-15) and 18-month follow-up (2016-17) for adolescents aged 10-19 years living with HIV in the Eastern Cape province of South Africa. We used standardised tools to measure 11 SDG-aligned targets-antiretroviral therapy adherence, good mental health, no substance use, HIV care retention, school enrolment, school progression, no sexual abuse, no high-risk sex, no violence perpetration, no community violence, and no emotional or physical abuse. We also assessed receipt at both baseline and follow-up of six hypothesised development accelerators-government cash transfers to households, safe schools (ie, without teacher or student violence), free schools, parenting support, free school meals, and support groups. Associations of all provisions with SDG-aligned targets were assessed jointly in a multivariate path model, controlling for baseline outcomes and sociodemographic and HIV-related covariates, and adjusted for multiple outcome testing. Cumulative effects were tested by marginal effects modelling. FINDINGS: 1063 (90%) of 1176 eligible adolescents were interviewed. Three provisions were shown to be development accelerators. Parenting support was associated with good mental health (odds ratio 2·13, 95% CI 1·43-3·15, p<0·0001), no high-risk sex (2·44, 1·45-5·03, p=0·005), no violence perpetration (2·59, 1·63-4·59, p<0·0001), no community violence (2·43, 1·65-3·86, p<0·0001), and no emotional or physical abuse (2·38, 1·65-3·76; p<0·0001). Cash transfers were associated with HIV care retention (1·87, 1·15-3·02, p=0·010), school progression (2·05, 1·33-3·24, p=0·003), and no emotional or physical abuse (1·76, 1·12-3·02, p=0·025). Safe schools were associated with good mental health (1·74, 1·30-2·34, p<0·0001), school progression (1·57, 1·17-2·13, p=0·004), no violence perpetration (2·02, 1·45-2·91, p<0·0001), no community violence (1·81, 1·30-2·55, p<0·0001), and no emotional or physical abuse (2·20, 1·58-3·17, p<0·0001). For five of 11 SDG-aligned targets, a combination of two or more accelerators showed cumulative positive associations, suggesting accelerator synergies of combination provisions. For example, the fitted probability of adolescents reporting no emotional or physical abuse (SDG 16.2) with no safe schools, cash transfers, or parenting support was 0·25 (0·16-0·34). With cash transfer alone it was 0·37 (0·33-0·42), with safe school alone 0·42 (0·30-0·55), and with parenting support alone 0·44 (0·30-0·59). With all three development accelerators combined, the probability of adolescents reporting no emotional or physical abuse was 0·76 (0·67-0·84). After correcting for multiple tests, four of the SDG-aligned targets (antiretroviral therapy adherence, no substance use, school enrolment, and no sexual abuse) were not associated with any hypothesised accelerators. INTERPRETATION: The findings suggest the UN's accelerator approach for this high-risk adolescent population has policy and potential financing usefulness. Services that simultaneously promote several SDG targets, or combine to support particular targets, might be important to meet not only health-related targets, but also to ensure that adolescents in LMICs thrive within a new development framework. FUNDING: Nuffield Foundation, UK Research and Innovation Global Challenges Research Fund, UKAID, Janssen Pharmaceutica, International AIDS Society, John Fell Fund, European Research Council, Economic and Social Research Council, Philip Leverhulme Trust, and UNICEF.

  • TEST Household Economic Strengthening through Saving and Budgeting: Evidence from a Field Experiment in South Africa

    2019
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    Presentation
    CSAE Conference 2018: Economic Development in Africa

  • Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort.

    2019
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    Journal article
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    BMC Public Health
    BACKGROUND: Many adolescents living with HIV remain disconnected from care, especially in high-prevalence settings. Slow progressors-adolescents infected perinatally who survive without access to lifesaving treatment-remain unidentified and disconnected from heath systems, especially in high-prevalence settings. This study examines differences in educational outcomes for ALHIV, in order to i) identify educational markers for targeting HIV testing, counselling and linkages to care, and ii) to identify essential foci of educational support for ALHIV. METHODS: Quantitative interviews with N = 1063 adolescents living with HIV and N = 456 HIV-free community control adolescents (10-19 year olds) included educational experiences (enrolment, fee-free school, school feeding schemes, absenteeism, achievement), physical health, cognitive difficulties, mental health challenges (depression, stigma, and trauma), missing school to attend clinic appointments, and socio-demographic characteristics. Voluntary informed consent was obtained from adolescents and caregivers (when adolescent < 18 years old). Analyses included multivariate logistic regressions, controlling for socio-demographic covariates, and structural equation modelling using STATA15. RESULTS: ALHIV reported accessing educational services (enrolment, free schools, school feeding schemes) at the same rates as other adolescents (94, 30, and 92% respectively), suggesting that school is a valuable site for identification. Living with HIV was associated with poorer attendance (aOR = 1.7 95%CI1.1-2.6) and educational delay (aOR1.7 95%CI1.3-2.2). Adolescents who reported educational delay were more likely to be older, male, chronically sick and report more cognitive difficulties. A path model with excellent model fit (RMSEA = 0.027, CFI 0.984, TLI 0.952) indicated that living with HIV was associated with a series of poor physical, mental and cognitive health issues which led to worse educational experiences. CONCLUSION: Schools may provide an important opportunity to identify unreached adolescents living with HIV and link them into care, focusing on adolescents with poor attendance, frequent sickness, low mood and slow learning. Key school-based markers for identifying unreached adolescents living with HIV may be low attendance, frequent sickness, low mood and slow learning. Improved linkages to care for adolescents living with HIV, in particular educational support services, are necessary to support scholastic achievement and long-term well-being, by helping them to cope with physical, emotional and cognitive difficulties.
    Adolescents, Education, HIV/AIDS, Health, Path analyses, South Africa, Academic Success, Adolescent, Child, Cohort Studies, Female, HIV Infections, Health Services Accessibility, Health Status, Humans, Interviews as Topic, Male, Mental Health, Prevalence, School Health Services, Social Stigma, Socioeconomic Factors

  • Does free schooling affect pathways from adverse childhood experiences via mental health distress to HIV risk among adolescent girls in South Africa: a longitudinal moderated pathway model.

    2019
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    Journal article
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    J Int AIDS Soc
    INTRODUCTION: Adolescent girls are at high risk of HIV infection in sub-Saharan Africa. Mental health distress, driven by adverse childhood experiences (ACEs) such as abuse, poverty and family HIV, may be an important driver of HIV risk behaviour among adolescent girls, while education may mitigate these risks. This study aimed to develop an empirically based theoretical model between ACEs, mental health distress and HIV risk behaviour among adolescent girls in South Africa and to investigate the potential moderating effects of free schooling provision. METHODS: Self-report questionnaires using validated scales were completed by adolescent girls aged 12 to 17 at baseline in two provinces in South Africa in 2011, with a 99% one-year follow-up in 2012 (n = 1498). Sampling included every household in randomly selected census enumeration areas of four deprived health districts. Confirmatory factor analysis was employed to identify measurement models and a structural equation model was developed to test pathways of risk and protection. RESULTS: Internalizing and externalizing mental health distress fully mediated the positive relationship between ACEs at baseline and HIV risk behaviour at follow-up among adolescent girls. Internalizing mental health distress was associated with increased sexual risk at follow-up via higher externalizing problems. Free schooling provision at baseline and follow-up eliminated the pathway from internalizing to externalizing mental health distress by moderating the pathway between ACEs and internalizing mental health distress. It also weakened the pathway from externalizing mental health distress to HIV risk behaviour at follow-up through a direct negative effect on externalizing mental health distress. CONCLUSIONS: Reducing ACEs and adolescent mental health distress is essential for reducing HIV risk behaviour among girls in South Africa. Free schooling provision may be an important tool for reducing these problems and mitigating negative pathways to HIV risk among vulnerable adolescent girls.
    adolescent girls, adverse childhood experiences, mental health, sexual risk behaviour, social protection

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

    2019
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    Journal article
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    J Affect Disord
    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.
    Adolescents, Depression, HIV, Social support, Stigma, Suicide, Adolescent, Adolescent Behavior, Adult, African Continental Ancestry Group, Child, Cross-Sectional Studies, Female, HIV Infections, Humans, Male, Risk Factors, Self Report, Social Stigma, Social Support, South Africa, Suicidal Ideation, Suicide, Surveys and Questionnaires, Young Adult

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

    2019
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    Journal article
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    Transcult 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).
    South Africa, depression, family interventions, prevention, resilience, Adolescent, Adult, Aged, Depressive Disorder, Family Health, Female, Focus Groups, HIV Infections, Humans, Interviews as Topic, Male, Mental Health, Middle Aged, Parenting, Poverty, Resilience, Psychological, Risk Factors, Social Support, South Africa, Young Adult

  • 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.
    Adolescent HIV, bullying, sexual activity, substance use, suicidality
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Lucie Cluver - CV (June 2019)

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 is interested in supervising students who are absolutely dedicated to improving outcomes for children and young people in Africa. She is not interested in research without real impact. A really good grasp of statistics and teamwork are essential. She especially welcomes students from the African region.

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