Professor Lucie Cluver

lucie cluver july 2020
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, UNAIDS, Global Partnership to End Violence Against Children, 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.

PI Professor Cluver has an exceptional track record of impact, and in the past three years has been awarded the European Union Horizon 2020 Impact Award in 2019, the UNICEF Women Leaders in the HIV response for Children in 2018 and the ESRC Outstanding International Impact Prize in 2017. In 2019 she was recognised as one of UKRI’s 15 Women with Impact in Research. 

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.

Research

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. Since 2018 these programmes are They are now being scaled up in 25 countries across Africa, Asia, Eastern Europe, India and Latin America, and are available free on the WHO website. 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).

Preventing violence during COVID-19

Lucie Cluver's group leads a coalition of WHO, UNICEF, the Global Partnership to End Violence, USAID and the US Centers for Disease Control and Prevention in co-developed open-source COVID-19 parenting resources, condensing evidence from our multiple RCTs of child abuse prevention programmes in Africa, Asia and Europe, which were started with ERC-supported PACCASA and continued with CAPITA and HEY BABY. Worksheets were endorsed by all collaborating agencies, and released onto the WHO and UNICEF COVID-19 websites, alongside a letter in The Lancet. In 7 weeks these child abuse prevention resources reached 34 million families in 178 countries. They have been translated into 100+ languages and disseminated by governments including Bangladesh, Brazil, Cambodia, Colombia, France, Germany, Iceland, India, Kenya, Malaysia, Montenegro, Paraguay, Philippines, South Africa, Somalia, Sri Lanka, Thailand, Uganda, Vanuatu, and Vietnam. Social media includes reach to 12 million people through WHO’s WhatsApp system. 

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 an estimated 2.5 million 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 1,000+ 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 a European Union Horizon 2020 Impact Award, 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), the Oak Foundation, 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, 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,  South African National Lottery Distribution Trust Fund , UNFPA South Africa, The LEGO Foundation, COVID 19 Research Response Fund. Medical Sciences, HEFCE-GCRF Support Fund.

Selected publications

Cluver, L, Lachman, J, Sherr, L, Wessels, I, Krug, E, Rakotomalala, S, Blight, S, Hillis, S, Bachman, G, Green, O, Butchart, A, Tomlinson, M, Ward, C, Doubt, J, McDonald, K (2020) Parenting in a time of COVID-19. The Lancet. (letter) 

Toska, E, Cluver, L, Laurenzi, C, Zhou, S, Langwenya, N, Wittesaele, C, Sherr, L (in press) Reproductive aspirations, contraception use and dual protection among adolescent girls and young women: the effect of motherhood and HIV status. Journal of the International AIDS Society.

Sherr, L, Cluver, L, Desmond, C, Toska, E, Aber, L, Dhaliwal, M, Webb. D, Dugbazah, J (in press) A new vehicle to accelerate the UN Sustainable Development Goals’. Lancet Global Health (commentary). 

Steinert, J, Cluver, L et al (in press) Opening the Black Box: A Mixed-Methods Investigation of Social and Psychological Mechanisms Underlying Changes in Financial Behaviour. Journal of Development Studies.  

Cluver, L, Orkin, M, Campeau, L, Toska, E, Sherr, L, Webb, D, Carlqvist, A (2019) Improving lives by accelerating progress towards the Sustainable Development Goals for adolescents living with HIV: a prospective analysis. The Lancet Child and Adolescent Health. 3: 245-54.

Toska, E, Campeau, L, Cluver, L, Orkin, FM, Berezin, M, Sherr, L (2019) Dreams of an AIDS-free generation: Which supportive factors delay onset of adolescent sexual HIV-risk behaviours in South Africa. Journal of the International AIDS Society, 22 18-19.

Casale, M., Cluver, L., Pantelic, M., Toska, E., & Boyes, M. (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 

Haghighat, R, Cluver, L, Bungane, N, Toska, E (2018) 90-90-48 The reality of viral suppression among ART-initiated adolescents in South Africa. Journal of the International AIDS society.21. 144-144.

Cluver, L., Meinck, F., Steinert, J., Shenderovich, Y., Doubt, J., Romero, R., Gardner, F. (2018) 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, 3:e000539 PMID:29564157

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(1, Suppl.):e25056 

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 retention in care and adherence amongst adolescents living with HIV in South Africa. Journal of the International AIDS Society, 21, e25176. PMID:30240121.

Cluver, L., Meinck, F., Toska, E., Orkin, F., M., Hodes, R., & Sherr, L. (2018). Multitype violence exposures and adolescent antiretroviral nonadherence in South Africa. AIDS, 32(8), 975-983  

Steinert, J., Cluver, L., Meinck, F., Doubt, J., & Vollmer, S. (2018). Household economic strengthening through financial and psychosocial programming: Evidence from a field experiment in South Africa. Journal of Development Economics, 134, 443-466. 

Oliveras, C., Cluver, L., Bernays, S., & Armstrong, A. (2018). Nothing About Us Without RIGHTS-Meaningful Engagement of Children and Youth: From Research Prioritization to Clinical Trials, Implementation Science, and Policy. Journal of Acquired Immune Deficiency Syndromes, 78(1, Suppl.), S27-S31   

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
 

Oxford Research Archive

  • Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities.

    January 2021
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    Journal article
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    Prevention science : the official journal of the Society for Prevention Research
    Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed.

  • Opening the Black Box: A Mixed-Methods Investigation of Social and Psychological Mechanisms Underlying Changes in Financial Behaviour

    December 2020
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    Journal article
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    The Journal of Development Studies

  • Adolescent mothers affected by HIV and their children: A scoping review of evidence and experiences from sub-Saharan Africa.

    November 2020
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    Journal article
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    Glob Public Health
    While adolescents have received increasing attention in the global HIV response and international strategies and commitments, adolescent mothers and their children remain largely overlooked in research, funding and, programming for health-related outcomes. We conducted an extensive scoping review of current evidence on the experiences of adolescent mothers affected by HIV and their children in this region. We included published literature and conference abstracts, complemented by consultations with key stakeholders, and a review of documents through grey literature searching. First, we summarise the experiences of adolescent mothers and their children related to HIV and key health and development indicators. The syndemic of early motherhood and HIV in sub-Saharan Africa increases the vulnerability of adolescent mothers and their children. We then highlight lessons from a series of promising programmes focused on supporting adolescent mothers through novel approaches. In sub-Saharan Africa, supporting adolescent mothers living in high HIV-risk communities is critical not only to eliminate HIV/AIDS, but also to attain the Sustainable Development Goals. While research on and programming for adolescent mothers and their children is growing, the complex needs for this vulnerable group remain unmet. We conclude with evidence gaps and programming priorities for adolescent mothers affected by HIV and their children.
    Adolescence, HIV, children, motherhood, sub-Saharan Africa

  • Modelling the impact of maternal HIV on uninfected children: correcting current estimates.

    November 2020
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    Journal article
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    AIDS Care
    A mathematical model, populated primarily with data from South Africa, was developed to model the numbers of children affected by maternal HIV, and the number who will experience long-term negative developmental consequences. A micro-simulation model generated two scenarios. The first simulated a cohort of women whose HIV status mimicked that of a target population, and mother-child dyads by way of age- and disease-specific fertility rates. Factors defining risk were used to characterize the simulated environment. The second scenario simulated mother-child dyads without maternal HIV. In the first scenario an estimated 26% of children are orphaned, compared to 10% in the absence of HIV. And a further 19% of children whose mother is alive when they turn 18 are affected by maternal HIV. School drop-out among all children increased by 4 percentage points because of maternal HIV, similarly population level estimates of abuse and negative mental health outcomes are elevated. Relative to HIV unaffected children, HIV affected have elevated risk of poor outcomes, however not all will suffer long-term negative consequences. Interventions to protect children should target the proportion of children at risk, while interventions to mitigate harm should target the smaller proportion of children who experience long-term negative outcomes..
    Children affected by HIV, micro-simulation, modelling, orphans, Child, Child Health, Cohort Studies, Female, HIV Infections, Health Status, Humans, Mother-Child Relations, Mothers, Quality of Life, South Africa

  • Prospective associations between bullying victimisation, internalised stigma, and mental health in South African adolescents living with HIV.

    November 2020
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    Journal article
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    J Affect Disord
    BACKGROUND: Adolescents living with HIV may be at elevated risk of psychological problems, which are correlated with negative health outcomes. In cross-sectional research with HIV-affected adolescents, bullying victimisation and internalised HIV stigma have been associated with poorer psychological health. We extended these findings and tested longitudinal associations between bullying victimisation, internalised stigma, and mental health among adolescents living with HIV. We also tested whether relationships between bullying victimisation and psychological symptoms were mediated by internalised stigma. METHOD: Adolescents living with HIV (n = 1060, 10-19 years, 55% female), who had ever initiated HIV treatment in 53 public health facilities in the Eastern Cape, South Africa, were interviewed and followed up 18 months later (n = 995, 94% retention). Participants completed well-validated measures of depression, anxiety, posttraumatic stress, bullying victimisation, and internalised stigma. RESULTS: After adjusting for baseline mental health and sociodemographic characteristics, baseline internalised stigma prospectively predicted poorer outcomes on all psychological measures. Bullying victimisation at baseline was not directly associated with any psychological measures at follow up; however, it was indirectly associated with all psychological measures via internalised stigma. LIMITATIONS: Reliance on self-report measures and poor reliability of the depression scale. CONCLUSIONS: Bullying victimisation is associated with internalised stigma, which in turn predicts psychological symptoms over time. Interventions reducing internalised stigma and associated psychological distress are needed, and these should be integrated into HIV care to ensure optimal HIV management. The implementation of bullying prevention programs may reduce internalised stigma and promote mental health among adolescents living with HIV.
    Adolescents, Bullying victimisation, HIV, Mental health, Stigma

  • Violence prevention accelerators for children and adolescents in South Africa: a path analysis using two pooled cohorts

    November 2020
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    Journal article
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    PLoS Medicine

  • Depressive symptoms among children attending community based support in South Africa - pathways for disrupting risk factors.

    October 2020
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    Journal article
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    Clinical child psychology and psychiatry
    Children in Southern Africa are exposed to high rates of structural and family adversities. This study tests whether services from Community Based Organisations (CBOs) in South Africa can promote children's resilience against depression exposed to such adversities. Two linked longitudinal studies were conducted, comprising n = 1848 children aged 9 to 13 years. One group received CBO services, whilst the other (quasi-control) did not. Analyses used interaction terms in regression models to test for potential moderation effects of CBO attendance, and marginal effects models to interpret significant interactions. Two interaction effects were shown, demonstrating moderation effects of CBO attendance on common structural disadvantages. First, children exposed to community violence showed increased depression (contrast = 0.62 [95%CI 0.43, 0.82], p < .001), but this association was removed by CBO access (contrast = 0.07 [95%CI -0.28, 0.43], p = .682). Second, children living in informal housing showed increased depression (contrast = 0.63 [95%CI 0.42, 0.85], p < .001), however, this association was removed by CBO access (contrast = 0.01 [95%CI -0.55, 0.56], p = .977). CBO attendance is associated with fewer depressive symptoms, and can buffer against important structural adversities of poor housing and violence that are common in high HIV-prevalence areas. However, CBO attendance was not able to remove the increased psychosocial distress associated with some family-level vulnerabilities such as orphanhood and abuse. These findings highlight the centrality of CBO-provided psychosocial support for children in Southern Africa, and suggest areas for bolstering provision.

  • Parenting, mental health and economic pathways to prevention of violence against children in South Africa.

    October 2020
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    Journal article
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    Social science & medicine (1982)
    BACKGROUND:Parenting programs based on social learning theory have increasing empirical evidence for reducing violence against children. Trials are primarily from high-income countries and with young children. Globally, we know little about how parenting programs work to reduce violence, with no known studies in low or middle-income countries (LMICs). This study examines mechanisms of change of a non-commercialized parenting program, Parenting for Lifelong Health for Teens, designed with the World Health Organization and UNICEF. A cluster randomized trial showed main effects on parenting and other secondary outcomes. We conducted secondary analysis of trial data to investigate five potential mediators of reduced violence against children: improved parenting, adolescent behaviour, caregiver mental health, alcohol/drug avoidance, and family economic strengthening. METHODS:The trial was implemented in rural South Africa with 40 sites, n = 552 family dyads (including adolescents aged 10-18 and primary caregivers). Intervention sites (n = 20) received the 14-session parenting program delivered by local community members, including modules on family budgeting and savings. Control sites (n = 20) received a brief informational workshop. Emotional and physical violence against children/adolescents and each potential mediator were reported by adolescents and caregivers at baseline and 9-13 months post-randomisation. Structural equation modelling was used to test simultaneous hypothesized pathways to violence reduction. RESULTS:Improvements in four pathways mediated reduced violence against children: 1) improved parenting practices, 2) improved caregiver mental health (reduced depression), 3) increased caregiver alcohol/drug avoidance and 4) improved family economic welfare. Improved child behaviour was not a mediator, although it was associated with less violence. CONCLUSIONS:Simultaneously bolstering a set of family processes can reduce violence. Supporting self-care and positive coping for caregivers may be essential in challenging contexts. In countries with minimal or no economic safety nets, linking social learning parenting programs with economic strengthening skills may bring us closer to ending violence against children.

  • The parenting 'vaccine'.

    October 2020
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    Journal article
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    Nat Hum Behav
    Adult, Child, Child Abuse, Education, Nonprofessional, Humans, Parenting

  • Reproductive aspirations, contraception use and dual protection among adolescent girls and young women: the effect of motherhood and HIV status.

    September 2020
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    Journal article
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    J Int AIDS Soc
    INTRODUCTION: There is a growing interest in adolescent motherhood and HIV among policymakers and programme implementers. To better shape services and health outcomes, we need evidence on reproductive aspirations and contraception use in this high-risk group, including the effect of motherhood and HIV status. We report data from a large survey of adolescent girls and young women conducted in a mixed rural-urban district in South Africa. METHODS: Quantitative interviews were conducted with 1712 adolescent girls and young women (ages 10 to 24): 336 adolescent mothers living with HIV (AMLHIV), 454 nulliparous adolescent girls living with HIV (ALHIV), 744 HIV-negative adolescent mothers (control adolescent mothers) and 178 HIV-negative nulliparous adolescent girls (nulliparous controls) in 2018 to 2019. Standardized questionnaires included socio-demographic measures, reproductive health and contraception experiences. Reproductive aspirations were measured as the number of children participants wanted to have. Dual protection was computed as use of both hormonal and barrier contraception or abstinence. Multivariate logistic regression and marginal effects models in STATA 15 were used to test associations between HIV status, adolescent motherhood and outcomes of reproductive aspirations, contraception use and dual protection, controlling for covariates. RESULTS AND DISCUSSION: Nearly 95% of first pregnancies were unintended. Over two-thirds of all participants wanted two or more children. Hormonal contraception, condom use and dual protection were low across all groups. In multivariate regression modelling, ALHIV were less likely to report hormonal contraception use (aOR 0.55 95% CI 0.43 to 0.70 p ≤ 0.001). In marginal effects modelling, adolescent mothers - independent of HIV status - were least likely to report condom use at last sex. Despite higher probabilities of using hormonal contraception, rates of dual protection were low: 17.1% among control adolescent mothers and 12.4% among AMLHIV. Adolescent mothers had the highest probabilities of not using any contraceptive method: 29.0% among control mothers and 23.5% among AMLHIV. CONCLUSIONS: Among adolescent girls and young women in HIV-endemic communities, reproductive aspirations and contraceptive practices affect HIV risk and infection. Tailored adolescent-responsive health services could help young women plan their pregnancies for when they are healthy and well-supported, and help interrupt the cycle of HIV transmission by supporting them to practice dual protection.
    HIV, South Africa, adolescents, contraception, dual protection, motherhood
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CV

Lucie Cluver - CV (December 2020)

Current projects

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

Completed projects
Previous students

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
Supervision

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.

Current students
News