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A collaborative partnership to conduct research and training to improve treatment outcomes for adolescents living with HIV in the Cape Town Metropole, South Africa

UWC FACULTY: Prof Brian van Wyk 
MU FACULTY: Prof Michelle Teti 
DATE OF REPORT: 3 November 2023

Overview of Projects and Visits

Prof Teti and I met in 2017 when she visited UWC School of Public Health (SOPH) and presented her photovoice research with people living with HIV in the USA. At that stage I was conceptualizing a research study to “develop interventions to improve adherence amongst adolescents living with HIV and on treatment in public primary health care facilities in the Cape Town Metropole in the Western Cape province”. I considered photovoice methods as well suited as a participatory approach to research with adolescents, and we agreed that a research collaboration would be fruitful to advance our research agendas in the area of HIV.

I was successful in securing a MRC-Self-initiated Research (MRC-SIR) grant to conduct formative research on Improving adherence, retention in care and treatment outcomes for adolescents on anti-retroviral treatment in the Western Cape Metropole. This project was planned for 2018-2020, but were extended to 2022, due to the interruptions due to the COVID-19 pandemic. A key phase in the project, involved photovoice projects with adolescents on HIV treatment in three public primary health care settings in the Cape Metropole.

First Visit

Prof Teti visited to UWC in July –August 2018 on a UMSAEP grant. During this visit she trained the UWC-SOPH project team in Photovoice methods and ethics. We also conducted site visits and meetings with relevant stakeholders. Based on this information, we revised the Photovoice protocol, to using camera phones for the project rather than normal cameras. We published a paper on the adaption of the photovoice methods used in US to research with adolescents living with HIV in South Africa (1). With the assistance of MU School of Health Professions Catalyst grant, we were able to procure 18 camera phones, and piloted the photovoice study in two facilities to “test” its adaptation in real-life settings.

Second Visit

Between April 1-15, 2019, I received an UMSAEP award to visit Missouri University, Columbia, to receive on-hands mentoring by Prof Teti on how to analyse the photovoice data that we collected in the pilot study. We subsequently joint-authored a publication on this study (2).

Upon my return to South Africa, I was able to pass on the training that I received in analysis of photovoice data to my PhD students (Dr Zaida Orth and Dr Ferdinand Mukumbang). They were able to apply photovoice methods (with high level analyses) in their respective studies and consequently published three papers (3,4,5).

Break in Collaboration During the COVID-19 Pandemic

Prof Teti successfully applied for a Fulbright fellowship to spend 6-8 months in Cape Town, South Africa in 2020 to work on a joint photovoice project and to conduct photovoice training workshop with faculty in the UWC-SOPH. However, due to the outbreak of COVID-19 pandemic, she was not able to undertake the fellowship in 2020 or 2021, and forfeited the award.

In this break period, we tried to maintain collaborative activities, most notably in undertaking a systematic review on the “use of photovoice in health research with adolescents in Africa.” We have completed the review, and are in the final stages of preparing the manuscript for submission for review in a peer-reviewed journal.

In this period, I successfully applied for a MRC-SIR grant to investigate the “Impact of COVID- 19 pandemic on treatment outcomes for adolescents on HIV treatment in the Western Cape, South Africa”, that will also use photovoice methods in one of the phases, and with Prof Teti as co-investigator.

Based on the work on the successful completion of the initial MRC-SIR project, I was successful in a follow-up grant on Development of a supportive transition protocol for adolescents on HIV treatment, which was funded by the National Research Foundation.

I recruited two Psychology research interns/pre-doc fellows to the above two projects. Both received training in Photovoice methods via distance learning by Prof Teti over November – December 2022. They both went on to register as PhD students in 2023, using the two designated projects as the basis for their PhD projects.

Third Visit

I undertook a short visit to UM-Columbia between September 29 - October 8, 2022. The purpose of this visit was to re-ignite the collaboration between Prof Teti and myself. One of the aims of the visit was to consider the possibility of a comparative analysis between the COVID-19 projects that were conducted with students at MU and adolescents living with HIV in the Cape Town Metropole, South Africa. However, the divergence between the projects in terms of aims and target population means that this was not feasible.

The second aim of the visit was to plan for a photovoice training workshop with UWC staff in Cape Town, South Africa. The planned date was for the Winter School 2023 period in South Africa. The training (reported below) was successfully delivered by and with Prof. Teti’s UMSAEP visit in July 2023.

It was also further discussed to host joint courses in Health Promotion with UWC-SOPH postgraduate students and MU students in Public Health during the Winter School period/Summer break in USA. However, these discussions could not be actualized because UWC-SOPH ceased to host Winter School programme in 2023.

Following on with the photovoice project, I did a photovoice exhibition, entitled “Portraits of risk and resilience of adolescents on HIV treatment” at the Health Systems Research conference 2022 in Bogota, Colombia and poster presentation at Fast Track Cities conference 2023 in Amsterdam, Netherlands.

Fourth Visit

Prof Teti received the UMSAEP travel award to visit UWC-SOPH between July 2 – 14, 2023. The main purpose of the visit was to conduct a photovoice training workshop with UWC-SOPH staff and students. The training was attended by 12 participants, and took place over 3 days. The feedback on the course was overwhelmingly positive as participants learned about photovoice methods as a participatory approach as well as given the opportunity to conduct their own photovoice project. In addition, the participants received a text-book on photovoice methods as well as additional sources for reading, to further their understanding on this methodology.

Appreciation

I want to express my appreciation for the UMSAEP awards, and in particularly Prof Rod Uphoff and Prof Jose Frantz, who were instrumental in supporting our reciprocal visits that dated back to 2018. The collaboration was extremely fruitful, resulting in five peer-reviewed publications, two international conference presentations as well as supporting two PhD students towards completion of their degrees. In addition, the training in photovoice methods left a deposit in UWC-SOPH, with many colleagues and students becoming conversant in this methodology.

Over the five years, Michelle and I, were not only colleagues but also friends. It was a truly cultural enriching experience for me to interact with my colleagues in Missouri.

Yours sincerely

Prof Brian van Wyk

References

1. Teti M & Van Wyk B (2020). Qualitative methods without borders: Adapting Photovoice from a U.S. to South African setting.

2. Van Wyk B & Teti M. (2020). Portraits of HIV: A pilot photovoice study of adolescent experiences of HIV treatment in South Africa. Journal of Global Health

   Reports,

3. Orth Z & van Wyk B (2021). A facility-based family support intervention to improve treatment outcomes for adolescents on antiretroviral therapy in the Cape Metropole, South Africa. Journal of the International Association of Providers of AIDS

   Care,

4. Orth Z & van Wyk B (2022). Discourses of Mental Wellness among Adolescents living with HIV in Cape Town, South Africa. Psychology Research and Behavior Management,
5. Mukumbang FC & van Wyk B (2020). Leveraging the photovoice methodology for critical realist theorizing. International Journal of Qualitative Methods, 19, 1-