Abstract Background According to the national strategic plan, South Africa aims to eliminate malaria by 2030. Only three out of 9 provinces are malaria endemic. These are Mpumalanga, Limpopo and the north–eastern parts of KwaZulu-Natal provinces. It is important to investigate community and healthcare worker perceptions regarding malaria prevention, control and elimination interventions to enable development of a Social Behavioural Change Communication (SBCC) strategy for Jozini local municipality to complement the National Strategic Plan 2025–2030. Methods A cross-sectional mixed-method study was conducted in six communities and their respective healthcare facilities in Jozini local municipality, KwaZulu-Natal, during 2025. A structured questionnaire was administered to 384 community participants using a systematic household sampling. In addition, semi-structured interviews were conducted with 15 healthcare workers selected purposively. Quantitative data were analysed using descriptive statistics, Chi-square (χ2) tests (p < 0.05) and Fisher’s exact test (p < 0.05) where expected cell counts were less than 5, while qualitative responses were analysed thematically. Results Three hundred and eighty-four community members and 15 healthcare workers were interviewed. Community respondents (median age 36 years; 72% female) showed high malaria awareness (96%), with 92% correctly identifying mosquito bites as the main transmission route. Overall, 97% had high knowledge, 79% positive attitudes, and 64% good practices. Knowledge was significantly associated with age (χ2 = 9.61, p = 0.01) but not with gender, education, employment status, or residence duration, and knowledge level was not significantly associated with attitudes or practices (p > 0.05). Healthcare workers showed strong technical knowledge of malaria transmission and prevention, and most reported involvement in diagnosis, treatment, and community outreach activities. However, qualitative findings highlight challenges related to irregular training, staffing gaps, and shortages of diagnostic tools and commodities. Conclusions The study found that although awareness of malaria is generally high in Jozini local municipality, misconceptions and inconsistent prevention practices remain. Community health workers are key information sources, but barriers such as poverty, cultural beliefs, and limited resources affect prevention efforts. Healthcare providers are knowledgeable but face operational challenges. These findings underscore the need for targeted SBCC interventions to support malaria control under South Africa’s NSP 2025–2030.

Background: Learner substance abuse is a global public health concern contributing to preventable injuries, poor academic performance, and increased dropout rates. Addressing it in schools is crucial for improving both educational and health outcomes. Aim: This study explores high school educators’ perceptions and experiences of learner substance abuse. Setting: The study was conducted in six high schools in Galeshewe Township, Northern Cape province. Methods: A qualitative, exploratory and descriptive approach was employed. Sixteen Life Orientation (LO) educators were purposively sampled for in-depth interviews. Data were collected using a semi-structured guide until saturation. Trustworthiness was ensured through credibility, dependability, transferability, and confirmability. Thematic analysis followed Braun and Clarke’s six-step process, with transcription via Microsoft Word and Excel. Results: Four themes emerged: factors driving learner substance abuse, educational disruptions, educator training and support, and intervention strategies. Educators reported substance abuse as common both in school and off-premises especially among older boys. They also observed an increasing trend among younger learners and girls. It was linked to disruptive behaviour affecting teaching and learning. Educators felt unprepared to manage these issues and criticised the LO curriculum’s limitations. Conclusion: Educators emphasised the need for specialised training programmes to equip them with skills to manage learners involved in substance abuse. They also called for greater support from leadership in the Department of Education. Contribution: The study’s findings highlight the challenges of learner substance abuse in the Northern Cape and provide context-specific interventions that can be used to inform policy that addresses substance abuse in schools.

Background: Despite South Africa’s progress in expanding access to antiretroviral therapy (ART), retaining people living with HIV (hereafter referred to as patients) in care remains a major challenge. Retention is essential for achieving viral suppression and preventing onward HIV transmission. Objectives: This study aimed to explore the perceptions and experiences of patients and healthcare providers regarding factors influencing retention in care during the first 12 months of ART. Method: A qualitative exploratory design was used at Kanyamazane Community Health Centre (CHC), a primary healthcare facility in Mpumalanga province, South Africa. Semi-structured interviews were conducted with 12 patients and four healthcare providers, purposively sampled to include those consistently retained and those re-engaged after loss to follow-up. Data were transcribed verbatim and analysed thematically using Braun and Clarke’s framework with ATLAS.ti. Trustworthiness was ensured through member-checking and triangulation. Results: Six key themes were identified: (1) social and clinical support, (2) health education and empowerment, (3) motivation, (4) geographical and financial constraints, (5) stigma and disclosure challenges and (6) health system-related barriers. Facilitators of retention included family support, peer groups and differentiated service delivery models. Barriers included long waiting times, staff shortages and inadequate follow-up systems. Participants recommended structured appointment systems and personalised case management. Conclusion: Retention in HIV care is influenced by an interplay of individual, social and health system factors. Holistic, person-centred interventions are needed to promote early and sustained engagement in care. Contribution: This study demonstrates that early retention in HIV care is strengthened by family involvement, peer support, continuous counselling and home-based care, while barriers such as stigma, long clinic waiting times and poor tracing systems persist. It provides actionable strategies including structured booking systems and tailored case management to improve retention.

South Africa continues to face one of the world’s highest HIV burdens, with 7.7 million people living with HIV (PLWHIV) in 2023. Despite progress toward UNAIDS 95–95–95 targets, challenges in long-term retention and treatment outcomes persist. This study aimed to evaluate 10-year antiretroviral therapy (ART) outcomes among PLWHIV initiated on treatment in 2013 within Tshwane District, South Africa. Retrospective cohort using Tier.Net data from 1,337 adults across 10 randomly selected facilities (clinics and community health centres [CHCs]). Outcomes were retention, loss to follow‑up (LTFU), mortality, viral suppression, and CD4 recovery. We used Kaplan–Meier methods and multivariable models (Cox for LTFU and mortality, logistic for viral suppression, linear for CD4 change). Mortality analyses were limited to participants with complete ascertainment (n = 640). At 10 years, 47.7

Sub-Saharan African countries possess rich mineral resources that offer socio-economic development opportunities for mining communities. However, the prioritization of health and wellbeing impacts during the mining life cycle remains unclear. This review examines the focus on health and wellbeing in mining communities within the sub-Saharan African context. An online literature search was conducted across four databases (Scopus, PubMed, ProQuest, Web of Science) using the PICOS framework for eligibility criteria. The Rayyan tool was used for screening and data extraction. 45 studies were included (20 qualitative, 25 quantitative, including mixed methods). Most studies were from South Africa. Health impacts identified included: (a) HIV/AIDS, (b) Tuberculosis (TB), (c) Hypertension, and (d) Health Impact Assessment (HIA). The study also explored the mining life cycle stages—Exploration, Development, Production, and Closure—focusing on health and wellbeing prioritization. While mining offers socio-economic benefits, health and wellbeing impacts are not prioritized, especially in the exploration stage. Tools like HIAs provide valuable insights, but mining communities continue to face health challenges, both positive and negative. : CRD42023474494.

This study aims to evaluate the representation of entrepreneurship in business studies syllabus in South African Schools. A qualitative research methodology was used to evaluate the entrepreneurship in South African secondary schools. Furthermore, little representation of entrepreneurship in the syllabus and business studies have direct link with entrepreneurship. Currently, the Grade 10-12 curriculum for Business Studies focus on the development of knowledge, skills and values. This study calls for Self- Directed Learning in Business Studies Grades 10 -12 to promote entrepreneurship in South African Schools. A purposive sample of ten Grade 12 teachers were selected from five secondary schools, to cater for all quintile 1 to 5 in Edendale circuit. A case study research design was employed. Data collection was prepared using face-to-face, semi-structured interviews. Generate data was analysed through thematic analysis. The study adopted the Achievement Goal Theory. The findings indicated that challenges facing students is the lack of practical demonstration because business studies is a practical topics. Moreover, the findings revealed obstacles in successful teaching and learning of business studies in secondary schools, due to lack of competent teachers, insufficient instructional resources and bad teaching methods. The study recommends for the implementation of self-direct learning program on entrepreneurship were learners for grade 8 to 12 can learn on their pace. In addition, incorporating entrepreneurship courses into the curriculum, fostering an entrepreneurial mind-set, and providing mentorship can equip learners with the skills and knowledge necessary to start their own businesses. Furthermore, collaboration with local entrepreneurial ecosystems, and funding organizations is important.

The training model for Clinical Associates (Clin-As), initially centered on district hospitals, has increasingly involved primary healthcare (PHC) facilities over the past few years. This study explore and compare the perceptions and experiences of Clin-A students regarding learning opportunities and involvement during hospital and clinic rotations. This cross-sectional mixed-methods study involved two primary data collection techniques: the administration of the validated medical education instructional questionnaire (MedIQ) questionnaire and the facilitation of focus group discussions. A total of 74 Clin-A students participated in the quantitative study, including 20 s-year students from 2022, 35 s-year students from 2023, and 19 third-year students from 2023. The only statistically significant difference was noted in follow-up care, where student involvement was significantly higher in clinics (M = 3.39) compared to hospitals (M = 2.96), with a t-value of 2.933 (p = 0.002). For learning opportunities, the highest mean difference was observed in ‘participation in patient education’, where clinics (M = 4.38) had a higher mean than hospitals (M = 3.96), but without statistically significance (t = 1.715, p = 0.089). Students perceived better learning diversity and proficiency development in clinics (M: 3.91, SD: 1.31; M: 4.18, SD: 1.203) compared to hospitals (M: 4.00, SD: 1.489; M: 3.97, SD: 1.385). Clinics generally outscored hospitals, especially in involvement in patient education, chronic illness, and procedures. Ten students attended two focus group discussion: one with 2023 third-years (n = 5) and one with 2023 s-years (n = 5). Students valued clinics for skill development and patient journey exposure but faced challenges such as feeling like employees, disrupted learning from frequent rotations, patient overcrowding, and poor communication between the program and healthcare staff. This study underscores the importance of primary healthcare settings in Clin-A training, demonstrating that clinics provide learning opportunities and involvement in patient care comparable to hospitals. To address challenges such as high workload areas where students feel like employees, insufficient teaching, lack of staff awareness, limited learning in low-volume clinics, and disrupted rotations requires, structured rotations, enhanced preceptor training, and improved communication between programs and clinical sites are essential.

INTRODUCTION:Artificial intelligence (AI) and, in particular, machine learning (ML) have emerged as transformative tools in HIV care, driving advancements in diagnostics, treatment monitoring and patient management. The present review aimed to systematically identify, map and synthesize studies on the use of AI methods across the HIV care continuum, including applications in HIV testing and linkage to care, treatment monitoring, retention in care, and management of clinical and immunological outcomes. METHODS:A comprehensive literature search was conducted across databases, including PubMed and ProQuest Central, Scopus and Web of Science, covering studies published between 2014 and 2024. The review followed PRISMA guidelines, screening 3185 records, of which 47 studies were included in the final analysis. RESULTS:Forty-seven studies were grouped into four thematic areas: (1) HIV testing, AI models improved diagnostic accuracy, with ML achieving up to 100% sensitivity and 98.8% specificity in self-testing and outperforming human interpretation of rapid tests; (2) Retention in care and virological response, ML predicted clinic attendance, viral suppression and virological failure (72-97% accuracy; area under the curve up to 0.76), enabling early identification of high-risk patients; (3) Clinical and immunological outcomes, AI predicted disease progression, immune recovery, comorbidities and HIV complications, achieving up to 97% CD4 status accuracy and outperforming clinicians in tuberculosis diagnosis; (4) Testing and treatment support, AI chatbots improved self-testing uptake, linkage to care and adherence support. Methods included random forests, neural networks, support vector machines, deep learning and many others. DISCUSSION:AI has the potential to transform HIV care by improving early diagnosis, treatment adherence and retention in care. However, challenges such as data quality, infrastructure limitations and ethical considerations must be addressed to ensure successful implementation. CONCLUSIONS:AI has demonstrated immense potential to address gaps in HIV care, improving diagnostic accuracy, enhancing retention strategies and supporting effective treatment monitoring. These advancements contribute towards achieving the UNAIDS 95-95-95 targets. However, challenges such as data quality and integration into healthcare systems remain. Future research should prioritize scalable AI solutions tailored to high-burden, resource-limited settings to maximize their impact on global HIV care. PROSPERO NUMBER:PROSPERO 2024 CRD42024517798 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024517798.

Background: Community health workers (CHWs) play an important role in health promotion through health campaigns and home visits, and provide linkage to care and support patient management. In the informal settlements, CHWs identify health challenges and help residents to access healthcare facilities. Aim: This study aimed to explore the perception held by the community members regarding CHWs’ contribution to health promotion in Melusi informal settlements within the Tshwane district. Setting: The study was conducted in Melusi informal settlement situated in Pretoria west in South Africa. Methods: Descriptive exploratory qualitative research methods were used, with open and closed-ended questions during individual interview sessions. Participants were purposefully selected in collaborating with the community leaders and using CHWs’ data to identify individuals with direct interaction with CHWs. Results: Participants praised CHWs’ communication skills, engagement strategies, and ability to provide valuable health services. Community members expected CHWs to provide healthcare services, educational support, advocacy for health issues and guidance on well-being. Barriers such as community resistance, a lack of privacy and difficulties in reaching households were noticed. However, CHWs were commended for their impact on well-being, offering health services, emergency support, food assistance and improved healthcare accessibility. Conclusion: The study indicates that community members have positive perceptions of CHWs. This highlights the significant role of CHWs in promoting health and well-being within the community. Contribution: This study provides insights into community perceptions of CHWs in informal settlements, emphasising their impact on community well-being. It provides a basis for their effectiveness and support in delivering health services in the informal settlement.

Background: South Africa’s health care system grapples with persistent challenges, including health care provider shortages and disparities in distribution. In response, the government introduced clinical associates (Clin-As) as a novel category of health care providers. Aim: This study mapped Clin-As’ history and practice in South Africa, assessing their roles in the health workforce and offering recommendations. Methods: Following the framework outlined by Arksey and O’Malley, we conducted a comprehensive literature search from January 2001 to November 2021, utilising PubMed, Scopus and EBSCOhost databases. One thousand six hundred and seventy-two articles were identified and then refined to 36 through title, abstract and full-text screening. Results: Strengths of the Clin-A cadre included addressing rural workforce shortages and offering cost-effective health care in rural areas. Challenges to the success of the cadre included stakeholder resistance, rapid implementation, scope of practice ambiguity, inadequate supervision, unclear roles, limited Department of Health (NDoH) support, funding deficits, Clin-As’ perceived underpayment and overwork, degree recognition issues, inadequate medical student training on Clin-A roles, vague career paths and uneven provincial participation. Conclusion: As a health care provider cadre, Clin-As have been welcomed by multiple stakeholders and could potentially be a valuable resource for South Africa’s health care system, but they face substantial challenges. Realising their full potential necessitates enhanced engagement, improved implementation strategies and precise scope definition. Contribution: This study acknowledges Clin-As in SA as a promising solution to health care workforce shortages but highlights challenges such as stakeholder resistance, insufficient NDoH support and unclear policies, emphasising the need for comprehensive efforts to maximise their potential.

Background. Many studies have shown that South African women tend to initiate antenatal care late in their pregnancies. This presents challenges in the provision of quality healthcare to both mother and child. There are several studies on the social and cultural reasons for late booking. However, understanding the factors in a woman’s choice to initiate antenatal care is important in informing healthcare strategies and policies. Methods. This study was an analytical cross-sectional study of household and general health factors associated with attendance of antenatal care by pregnant women in Tshwane in 2015. It was a secondary data analysis from complete data sampling households registered on AitaHealthTM. Univariate and multivariate logistic regression was used to assess which factors are associated with antenatal care attendance. Results. The age of the head of the household was a significant factor in the attendance of antenatal care. The odds of attending antenatal care were 3.3, 2.1 and 1.8 times higher in households where the head of the household was 30 - 39 years of age, 20 - 29 or 40-49 years of age, respectively, than when between 10-19 years of age. Factors that increased the odds of attending antenatal care were living in households that had electricity and piped water, and running a business from home. Residing in a permanent dwelling and being food secure increased the odds of antenatal care attendance. Conclusion. The identified health and household factors should inform policies and programmes geared towards improving services around antenatal care provision.

Background: Since 2019, the World Health Organization has recommended dolutegravir-containing regimens for HIV in low- and middle-income countries because of its high genetic barriers to resistance, lower drug interactions, fewer side effects, higher viral load (VL) suppression rates and cost-effectiveness compared to efavirenz.Objectives: This study investigates factors associated with unsuppressed VLs in people living with HIV on tenofovir-lamivudine and dolutegravir (TLD) in South Africa (SA).Method: A cross-sectional study was conducted between October 2023 and February 2024 at Mamelodi Regional Hospital’s Ntshembo Clinic. Participants were people living with HIV aged 18 years and older, more than 6 months on TLD, with either suppressed (≤ 50 copies/mL) or unsuppressed ( 50 copies/mL) VLs.Results: Significant associations were found between unsuppressed VL and factors such as sex, marital status, occupation and education level. Male participants were less likely to achieve VL suppression than female participants (odds ratio: 0.45, p = 0.0007). Poor antiretroviral therapy adherence was linked to higher unsuppressed VL (p 0.05). Newly initiated patients had significantly lower suppression rates (p 0.05). The use of traditional or herbal and religious products was also linked to unsuppressed VL (p 0.05).Conclusion: The study highlights the importance of addressing adherence factors to improve VL suppression rates among people living with HIV on TLD.Contribution: Tailored interventions targeting adherence, especially among newly initiated patients, and addressing the use of traditional or herbal and religious products are warranted to enhance treatment outcomes.

Background The COVID-19 pandemic caused great social, political and economic disruption, and imposed unprecedented changes in work, lifestyle, service delivery and social interactions in South Africa and worldwide. Healthcare providers, working in often already overstretched healthcare systems, found themselves at the forefront of global and national efforts to contain the havoc of morbidity and mortality wreaked by SARS-CoV2. This chapter describes efforts by the University of Pretoria’s Department of Family Medicine (UPDFM) to deliver on its mandate of teaching, learning, and research in the face of the disruptions of the COVID-19 pandemic during the March-September 2020 nationwide hard lockdown. Methods A perspective review was undertaken, drawing on reports, meeting minutes, email correspondences and electronic personal communications analysed to describe the activities undertaken by the UPDFM during the study period. Results Nationally, some of the adaptive responses triggered by the COVID-19 lockdown drew from the pre-existing UPDFM repertoire of community-oriented, learner- and patient-centred practices of service delivery. Key among these practices were data collection and management using validated tools; virtual communication and meetings; health promotion and disease prevention through training nurses, community health workers and patients on newly developed Covid-19 prevention strategies; clinical intervention, including screening and diagnosis, treatment and care coordination using telemedicine and full service delivery in homeless shelters; patient referral/mobility by staff using sponsored rental cars and using an application to call an ambulance, and treatment continuation through home delivery of medication. Conclusions COVID-19 restrictions presented the UPDFM with a unique opportunity to draw from its experience and create rapid, impactful interventions. Most lessons learnt by the UPDFM during the crisis proved invaluable for use beyond the acute phase of the pandemic, thereby transforming the health system for better pandemic preparedness.

While the impact of Community Health Workers (CHWs) on home-based human immunodeficiency virus (HIV) care has been documented, barriers and recommendations have not been systematically reviewed. Following the reporting requirements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we used an aggregative narrative synthesis approach to summarize the results of qualitative studies published between January 1, 2000, and November 6, 2020 in the following databases: PubMed, CINAHL, PsychINFO, Web of Science, and Google Scholar. In total, 17 studies met the selection criteria and were included in the analysis. They reported on a range of roles played by CHWs in HIV care, including education and health promotion; HIV-specific care (HIV testing services; screening for opportunistic infections and acute illness); medication delivery; tracing persons who had defaulted from care; and support (treatment support; referral; home-based care; and psychosocial support). Many different barriers to community-based HIV care were reported and centered on the following themes: Stigma and nondisclosure; inadequate support (lack of resources, inadequate training, inadequate funding, and inadequate monitoring); and health system challenges (patients' preference for more frequent visits and poor integration of CHWs in the wider health care system). Recommendations to mitigate these barriers included: addressing HIV-related stigma; introducing updated and relevant CHW training; strengthening the supervision of CHWs; coordinating care between the home and facilities; incorporating patient-centered mHealth approaches; and committing to the funding and resources needed for successful community-based care. In summary, CHWs are providing a variety of important community-based HIV services but face challenges with regards to training, resources, and supervision.

Training and development may not be a panacea for all the challenges that organisations face in the 21st century, but it has important implications on employee performance and overall organisational performance. Organisations that want to improve performance and productivity can do so through leveraging their most valuable resource, its people. The significance of this study is to inform curriculum developers about the skills shortage in the footwear industry in South Africa. The core problem this study seeks to address is the skills shortage in the footwear industry in South Africa. Furthermore, currently in KwaZulu-Natal, universities, technical and vocational education do not provide training on footwear. The mixed research method was employed. The purposive sampling was used to select the participants from Dick Whittington Shoes (Pty) Ltd Questionnaires, focus group interviews and document reviews were used to gather data. The findings of the study show that the human resource manager is facing a serious challenge from employees, which is a higher rate of absenteeism this hamper the performance of the organisation. The study found that the majority of employees are above the age of 55 years. In addition, they retire the organisation will re-employ them on the contract bases precisely because they find it hard to find incumbent with skills. The study recommended the need for a proper framework on continuous training and development of employees in the footwear industry in South Africa. Secondly, the public-private partnership with universities to bridge the skills gap and improve the gross domestic product in South Africa if implemented this could bring a resolution to the problems and challenges posed.

Human immunodeficiency virus (HIV) remains the biggest public health challenge faced by South Africa (SA). To alleviate overcrowding in health facilities, ward-based primary health care outreach teams, consisting of community health workers (CHWs) led by a nurse, were introduced. The aim of this study was to assess the acceptability of community-based HIV services offered by CHWs. A survey was conducted in 10 clinics across Tshwane district, Gauteng, SA, between November 2020 and May 10, 2021. CHWs conducted interviewer-administered standardized questionnaires with 674 adult participants. Overall, 95.5% of participants thought that home-based HIV care is a good initiative and rated screening for illnesses and referral to health facilities highly. Although the vast majority (>94%) were willing to disclose their status to health professionals in clinics, women were more willing to do so. Only 53.6% of participants were willing to disclose their HIV status to a CHW from the same neighborhood and 28.8% would find it problematic if CHWs visited them at home with branded cars. Participants had different preferences, mostly determined by region, how long they had been on antiretroviral treatment, whether they had been informed about CHWs, age, and gender. More work is needed to understand and accommodate regional differences and individual preferences.

. This research investigates teachers overworking and associated stress. Teachers must deal with mixed, profound types of interactions and respond to requests by colleagues, managers, parents, and community members. The work of teachers is very complex, especially in the classroom, because it requires to be constantly alert to everything that happens in there both in terms of student behavior, their emotions and their accumulation of knowledge. Teachers spend a good part of their time at work, being involved in relationships both with the beneficiaries of the services provided (students) and with other teachers, principals, inspectors etc.. All these relationships require a great deal of emotional effort, intellectually, mentally and even physically. At the same time, the teaching activities (teaching, guidance, evaluation) also require a lot of effort. It takes several hours of study to prepare for the lesson, and over time it is time-consuming, with teachers often giving up personal activities in order to perform their duty. Teachers overworking occurs when they cannot achieve a balance between the many demands they have to face: professional, social, family and they feel that they cannot give enough time to any of them. They report experiencing very high stress related to overworking. Action can be taken once the effects of teachers overworking are understood.

Background: Only 66% of South African people living with HIV (PLWH) are virologically suppressed. Therefore, it is important to develop strategies to improve outcomes. Objectives: Assess the effect of interventions on 12-month retention in care and virological suppression in participants newly initiated on antiretroviral therapy. Method: Fifty-seven clinics were randomised into four arms: Ward-based primary health care outreach teams (WBPHCOTs); Game; WBPHCOT–Game in combination; and Control (standard of care). Sixteen clinics were excluded and four re-allocated because lay counsellors and operational team leaders failed to attend the required training. Seventeen clinics were excluded due to non-enrolment. Results: A total of 558 participants from Tshwane district were enrolled. After excluding ineligible participants, 467 participants were included in the analysis: WBPHCOTs (n = 72); Games (n = 126); WBPHCOT–Games (n = 85); and Control (n = 184). Retention in care at 12 months was evaluable in 340 participants (86.2%) were retained in care and 13.8% were lost to follow-up. The intervention groups had higher retention in care than the Control group, but this only reached statistical significance in the Games group (96.8% vs 77.8%; relative risk [RR] 1.25; 95% confidence interval [CI]: 1.13–1.38; P = 0.01). The 12 month virologic suppression rate was 75.3% and was similar across the four arms. Conclusion: This study demonstrated that an adherence game intervention could help keep PLWH in care. What this study adds: Evidence that interventions, especially Games, could improve retention in care.

Due to the level of unemployment rate in South African among the young, the paper seeks to assess the adoption of entrepreneurship education as a strategic approach to curb youth unemployment within a District Municipality public high schools in KwaZulu-Natal South Afrrica. The target population was 489 principals from high schools within the within the District Municipality. A mixed methods approach was used and a questionnaire was constructed and administered to participants via online platform. Also, an online one on one interviews were conducted with principals. All data was analysed using SPSS version 25 that generate data into table and bar graphs. The paper revealed that they are many challenges with the adoption of entrepreneurship and these challenges include financial challenge, lack of entrepreneurship education in public schools and lack of support. Small Enterprise Finance Agency (SEFA), National Youth Development Agency (NYDA), Department of Trade and Industry (DTI), Small Enterprise Development Agency (SEDA) and National Empowerment Fund (NEF) should run more awareness campaigns on media platforms used by students and the youth to promote entrepreneurship.