The impact of the National HIV Health Care Worker Hotline on patient care in South Africa

<p>Abstract</p> <p>Background</p> <p>South Africa has a huge burden of illness due to HIV infection. Many health care workers managing HIV infected patients, particularly those in rural areas and primary care health facilities, have minimal access to information resources and to advice and support from experienced clinicians. The Medicines Information Centre, based in the Division of Clinical Pharmacology at the University of Cape Town, has been running the National HIV Health Care Worker (HCW) Hotline since 2008, providing free information for HIV treatment-related queries via telephone, fax and e-mail.</p> <p>Results</p> <p>A questionnaire-based study showed that 224 (44%) of the 511 calls that were received by the hotline during the 2-month study period were patient-specific. Ninety-four completed questionnaires were included in the analysis. Of these, 72 (77%) were from doctors, 13 (14%) from pharmacists and 9 (10%) from nurses. 96% of the callers surveyed took an action based on the advice received from the National HIV HCW Hotline. The majority of actions concerned the start, dose adaption, change, or discontinuation of medicines. Less frequent actions taken were adherence and lifestyle counselling, further investigations, referring or admission of patients.</p> <p>Conclusions</p> <p>The information provided by the National HIV HCW Hotline on patient-specific requests has a direct impact on the management of patients.</p

Conceptualizing Community Oriented Primary Care (COPC) - the Tshwane, South Africa, health post model

Health sector reforms initiated in South Africa in 1994 adopted a primary health care approach to strengthen the health system and achieve public health outcomes through disease prevention and health promotion.1 This led to the building of many new clinics to make health services more accessible, affordable and equitable. However, the pressures of a predominantly hospitalcentric health care system and emerging epidemics prevented the successful provision of quality comprehensive, integrated primary care to millions of South Africans. Also, little attention was given to community partnerships and multi-sectoral collaboration.The authors thank the Foundation for Professional Development for the financial support.http://www.phcfm.orgam201

Factors associated with patients’ understanding of their management plan in Tshwane clinics

BACKGROUND: This research focused on patients’ views regarding healthcare services and identified factors associated with understanding of their management plan. AIM: To develop a baseline for patient–clinician collaboration and the extent to which patients felt included and understood their treatment plan. SETTING: Tshwane district (South Africa) public health outpatient clinics. METHOD: Medical students interviewed 447 patients in 22 clinics in Tshwane district. Agreement was measured by the percentage of cases in which patients and clinicians were in accord about a particular aspect of the consultation. RESULTS: About one-third of patients incorrectly answered questions on whether changes in lifestyle or diet were prescribed as part of their treatment. The likelihood that patients understood their plan was associated with seeing the same clinician three or more times; having a consultation in their same or a similar language; patient participation in the diagnosis; and feeling that the clinician had explained their health problems to them. CONCLUSIONS: There is need for greater emphasis on continuity of care, the clinicians’ ability to speak the patient’s language and involving patients in the consultation.PRESENTATION: Cette étude se concentrait sur les points de vue des patients concernant les services de santé et les facteurs identifiés associés à la compréhension de leur plan de prise en charge. OBJECTIF: Développer une référence pour la collaboration entre patients et médecins et déterminer la mesure dans laquelle les patients avaient le sentiment d’être inclus à la préparation de leur plan de prise en charge et de le comprendre. CADRE: Centres médicaux publics accueillant des patients en consultation externe dans le district de Tshwane (Afrique du Sud). METHODE: Des étudiants en médecine ont interrogé 447 patients dans 22 centres médicaux dans le district de Tshwane. La concordance était mesurée par le pourcentage de cas dans lesquels les patients et les médecins étaient d’accord sur un aspect particulier de la consultation. RESULTATS: Environ un tiers des patients n’a pas su répondre correctement aux questions visant à déterminer si des changements dans leur style de vie ou régime alimentaire avaient été prescrits dans le cadre de leur traitement. La probabilité que les patients comprennent leur plan était associée au fait de consulter le même médecin à trois reprises ou plus, de consulter dans leur langue ou dans une langue similaire, de participer au diagnostic, et au sentiment que le médecin leur avait expliqué le problème de santé dont ils souffraient. CONCLUSIONS: Il est nécessaire de mettre davantage l’accent sur la continuité de la prise en charge, la capacité des médecins à parler la langue de leurs patients, et l’implication des patients dans la consultation.The authors are indebted to the 2012 class of fifth-year students who took part in this research. We thank them for their commitment to the project as well as their insightful feedback.J.H. (University of Pretoria) was the project leader. J.H., A.R. and T.R. (University of Pretoria) conceptualised and designed the study. L.F., T.R., N.S. (University of Pretoria) and H.K. and S.M. (University of Pretoria and Foundation for Professional Development) were responsible for experimental and questionnaire design. T.M. (University of Pretoria) made significant conceptual contributions to the article. L.F., T.M. and T.R. conducted the analysis and interpretation of the findings and prepared the manuscript. N.S. contributed to data collection and preparation.http://www.phcfm.orgam201

Improving management of tuberculosis in people living with HIV in South Africa through integration of HIV and tuberculosis services: a proof of concept study

Abstract Background South Africa’s tuberculosis burden is the third highest globally and is closely associated with the country’s devastating HIV epidemic. The separation of HIV and TB services in primary healthcare services in South Africa hampers TB case finding in patients who are co-infected with HIV and TB. This operational proof of concept study assessed an approach to improving tuberculosis detection and treatment by integrating tuberculosis management into HIV care. Methods The intervention involved workforce re-engineering accompanied by changes to the physical environment in three primary healthcare facilities in Gert Sibande district, Mpumalanga Province, that allowed HIV providers to test their HIV patients for TB and initiate and monitor TB treatment when indicated. To assess the proof of concept we compared the management of TB patients by HIV and TB providers, by reviewing the records of all facility patients who tested positive for tuberculosis between July 2015 and February 2016. We also considered the perceptions of healthcare providers and facility managers about the intervention through structured interviews. Results Approximately 30% of the 1855 patients with presumed TB in the three clinics had been identified by HIV providers. The percentage of patients consecutively tested for TB was 81.0% and 85.0% (p = 0.0551) for HIV and TB providers, respectively. Of the patients identified with TB by HIV and TB providers, 75.4% and 79.2% (p = 0.2876), respectively, were initiated on treatment. The defaulter rate was higher among HIV, compared to TB, providers (12.8% versus 4.2%). Overall, healthcare providers and facility managers had positive views of the intervention but raised concerns regarding potential increase in workload and administrative issues, as well as infection control. Conclusions The results of this proof-of-concept study indicate that the full spectrum of TB services can be easily and effectively integrated into existing HIV care programs. However, a possible shift in the service providers’ workload, including administrative tasks, must be tackled and effective infection control must be ensured. Further research is needed to assess the impact of TB service integration into the scope of HIV care (or other chronic care programs) on patient outcomes, including analysis of routine data

Communauté des soins axés primaire dans le district de Tshwane, Afrique du Sud : évaluation de la première phase de mise en oeuvre

Re-engineering primary health care is a cornerstone of the health sector reform initiated nationally in South Africa in 2009. Using the concept of ward based NGO-run health posts, Tshwane District, Gauteng, began implementing community oriented primary care (COPC) through ward based outreach teams (WBOT) in seven wards during 2011. OBJECTIVES: This study sought to gain insight into how primary health care providers understood and perceived the first phase of implementing COPC in the Tshwane district. METHOD: Qualitative research was performed through focus group interviews with staff of the seven health posts during September 2011 and October 2011. It explored primary health care providers’ understanding, perception and experience of COPC. RESULTS: Participants raised organisational, workplace and community relationship issues in the discussions. Organisationally, these related to the process of initiating and setting up COPC and the relationship between governmental and nongovernmental organisations. Issues that arose around the workplace related to the job situation and employment status and remuneration of health post staff. Community related issues centred on the role and relationship between service providers and their communities. CONCLUSION: COPC touched a responsive nerve in the health care system, both nationally and locally. It was seen as an effective way to respond to South Africa’s crisis of health care. Initiating the reform was inevitably a complex process. In this initial phase of implementing COPC the political commitment of governmental and nongovernmental organisations was evident. What still had to be worked through was how the collaboration would materialise in practice on the ground.La restructuration des soins de santé primaire a constitué une étape clé de la réforme du secteur de la santé initiée en Afrique du Sud au niveau national en 2009. Utilisant le concept de postes de santé gérés par des ONG et basés dans les quartiers, le district de Tshwane, dans la province du Gauteng, a commence à mettre en oeuvre des soins de santé primaire communautaires (COPC, Community oriented primary care) dans sept quartiers au cours de l’année 2011. OBJECTIFS: L’objectif de cette étude était d’obtenir des informations sur la manière dont les fournisseurs de soins de santé primaire comprenaient et percevaient la première phase de mise en oeuvre des COPC dans le district de Tshwane. METHODE: Une étude qualitative a été réalisée par le biais de groupes de discussion avec le personnel de sept postes de santé au cours des mois de septembre et d’octobre 2011. Celle-ci a permis d’étudier la compréhension, la perception et l’expérience qu’avaient les fournisseurs de soins de santé des COPC. RESULTATS: Au cours des discussions, les participants ont soulevé des questions d’ordre organisationnel, relatives au lieu de travail et aux relations communautaires. Sur le plan organisationnel, ces questions se rapportaient au processus d’initiation et de mise en place des COPC et à la relation entre les organisations gouvernementales et non gouvernementales. Les questions associées au lieu de travail se rapportaient à la situation professionnelle et au statut professionnel et à la rémunération du personnel des postes de santé. Les questions associées à la communauté étaient centrées sur le rôle et la relation entre les prestataires de services et leurs communautés. CONCLUSION: Les COPC on permis de toucher un point sensible du système de santé, tant au niveau national que local. Ils étaient perçus comme un moyen efficace de répondre à la crise des services de santé à laquelle l’Afrique du Sud était confrontée. Au cours de cette première phase de mise en oeuvre des COPC, l’engagement politique des organisations gouvernementales et non gouvernementales est apparu de manière évidente.http://www.phcfm.orgam201