The impact of an HIV/AIDS workplace wellness programme in a large packaging factory

ABSTRACT Introduction: As the impact of HIV/AIDS on the business sector has become more visible, businesses have increasingly seen the advantages of creating HIV/AIDS management programmes for their workplaces – and some even beyond the workplace, to their surrounding communities. The aim of the study was to determine the effect and benefit of a large company’s HIV/AIDS workplace wellness programme. Study objectives were to a) describe the effect of the wellness programme as measured by differences in CD4 counts and percentages, weight, episodes of diarrhoea and sick leave; and b) to explore the perceptions and views of the occupational health nursing practitioners (OHNPs) regarding what they observe the benefit of the wellness programme to be on the general sense of health and well-being of the HIV-positive employees. Materials and methods: The study was performed at 10 of the Gauteng factories of a large multi-national packaging company. Quantitative data was collected by means of a confidential retrospective review of 36 HIV-positive employees’ occupational health records. Mostly descriptive and some inferential data analysis was performed. Qualitative measurement was done through semi-structured interviews with nine OHNPs to gain information about their perceptions and opinions regarding the benefit of the wellness programme. Thematic analysis of qualitative data was carried out. Results: The benefit of the HIV workplace wellness programme was not seen when considering CD4 counts and CD4 percentages. Episodes of diarrhoea over time and absenteeism data also did not show any benefit. However, changes in weight were observed (participants gained an average of 1.5kg over the study period) although this was not statistically significant. The qualitative data showed that employees benefit from the wellness programme, particularly in terms of their physical and mental well-being. Emerging themes related to fear of loosing one’s job and denial of the reality of HIV/AIDS; stigma and discrimination in the workplace and in the community at large; trust versus mistrust of the Company’s HIV management system; acceptance of the condition; the acceptability of nutritional supplements; and the general benefit of the wellness programme. Other related themes that emerged included issues regarding VCT, peer education, the provision of anti-retroviral therapy (ART), the role of trade unions, barriers in the public health care system and OHNPs’ frustrations with the wellness programme. Discussion: The most beneficial aspect of the wellness programme appeared to be the trust relationship that employees on the wellness programme have with the OHNPs. Because of this, employees experience a sense of support and are more likely to accept their HIV-positive condition. This contributes to a sense of mental well-being. Early intervention and better management of the condition also occur and there is better compliance to treatment and disease management protocols. There was also a general sentiment that there were benefits in the use of nutritional supplements. Employees reported feeling healthier (e.g. having more energy when using nutritional supplements) and this contributed to a sense of physical well-being. A big challenge is to overcome mistrust amongst the general employee population who have not joined the wellness programme and to deal with the ever-present issues relating to the fear of loosing their job if found to be HIV-positive as well as denial of the condition. This fear and denial perpetuates the reality of discrimination and stigmatisation, which inevitably negatively affects the social well-being of HIV-positive employees. Limitations of the study included a small sample size; inconsistent data collection methods by the OHNPs in the various clinics; the complicated nature of nutritional supplementation, which makes it difficult to study superficially; and that HIV-positive employees could not be interviewed directly as they were not willing to be interviewed. Recommendations: Further research should be performed in the area of workplace wellness programmes. More efficient data collection systems should be put in place to measure the impact of HIV/AIDS and the effectiveness of workplace interventions. HIV-positive employees who have disclosed their status could be used as positive role models in HIV/AIDS programmes. Confidentiality protocols should continue to be strictly adhered to as this promotes the trust relationship. An HIV/AIDS nutritional expert should be involved in advising about the use of optimal supplements in the wellness programmes as OHNPs have differing opinions. Other health professionals could be involved in HIV wellness programmes, e.g. occupational therapists, social workers, etc. Companies should investigate how they can get involved in HIV/AIDS-related activities and partnerships in the communities where their employees live as many employees struggle with issues of poverty over-and-above being HIV-positive

An evaluation of the National Certificate (Vocational) Primary Health qualification for community health workers in South Africa

Background: In South Africa, the re-engineering of primary health care (PHC) includes establishing PHC teams, also called ward-based outreach teams (WBOTs), which consist of community health workers (CHWs) who perform health promotion, disease prevention and disease management in households in defined areas. The need to train CHWs properly has been recognised and various training programmes currently exist. A qualification developed by the Department of Higher Education and Training (DHET) to educate potential CHWs is the National Certificate (Vocational) Primary Health programme. Registered on NQF Levels 2, 3 and 4, subjects include Community Oriented Primary Care, Public Health, Human Body and Mind, South African Health Systems, English, Mathematics, and Life Orientation. It has been offered since 2013 on a full-time basis over three years at various Technical and Vocational Education and Training (TVET) Colleges across South Africa. In 2014 the Department of Family Medicine at the University of Pretoria entered into a partnership with the City of Tshwane and Gert Sibande TVET College to present the NC(V) Primary Health curriculum to a cohort of existing CHWs on a part-time basis over four years. Aim and objectives: This research aimed to evaluate the NC(V) Primary Health qualification to determine whether it is adequate, appropriate, effective, and relevant training for CHWs in PHC teams in South Africa. The objectives of the research were 1) to evaluate the NC(V) Primary Health programme; 2) to determine how the NC(V) Primary Health programme contributed regarding PHC provided to individuals and families in defined geographical areas, curriculated qualifications and human resource development, and individual learning, employment and personal aspirations; 3) to document lessons learnt from the implementation of the NC(V) Primary Health qualification nationwide; and 4) to make recommendations regarding CHW training for South African ward-based outreach teams. Methodology: The pragmatic evaluation used qualitative methods to gain information from participants in three provinces, from both the full-time and part-time offerings. There were 65 participants in the research, including TVET college managers, NC(V) Primary Health lecturers, curriculum experts, a government consultant, a PHC team leader, NC(V) Primary Health students, and existing CHWs doing the programme part-time. Thirteen in-depth interviews, seven focus groups, five written lecturer reflections, nine written student reflections, and various fieldwork notes were used as sources of data. Thematic analysis of data was performed, and relevant theoretical frameworks were used to make sense of the data. Various policy and curriculum documents were also analysed. Results: The NC(V) Primary Health programme was well-structured to produce workers with the required competencies in primary health. Students’ understanding and application of theory and practice contributed to growth in critical thinking and development of agency. Participants expressed deep commitment to and belief in the programme. Although the full-time programme did not have sufficient fieldwork learning opportunities, a unique strength was the interprofessional nature of teaching and students benefitted from exposure to various health professionals. Improving English, mathematics and computer skills were also advantageous. Hope at the possibility of second chances and a better future was evident, and some students were able to access further educational opportunities. The programme was regarded by participants as transformative, empowering and, thus, of value to communities. However, frustration and disappointment were apparent from those who had experienced criticism of their participation in the programme or when their learning and contribution was not valued in PHC teams. Disappointment and despondency were palpable among participants regarding the unfolding uncertainty about the future of the programme, and also their own futures. Conclusion: This study contributes to the ongoing discourse around the education and training of CHWs in South Africa. Careful, respectful and thoughtful regard must be given to the training as people’s lives – individuals, families, and communities – are deeply and directly affected by the training and associated vocational prospects (or lack thereof). CHW education and training programmes should be based on the community oriented primary care (COPC) approach and consider the capabilities of CHWs in context. Novel partnerships and interprofessional contributions will optimise education and training and produce well-rounded and competent CHWs. Structuring of programmes should be in line with the NQF to facilitate career progression and pathways. These findings are in line with policy recommendations from the recently published WHO ‘Guideline on health policy and system support to optimize community health worker programmes’. CHWs should not be underestimated and their voices need to be heard, especially in terms of their contributions and valuable work, their learning needs, and as advocates for the communities they serve. Keywords: NC(V) Primary Health, Community Health Worker, Education and Training, Primary health care re-engineering, Ward-based primary health care outreach teamsThesis (PhD)--University of Pretoria, 2019.NRF UP PhD BursaryFamily MedicinePhDUnrestricte

Tuberculosis infection control practices in a high-burden metro in South Africa : a perpetual bane for efficient primary health care service delivery

Background: Tuberculosis (TB) prevention, including infection control, is a key element in the strategy to end the global TB epidemic. While effective infection control requires all health system components to function well, this is an area that has not received sufficient attention in South Africa despite the availability of policy and guidelines. Aim: To describe the state of implementation of TB infection control measures in a high-burden metro in South Africa. Setting: The research was undertaken in a high TB-and HIV-burdened metropolitan area of South Africa. More specifically, the study sites were primary health care facilities (PHC), that among other services also diagnosed TB. Methods: A cross-sectional survey, focusing on the World Health Organization levels of infection control, which included structured interviews with nurses providing TB diagnosis and treatment services as well as observations, at all 41 PHC facilities in a high TB-burdened and HIV-burdened metro of South Africa. Results: Tuberculosis infection control was poorly implemented, with few facilities scoring 80% and above on compliance with infection control measures. Facility controls: 26 facilities (63.4%) had an infection control committee and 12 (29.3%) had a written infection control plan. Administrative controls: 26 facilities (63.4%) reported separating coughing and non-coughing patients, while observations revealed that only 11 facilities (26.8%) had separate waiting areas for (presumptive) TB patients. Environmental controls: most facilities used open windows for ventilation (n = 30; 73.2%); however, on the day of the visit, only 12 facilities (30.3%) had open windows in consulting rooms. Personal protective equipment: 9 facilities (22%) did not have any disposable respirators in stock and only 9 respondents (22%) had undergone fit testing. The most frequently reported barrier to implementing good TB infection control practices was lack of equipment (n = 22; 40%) such as masks and disposable respirators, as well as the structure or layout of the PHC facilities. The main recommendation to improve TB infection control was education for patients and health care workers (n = 18; 33.3%). Conclusion: All levels of the health care system should be engaged to address TB prevention and infection control in PHC facilities. Improved infection control will address the nosocomial spread of TB in health facilities and keep health care workers and patients safe from infection

State and non-state mental health service collaboration in a South African district : a mixed methods study

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Unpacking the dynamics of double stigma : how the HIV-TB co-epidemic alters TB stigma and its management among healthcare workers

Background HIV and tuberculosis (TB) are intricably interlinked in South Africa. The social aspects of this co-epidemic remain relatively unexplored. More specifically, no research has quantitatively explored the double stigma associated with HIV and TB in this context, and more specifically the impact of the co-epidemic on [1] the stigmatisation of TB and [2] the TB stigma mangement strategy of covering (i.e. the use of TB as a cover for having HIV). The current study aims to address this research gap by disentangling the complex mechanisms related to HIV-TB stigma. Methods Using Structural Equation Modelling (SEM), data of 882 health care workers (HCWs) in the Free State province, South Africa, are analysed to investigate the link between the stigmatization of HIV and TB and the stigma management by those affected. The current study focuses on health care workers (HCWs), as both TB and HIV have a severe impact on this professional group. Results The results demonstrate that the perceived link between the epidemics is significantly associated with double HIV-TB stigmatization. Furthermore, the link between the illnesses and the double stigma are driving the stigmatization of TB. Finally, the link between HIV and TB as well as the stigmatization of both diseases by colleagues are associated with an increased use of covering as a stigma management strategy. Conclusions This is the first quantitative study disentagling the mediating role of double stigma in the context of the co-epidemic as well as the impact of the co-epidemic on the social connotations of TB. The results stress the need for an integrated approach in the fight against HIV and TB recognizing the intertwined nature of the co-epidemic, not only in medical-clinical terms, but also in its social consequences

Methadone use for acute opioid withdrawal in Tshwane shelters during the COVID-19 lockdown

Background: Temporary shelters were established for street-based people during the national level 5 coronavirus disease 2019 (COVID-19) lockdown. However, street-based substance users’ need to access substances was not addressed, resulting in large numbers of people experiencing withdrawal. The Community Oriented Substance Use Programme (COSUP) in Tshwane provided methadone to manage opioid withdrawal. Methods: A cross-sectional, descriptive study was conducted using the daily methadone dosing records from shelters in Tshwane between March 2020 and September 2020. Results: The final analysis included 495 participants, of which 64 (12.9%) were initiated on 20 mg – 30 mg of methadone, 397 (80.2%) on 40 mg – 50 mg, and 34 (6.9%) on 60 mg – 70 mg. A total of 194 (39.2%) participants continued their initiation dose for 1–2 months, after which 126 (64.9%) had their doses increased, and 68 (35.1%) had their doses decreased. Approximately 12 (2.4%) participants were weaned off methadone after 1–3 months and 46 (9.3%) after 4–6 months. In all, 100 (20.2%) participants left the shelter prematurely and did not continue with methadone. A total of 126 (25.5%) participants continued to stay in the shelters and received methadone for 6 months, with 125 (25.3%) participants leaving the shelter with continued follow-up at a COSUP site. Conclusion: This study demonstrates variability in methadone dosing regimens among shelter residents. As the lockdown measures eased, many chose to leave the shelters, while others remained to receive methadone and other services. The COSUP appears to be effective during periods of increased vulnerability, since a large number of participants were successfully followed up. Contribution: Opioid dependence is a persistent, lifelong disease. It is multifaceted with complex environmental and individual determinants. This study highlighted the use of opioid substitution therapy during a period of increased vulnerability

Mental health symptoms among homeless shelter residents during COVID-19 lockdown in Tshwane, South Africa

Background: In order to contain the spread of COVID-19 in South Africa during the national state of emergency, the Gauteng Department of Social Development established temporary shelters and activated existing facilities to provide basic needs to street-homeless people in Tshwane, which facilitated primary health care service-delivery to this community. Aim: This study aimed to determine and analyse the prevalence of mental health symptoms and demographic characteristics among street-homeless people living in Tshwane’s shelters during lockdown. Setting: Homeless shelters set up in Tshwane during level 5 of the COVID-19 lockdown in South Africa. Methods: A cross-sectional, analytical study was conducted using a Diagnostic and Statistical Manual of Mental Disorders (DSM-5)-based questionnaire that looked at 13 mental health symptom domains. Results: Presence of moderate-to-severe symptoms were reported among the 295 participants as follows: substance use 202 (68%), anxiety 156 (53%), personality functioning 132 (44%), depression 85 (29%), sleep problems 77 (26%), somatic symptoms 69 (23%), anger 62 (21%), repetitive thoughts and behaviours 60 (20%), dissociation 55 (19%), mania 54 (18%), suicidal ideation 36 (12%), memory 33 (11%) and psychosis 23 (8%). Conclusion: A high burden of mental health symptoms was identified. Community-oriented and person-centred health services with clear care-coordination pathways are required to understand and overcome the barriers street-homeless people face in accessing health and social services. Contribution: This study determined the prevalence of mental health symptoms within the street-based population in Tshwane, which has not previously been studied

A qualitative study of occupational therapists’ understanding of spirituality in South Africa

Occupational therapy is a holistic profession that assists clients to restore meaning to their lives—a vital spiritual task. Spirituality is a multifaceted and multidimensional construct that occupational therapists need to integrate into everyday practice. In this study, Occupational Therapy educators’ and clinicians’ understanding of spirituality in their practice was qualitatively explored by purposively selecting 24 participants who attended a workshop based on an appreciative approach, in Gauteng, South Africa. Data were collected through self-report interview schedules and focus group inquiries and were analysed using the creative hermeneutic method. Participants expressed spirituality in occupational therapy as connectedness, meaning of life and client-centred practice.https://link.springer.com/journal/10943hj2023Family MedicineNursing ScienceOccupational Therap

Retention of service users on opioid substitution therapy in the City of Tshwane, South Africa

DATA AVAILABILITY : The data that support the findings of this study are available from the corresponding author, upon reasonable request.BACKGROUND : Opioid substitution therapy (OST) is evidence-based treatment for opioid use disorders and, when taken as maintenance therapy, has proven health and social benefits. The benefits of OST are achieved through the retention of service users in the treatment programme. AIM : To identify factors that affected retention of service users who had OST interrupted in less than 6 months of being in an OST programme. SETTING : This qualitative study was conducted with19 service users from eight Community-Oriented Substance Use Programme (COSUP) sites in the City of Tshwane, Gauteng, South Africa. METHODS : Participants were COSUP service users who had interrupted OST in less than 6 months since initiation and were purposefully selected from all COSUP sites. Demographic information was obtained and four focus group discussions covered challenges of OST retention. Discussions were recorded, transcribed and qualitatively analysed using Attride-Stirling’s thematic networks framework. RESULTS : The 19 participants were all male, mostly black African, with a mean age of 26 years. Facilitators of retention in OST were individual readiness to change OST accessibility, positive family and peer support, treatment monitoring, understanding and managing expectations of service users, contribution in society and meaningful opportunities for engagement. Barriers were the cost of OST, bureaucracy within the programme, inability to communicate challenges timeously and effectively to treatment providers, boredom, cravings and poverty. CONCLUSION : Opioid substitution therapy programmes can ensure a holistic approach to prevent and treat harms related to illicit opioid use if they remain person-centred and are well-funded. CONTRIBUTION : Understanding the barriers to, and facilitators of retention on OST can contribute to improved community-based service delivery.The Community-Oriented Substance Use Programme is funded by the City of Tshwane.http://www.phcfm.orgFamily Medicin

Reducing HIV- and TB-Stigma among healthcare co-workers in South Africa: Results of a cluster randomised trial.

RATIONALE: The HIV and TB co-epidemic has a severe impact on the South African healthcare workforce and health system. HIV- and TB- stigma directed from healthcare workers (HCWs) towards colleagues not only has a negative impact on the mental health and well-being of the HCWs, but has been identified as a barrier to their own health-seeking behaviour. It also increases the strain on the health system due to absenteeism. OBJECTIVE: This cluster-randomised trial tested an intervention to reduce HIV- and TB-stigma among HCWs. The intervention, based on the theory of Diffusion of Innovations consisted of training healthcare workers as change agents in a Social and Behavioural Change Communication workshop to help them change stigmatising attitudes in the workplace. This was supported by a social marketing campaign. METHODS: Eight hospitals in the Free State province were randomised into intervention and control group in a stratified study design. 652 respondents randomly drawn from the hospitals were surveyed on aspects of HIV and TB stigma once in 2016 and again in 2018. Since the study only used four hospitals per intervention arm, cluster-based summaries were compared when analysing the intervention effect, using the nonparametric Mann-Whitney test. To explore how the intervention worked, 24 qualitative focus groups were conducted following the intervention. RESULTS: The quantitative test did not show a significant intervention effect on stigma between intervention and control groups. Qualitative evidence reported new awareness and changed behaviour related to HIV- and TB-stigma among individual HCWs, but a combination of factors including strong social hierarchies in the workplace and the down-scaling of the original version of the intervention seemed to reduce the impact. Conclusion The findings did not indicate a significant intervention effect, but show the potential of using HCWs as change agents to reduce HIV and TB stigma in their local communities