Improving Estimates of Social Contact Patterns for Airborne Transmission of Respiratory Pathogens.

Data on social contact patterns are widely used to parameterize age-mixing matrices in mathematical models of infectious diseases. Most studies focus on close contacts only (i.e., persons spoken with face-to-face). This focus may be appropriate for studies of droplet and short-range aerosol transmission but neglects casual or shared air contacts, who may be at risk from airborne transmission. Using data from 2 provinces in South Africa, we estimated age mixing patterns relevant for droplet transmission, nonsaturating airborne transmission, and Mycobacterium tuberculosis transmission, an airborne infection where saturation of household contacts occurs. Estimated contact patterns by age did not vary greatly between the infection types, indicating that widespread use of close contact data may not be resulting in major inaccuracies. However, contact in persons >50 years of age was lower when we considered casual contacts, and therefore the contribution of older age groups to airborne transmission may be overestimated

Cape Town social contact data

Social contact data collected from 1115 adults (aged 15+ years) located in Western Cape Province, South Africa. It is comprised of five data tables: [1] 'Main data' contains information on participant age, religion, education level, employment status, household income, duration lived in home, number of people in household, places worked in past 4 weeks; [2] 'Household data' contains information on the participants’ household members; [3] 'Close contacts data' contains detailed information on participants’ close contacts; [4] 'Building data' contains information on time spent and people present in indoor locations that the participants visited; and [5] 'Transport data' contains information on time spent and people present on transport used by the participants. The ODK questionnaire is also included

Implementation outcomes of a health systems strengthening intervention for perinatal women with common mental disorders and experiences of domestic violence in South Africa: Pilot feasibility and acceptability study

Background South Africa has a high burden of perinatal common mental disorders (CMD), such as depression and anxiety, as well as high levels of poverty, food insecurity and domestic violence, which increases the risk of CMD. Yet public healthcare does not include routine detection and treatment for these disorders. This pilot study aims to evaluate the implementation outcomes of a health systems strengthening (HSS) intervention for improving the quality of care of perinatal women with CMD and experiences of domestic violence, attending public healthcare facilities in Cape Town. Methods Three antenatal care facilities were purposively selected for delivery of a HSS programme consisting of four components: (1) health promotion and awareness raising talks delivered by lay healthcare workers; (2) detection of CMD and domestic violence by nurses as part of routine care; (3) referral of women with CMD and domestic violence; and (4) delivery of structured counselling by lay healthcare workers in patients’ homes. Participants included healthcare workers tasked with delivery of the HSS components, and perinatal women attending the healthcare facilities for routine antenatal care. This mixed methods study used qualitative interviews with healthcare workers and pregnant women, a patient survey, observation of health promotion and awareness raising talks, and a review of several documents, to evaluate the acceptability, appropriateness, feasibility, adoption, fidelity of delivery, and fidelity of receipt of the HSS components. Thematic analysis was used to analyse the qualitative interviews, while the quantitative findings for adoption and fidelity of receipt were reported using numbers and proportions. Results Healthcare workers found the delivery and content of the HSS components to be both acceptable and appropriate, while the feasibility, adoption and fidelity of delivery was poor. We demonstrated that the health promotion and awareness raising component improved women’s attitudes towards seeking help for mental health conditions. The detection, referral and treatment components were found to improve fidelity of receipt, evidenced by an increase in the proportion of women undergoing routine detection and referral, and decreased feelings of distress in women who received counselling. However, using a task-sharing approach did not prove to be feasible, as adding additional responsibilities to already overburdened healthcare workers roles resulted in poor fidelity of delivery and adoption of all the HSS components. Conclusions The acceptability, appropriateness and fidelity of receipt of the HSS programme components, and poor feasibility, fidelity of delivery and adoption suggest the need to appoint dedicated, lay healthcare workers to deliver key programme components, at healthcare facilities, on the same day

Characteristics associated with time to linkage from hospital referral to local treatment initiation for TB in rural South Africa.

This is based on complete case dataset (n = 669). (DOCX)</p

S1 Data -

People with tuberculosis (TB) are often lost to follow-up during treatment transition to another facility. These losses may result in substantial morbidity and mortality but are rarely recorded. We conducted a record review on adults diagnosed with TB at 11 hospitals in Limpopo, South Africa, who were subsequently transferred to a local clinic to initiate or continue treatment. We then performed in-depth record reviews at the primary care clinic to which they were referred and called participants who could not be identified as starting treatment. Between August 2017 and April 2018, we reviewed records of 778 individuals diagnosed with TB in-hospital and later referred to local clinics for treatment. Of the 778, 88 (11%) did not link to care, and an additional 43 (5.5%) died. Compared to people without cough, those with cough had higher odds of linking to care (aOR = 2.01, 95% CI: 1.26–3.25, p = 0.005) and were also linked more quickly [adjusted Time Ratio (aTR) = 0.53, 95% CI:0.36–0.79, p</div

Time from hospital referral to presentation for initiation of treatment in rural South African clinics.

The black line represents the proportion of people who were referred from hospitals to local clinics for TB treatment and had successfully linked to care, by the number of days post-discharge shown on the x-axis. Of the 647 who linked to care, the plot does not include 90 people with missing or invalid date of presentation. The median time to linkage for the 557 people who linked to care and had a valid date of presentation was 4 days (IQR: 1, 14).</p

Characteristics associated with death of people with TB referred from hospital to local clinic for treatment initiation in rural South Africa.

This is based on complete case dataset (n = 669). This analysis considers deaths as all people who died during the study duration irrespective of time awaiting linkage to care or linkage to care status. Factors associated with death in the complete case analysis. People who died (n = 55) includes 24 and 31 people who died before and after linking to care, respectively. (DOCX)</p

Characteristics associated with death of people with TB referred from hospital to local clinic for treatment initiation in rural South Africa.

This analysis considers deaths as all people who died during the study duration irrespective of time awaiting linkage to care or linkage to care status. People who died (n = 76) includes 43 and 33 people who died before and after linking to care, respectively. (DOCX)</p

Patient flow diagram for study participants.

The patient flow diagram represents the cohort of people diagnosed with drug-sensitive TB at each study hospital between August 1, 2017 and April 30, 2018 who were followed via record review for establishing linkage to care. All participants were followed for a minimum of four months after TB diagnosis. Since the follow-up time varied for patients, not all patients had completed treatment by the time of record review.</p

Characteristics associated with time to linkage from hospital referral to local treatment initiation for TB in rural South Africa.

This is based on complete case dataset. (n = 669). This analysis used competing-risk accelerated failure time model after imputing median time to linkage for missing values. Death was treated as an event with competing risk. Time to linkage to care was censored at 90 days. (DOCX)</p