scholarly journals High rate of loss to follow-up and virological non-suppression in HIV-infected children on antiretroviral therapy highlights the need to improve quality of care in South Africa.

2021 ◽  
pp. 1-26
Author(s):  
Geneviève A.F.S. van Liere ◽  
Rivka Lilian ◽  
Jackie Dunlop ◽  
Carol Tait ◽  
Kate Rees ◽  
...  
Keyword(s):  
South Africa ◽  
Quality Of Care ◽  
Antiretroviral Therapy ◽  
High Rate ◽  
Improve Quality ◽  
Loss To Follow Up

scholarly journals The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Roxanna Haghighat ◽  
Elona Toska ◽  
Nontuthuzelo Bungane ◽  
Lucie Cluver
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Viral Suppression ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Clinical Records

Abstract Background Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. Methods All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014–2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. Results Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14–5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06–1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29–4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04–11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06–1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12–2.58], p=0.013) were more likely to be fully viral suppressed. Conclusions Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.

scholarly journals The Association between Quality of HIV Care, Loss to Follow-Up and Mortality in Pediatric and Adolescent Patients Receiving Antiretroviral Therapy in Nigeria

PLoS ONE ◽  
2014 ◽  
Vol 9 (7) ◽  
pp. e100039 ◽  
Author(s):  
Bisola Ojikutu ◽  
Molly Higgins-Biddle ◽  
Dana Greeson ◽  
Benjamin R. Phelps ◽  
Anouk Amzel ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Adolescent Patients

scholarly journals Clinical Mentorship of Nurse Initiated Antiretroviral Therapy in Khayelitsha, South Africa: A Quality of Care Assessment

PLoS ONE ◽  
2014 ◽  
Vol 9 (6) ◽  
pp. e98389 ◽  
Author(s):  
Ann Green ◽  
Virginia de Azevedo ◽  
Gabriela Patten ◽  
Mary-Ann Davies ◽  
Mary Ibeto ◽  
...  
Keyword(s):  
South Africa ◽  
Quality Of Care ◽  
Antiretroviral Therapy ◽  
Care Assessment ◽  
Clinical Mentorship

scholarly journals “If You Report Your Dad, How are You Going to Survive”: Health Practitioner Perspectives on Quality of Care for Survivors of Sexual Violence and the Challenge of Family Interference

2020 ◽  
pp. 088626052095962
Author(s):  
Leso Munala ◽  
Emily Welle ◽  
Emily Hohenshell
Keyword(s):  
Quality Of Care ◽  
Sexual Violence ◽  
Health Practitioner ◽  
Actual Process ◽  
Care Seeking ◽  
Loss To Follow Up ◽  
Female Survivors ◽  
Health Practitioners

This study examined the experiences and perspectives of health practitioners facing the challenges of providing services to female survivors of sexual violence. Interviews were conducted with 28 health practitioners, from eight post-rape care facilities located in Nairobi, Kenya. Data were analyzed using the Colaizzi’s 1978 analytical model. The analysis of the results was guided by four domains of the ecological framework: individual, interpersonal, community/cultural, and public policy. The study documented a myriad of detail about the challenges faced by women before reporting the crime as well as the actual process of reporting. One key finding from this study was that health practitioners perceived family interference as a barrier to reporting, access to care, and to the pursuit of justice for survivors, particularly if the perpetrator was a relative. Family interference was also identified as a factor with implications for health practitioners’ ability to ensure quality of care as it resulted in patients loss to follow-up and added to the negative emotional toll on health practitioners providing post-rape care. Three main themes emerged in practitioner responses related to this issue: (a) fear of consequences of reporting and care seeking, including economic vulnerability, family conflict, and retaliation such as divorce or further violence, (b) the trend toward out-of-court settlements rather than intervention through formal health and criminal justice sector challenges, and (c) attitudes toward sexual violence and survivors, normalization of rape, and victim-blaming attitudes. The study adds to our understanding of the obstacles faced by health practitioners providing post-rape care and provides a unique set of insights from the front lines on underlying factors contributing to these challenges.

scholarly journals The Anorexia Nervosa Care Pathway: Closing the Treatment Gap to Improve Care for Patients Admitted to Medical Hospitals

2021 ◽  
Author(s):  
Kathryn Allen ◽  
Kate O Brien ◽  
Marese O'Reilly ◽  
Deirbhile Henderson ◽  
Siobhan Machale ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Quality Of Care ◽  
Care Pathway ◽  
High Rate ◽  
Medical Complications ◽  
Hospital Inpatient ◽  
Improve Quality ◽  
Medical Monitoring ◽  
The Impact

Introduction: Medical complications of malnutrition and refeeding account for approximately half of deaths in anorexia nervosa (AN). The AN Care Pathway (ANCP) was introduced at our institution in 2016 to improve quality of care of patients admitted for medical observation and management. We report results from our review of medical complications and report the impact and adoption of the ANCP. Methods: The ANCP was developed in response to a need to improve quality of medical monitoring of patients with severe AN using Squire Guidelines and the Plan-Do-Study-Act cycle. All patients admitted to a medical hospital with AN between 2010-2020 were included after hospital inpatient enquiry and medical records were reviewed. Descriptive statistics were calculated using Stata (Statcorp). Results: Fifty-one patients (63 admissions) were included. Median BMI was 13.8 kg/m2 (11.9-22.5). After ANCP implementation in 2016, compliance with recommended daily ECG, thiamine and blood tests improved from 30% (n=8/27) to 86% (n=21/36). We report a high rate of medical complications of severe AN including anaemia (n=24, 47%), neutropoenia (n=18, 35%), abnormal liver bloods (n=15, 29%) and half developed refeeding syndrome. One-third patients had cardiovascular compromise including reduced cardiac contractility (n=13, 25%), pericardial effusion (n=7, 14%) and one death. Low BMI was associated with cardiovascular complications (mean BMI 13.5 kg/m2 vs 15.5 kg/m2, p=0.01) and neutropoenia (mean BMI 13.4 kg/m2 vs 15.4 kg/m2, p=0.02). Conclusion: Introduction of the ANCP improved quality of care during medical stabilisation. We report a high rate of medical complications of severe AN in patients admitted to a medical hospital. Use of multidisciplinary care protocols may contribute to quality improvement and improved consistency of care for this vulnerable population.

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