Lay Counsellors' Experiences of Delivering HIV Counselling Services in Public Health Facilities in a Eastern Cape Province District of South Africa

IntroductionAs countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative distributed HIV self-test (HIVST) kits using unincentivised HIV testing counsellors across 31 public facilities in Malawi, South Africa, Zambia and Zimbabwe. HIVST was distributed either through secondary (partner’s use) distribution alone or primary (own use) and secondary distribution approaches.MethodsWe evaluated the costs of adding HIVST to existing HIV testing from the providers’ perspective in the 31 public health facilities across the four countries between 2018 and 2019. We combined expenditure analysis and bottom-up costing approaches. We also carried out time-and-motion studies on the counsellors to estimate the human resource costs of introducing and demonstrating how to use HIVST for primary and secondary use.ResultsA total of 41 720 kits were distributed during the analysis period, ranging from 1254 in Zimbabwe to 27 678 in Zambia. The cost per kit distributed through the primary distribution approach was $4.27 in Zambia and $9.24 in Zimbabwe. The cost per kit distributed through the secondary distribution approach ranged from $6.46 in Zambia to $13.42 in South Africa, with a wider variation in the average cost at facility-level. From the time-and-motion observations, the counsellors spent between 20% and 44% of the observed workday on HIVST. Overall, personnel and test kit costs were the main cost drivers.ConclusionThe average costs of distributing HIVST kits were comparable across the four countries in our analysis despite wide cost variability within countries. We recommend context-specific exploration of potential efficiency gains from these facility-level cost variations and demand creation activities to ensure continued affordability at scale.

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Molecular Detection and Distribution of Six Medically Important Vibrio spp. in Selected Freshwater and Brackish Water Resources in Eastern Cape Province, South Africa

Frontiers in Microbiology ◽

10.3389/fmicb.2021.617703 ◽

2021 ◽

Vol 12 ◽

Author(s):

Oluwatayo E. Abioye ◽

Ayodeji Charles Osunla ◽

Anthony I. Okoh

Keyword(s):

Public Health ◽

South Africa ◽

Water Resources ◽

Brackish Water ◽

Water Samples ◽

Vibrio Vulnificus ◽

Health Concern ◽

Eastern Cape Province ◽

Eastern Cape ◽

Public Health Importance

Water resources contaminated with pathogenic Vibrio species are usually a source of devastating infection outbreaks that have been a public health concern in both developed and developing countries over the decades. The present study assessed the prevalence of six medically significant Vibrio species in some water resources in Eastern Cape Province, South Africa for 12 months. We detected vibrios in all the 194 water samples analyzed using polymerase chain reaction (PCR). The prevalence of Vibrio cholerae, Vibrio mimicus, Vibrio fluvialis, Vibrio vulnificus, Vibrio alginolyticus, and Vibrio parahaemolyticus in freshwater samples was 34, 19, 9, 2, 3, and 2%, and that in brackish water samples was 44, 28, 10, 7, 46, and 51%, respectively. The population of the presumptive Vibrio spp. isolated from freshwater (628) and brackish water (342) samples that were confirmed by PCR was 79% (497/628) and 85% (291/342), respectively. Twenty-two percent of the PCR-confirmed Vibrio isolates from freshwater (n = 497) samples and 41% of the PCR-confirmed Vibrio isolates from brackish water samples (n = 291) fall among the Vibrio species of interest. The incidences of V. cholerae, V. mimicus, V. fluvialis, V. vulnificus, V. alginolyticus, and V. parahaemolyticus amidst these Vibrio spp. of interest that were recovered from freshwater samples were 75, 14, 4, 6, 1, and 1%, whereas those from brackish water samples were 24, 7, 3, 3, 47, and 18%, respectively. Our observation during the study suggests pollution as the reason for the unusual isolation of medically important vibrios in winter. Correlation analysis revealed that temperature drives the frequency of isolation, whereas salinity drives the composition of the targeted Vibrio species at our sampling sites. The finding of the study is of public health importance going by the usefulness of the water resources investigated. Although controlling and preventing most of the factors that contribute to the prevalence of medically important bacteria, such as Vibrio species, at the sampling points might be difficult, regular monitoring for creating health risk awareness will go a long way to prevent possible Vibrio-related infection outbreaks at the sampling sites and their immediate environment.

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Health workers’ disrespectful and abusive behaviour towards women during labour and delivery: A qualitative study in Durban, South Africa

PLoS ONE ◽

10.1371/journal.pone.0261204 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261204

Author(s):

Sphindile Mapumulo ◽

Lyn Haskins ◽

Silondile Luthuli ◽

Christiane Horwood

Keyword(s):

Public Health ◽

South Africa ◽

Health Workers ◽

Working Women ◽

Adverse Outcomes ◽

Health Facilities ◽

Health Concern ◽

Disrespect And Abuse ◽

Public Health Facilities ◽

Abusive Behaviour

Background A high prevalence of disrespectful and abusive behaviour by health workers towards women during labour and delivery has been widely described in health facilities, particularly in Africa, and is a worldwide public health concern. Such behaviours are barriers to care-seeking, and are associated with adverse outcomes for mothers and newborns. This paper reports experiences of disrespectful care among informal working women in three public health facilities in Durban, South Africa. Methods A qualitative longitudinal study was conducted among a cohort of informal working women recruited during pregnancy in two clinics in Durban. The study comprised a series of in-depth interviews conducted at different time points from pregnancy until mothers had returned to work, followed by focus group discussions (FGDs) with cohort participants. We present data from participatory FGDs, known as ‘Journey with my Baby’, conducted at the end of the study, during which women’s experiences from pregnancy until returning to work were reviewed and explored. Thematic analysis was used with NVIVO v12.4. Results Three ‘Journey with my Baby’ FGDs were conducted with a total of 15 participants between March and October 2019. Many participants narrated experiences of disrespectful behavior from nurses during labour and childbirth, with several women becoming very distressed as a result. Women described experiencing rudeness and verbal abuse from nurses, lack of privacy and confidentiality, nurses refusing to provide care, being denied companionship and being left unattended for long periods during labour. Women described feeling anxious and unsafe while in the labour ward because of the behaviour they experienced directly and observed other patients experiencing. Such experiences created bad reputations for health facilities, so that women in the local community were reluctant to attend some facilities. Conclusion Disrespect and abuse continues to be a serious concern in public health facilities in South Africa. We challenge the health system to effectively address the underlying causes of disrespectful behavior among health workers, initiate robust monitoring to identify abusive behavior when it occurs, and take appropriate actions to ensure accountability so that women receive the high-quality maternity care they deserve.

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Community Service Nurses’ Experiences Regarding Mentoring in South Africa

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/4267 ◽

2019 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Sisinyana Hannah Khunou

Keyword(s):

Public Health ◽

South Africa ◽

Community Service ◽

Practical Experience ◽

Health Facilities ◽

North West ◽

Public Health Facilities ◽

Quality Patient Care ◽

The North ◽

Contextual Design

Newly qualified nurses are mandated to do compulsory community service after completion of their education. Anecdotal evidence indicates that these newly qualified nurses are not properly mentored. The purpose of the study was to explore and describe the experiences of community service nurses (CSNs) regarding their mentoring in the public health facilities in the North West province (NWP), South Africa. A qualitative exploratory descriptive contextual design was applied to get a better understanding of mentoring as experienced by CSNs in the NWP. A tape recorder was used to capture the interviews conducted with 28 newly qualified nurses who completed their community service two to three years ago and who were working at public health facilities in the NWP. ATLAS.ti 7 was used to analyse the data obtained from the participants. Three themes, namely (1) a lack of mentoring, (2) challenges of performing community service nursing, and (3) positive experiences emerged from the data collected from the CSNs. These themes were supported by the following sub-themes: Lack of supervision and support; no proper orientation in general; negative attitudes of other nurses to CSNs; unrealistic expectations from CSNs; getting blamed and bullied; CSNs’ lack of practical experience; inadequacy regarding their professional role; use of their education; and gained independence. The study recommended that the facility managers and different stakeholders work together in supporting the CSNs. This will minimise stress and a lack of confidence among CSNs and improve quality patient care.

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