Continuum in HIV care from entry to ART initiation in rural KwaZulu-Natal, South Africa

2014 ◽  
Vol 19 (6) ◽  
pp. 680-689 ◽  
Author(s):  
Mélanie Plazy ◽  
Rosemary Dray-Spira ◽  
Joanna Orne-Gliemann ◽  
François Dabis ◽  
Marie-Louise Newell
Keyword(s):  
South Africa ◽  
Hiv Care ◽  
Art Initiation ◽  
Kwazulu Natal

scholarly journals High incidence and persistence of hepatitis B virus infection in individuals receiving HIV care in KwaZulu-Natal, South Africa

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nokukhanya Msomi ◽  
Kogieleum Naidoo ◽  
Nonhlanhla Yende-Zuma ◽  
Nesri Padayatchi ◽  
Kerusha Govender ◽  
...  
Keyword(s):  
South Africa ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Hbv Infection ◽  
Hiv Care ◽  
Care Provision ◽  
Hbsag Positivity ◽  
Kwazulu Natal ◽  
B Virus ◽  
Clinical Records

Abstract Background Hepatitis B virus (HBV), Human Immunodeficiency virus (HIV) and Tuberculosis (TB) are common infections in South Africa. We utilized the opportunity of care provision for HIV-TB co-infected patients to better understand the relationship between these coinfections, determine the magnitude of the problem, and identify risk factors for HBV infection in HIV infected patients with and without TB in KwaZulu-Natal, South Africa. Methods This retrospective cohort analysis was undertaken in 2018. In-care HIV infected patients were included in the analysis. Results from clinical records were analysed to determine the prevalence, incidence, persistence and factors associated with HBsAg positivity in HIV-infected patients with or without TB co-infection. Results A total of 4292 HIV-infected patients with a mean age of 34.7 years (SD: 8.8) were included. Based on HBsAg positivity, the prevalence of HBV was 8.5% (363/4292) [95% confidence interval (CI): 7.7–9.3] at baseline and 9.4% (95%CI: 8.6–10.3%) at end of follow-up. The HBV incidence rate was 2.1/100 person-years (p-y). Risk of incident HBV infection was two-fold higher among male patients (HR 2.11; 95% CI: 1.14–3.92), while severe immunosuppression was associated with a greater than two-fold higher risk of persistent infection (adjusted risk ratio (RR) 2.54; 95% CI 1.06–6.14; p = 0.004. Additionally, active TB at enrolment was associated with a two-fold higher risk of incident HBV infection (aHR 2.38; 95% CI: 0.77–7.35). Conclusion The provision of HIV care and treatment in high HBV burden settings provide a missed opportunity for HBV screening, immunization and care provision.

scholarly journals Exploring the mechanism through which a child-friendly storybook addresses barriers to child-participation during HIV care in primary healthcare settings in KwaZulu-Natal, South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chipo Mutambo ◽  
Kemist Shumba ◽  
Khumbulani W. Hlongwana
Keyword(s):  
South Africa ◽  
Primary Healthcare ◽  
Hiv Care ◽  
Care Process ◽  
Analysis Method ◽  
Child Participation ◽  
Job Aids ◽  
Effective Manner ◽  
Kwazulu Natal ◽  
Depth Interviews

Abstract Background Healthcare workers (HCWs) in South Africa widely use job-aids as practical tools to enhance the provision of HIV services, thereby improving patient-provider interactions during the care process. Job-aids are visual support materials that provide appropriate information using graphics and words in a simple and yet effective manner. We explored the mechanism through the KidzAlive Talk tool storybook (Talk tool), a child-centred job-aid for HCWs that facilitates child-participation during HIV consultations in primary healthcare (PHC) clinics implementing the KidzAlive model. Methods The study was conducted in PHC clinics across four districts; namely: uMkhanyakude, Zululand, uMgungundlovu, and eThekwini in KwaZulu-Natal (KZN), South Africa. We conducted in-depth interviews with children (n = 30), their primary caregivers (PCGs) (n = 30), and KidzAlive trained and mentored HCWs (n = 20). Data were collected in both English and isiZulu languages through user-specific, structured in-depth interviews. All the interviews were audio-recorded (with participants’ assent and consent, respectively). Data were transcribed verbatim, prior to translating the isiZulu transcripts to English. Translations were done by a member of the research team competent in both languages. Electronic data were imported to NVivo 10 for analysis and subsequently analysed using a thematic analysis method followed by a constant comparative and modified grounded theory analysis method. Results The findings identified the following barriers to child-participation: Primary caregiver limiting the child’s involvement due to fear of traumatising them; HCWs’ limited knowledge and skills to deliver child-centred HIV care; childhood developmental stage-related limitations and healthcare institutional paternalism. The Talk tool addresses the above barriers by using simple language and terminology to cater for children at various stages of development; alleviating HCWs’ and PCGs’ fear of possible psychological harm to the child; using storytelling and colourful cartoon illustrations for child edutainment; Being versatile by allowing for multiple utility and tackling institutional paternalism that limit child-involvement in the process of care. Conclusions This study provided evidence on how the Talk tool storybook addresses barriers to child-participation in the HIV care process. The evidence generated from this study is compelling enough to recommend the scale-up of this innovation in low-resource settings.

scholarly journals Antiretroviral initiation of pregnant women and antenatal care booking practices in eThekwini District, KwaZulu-Natal, South Africa

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Nomonde Nozulu ◽  
Bernard M. Gaede
Keyword(s):  
South Africa ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Gestational Age ◽  
Retrospective Chart Review ◽  
Art Initiation ◽  
Kwazulu Natal ◽  
The Mean ◽  
Study Sites ◽  
Mother To Child

Background: The introduction of antiretroviral therapy (ART) in South Africa began as part of the prevention of mother-to-child transmission programme. For significant reduction of vertical transmission, early antenatal care booking and ART initiation are necessary.Aim: This study aimed to evaluate ART initiation and booking practices of women attending antenatal care in eThekwini district during financial years (FY) 2010/2011 and 2013/2014.Methods: An observational study used a retrospective chart review at four eThekwini district community health centres (CHC). From these CHCs, records of women that initiated ART in FY10/11 and FY13/14 were reviewed and compared for ART initiation delays and booking practices.Results: A total of 2749 pregnant women who attended antenatal care (ANC) at the study sites were found eligible for ART; of these, 49% (n = 1334) attended ANC in FY10/11 while 51% (n = 1414) attended in FY13/14. In FY10/11, 46% (n = 610) and 60 % (n = 855) of the womenwere initiated on ART during pregnancy. The mean gestational age at booking for FY10/11 was 20.88 (standard deviation [s.d.] = 5.6) and 18.40 (s.d. = 6.2) in FY13/14. The mean gestational age at ART initiation for women who initiated ART in FY10/11 was 26.30 (s.d. = 6.02) and in FY13/14 it was 19.06 (s.d. = 6.86).Conclusion: In FY13/14 ART initiations occurred within 4 days after booking. ANC booking before 20 weeks was found to have improved between the two years from 39% to 58%;however, on average, in both years women booked during the second trimester.

scholarly journals Factors affecting linkage to HIV care and ART initiation following referral for ART by a mobile health clinic in South Africa: evidence from a multimethod study

2019 ◽  
Vol 42 (5) ◽  
pp. 883-897 ◽  
Author(s):  
Brendan Maughan-Brown ◽  
Abigail Harrison ◽  
Omar Galárraga ◽  
Caroline Kuo ◽  
Philip Smith ◽  
...  
Keyword(s):  
South Africa ◽  
Mobile Health ◽  
Hiv Care ◽  
Health Clinic ◽  
Factors Affecting ◽  
Art Initiation ◽  
Linkage To Hiv Care

scholarly journals Information, motivation, and behavioral skills for early pre-ART engagement in HIV care among patients entering clinical care in KwaZulu-Natal, South Africa

AIDS Care ◽  
2013 ◽  
Vol 25 (12) ◽  
pp. 1485-1490 ◽  
Author(s):  
Laramie R. Smith ◽  
K. Rivet Amico ◽  
Paul A. Shuper ◽  
Sarah Christie ◽  
William A. Fisher ◽  
...  
Keyword(s):  
South Africa ◽  
Clinical Care ◽  
Hiv Care ◽  
Behavioral Skills ◽  
Kwazulu Natal ◽  
Engagement In Hiv Care

scholarly journals Implementation of HIV Self-Testing to Reach Men in Rural uMkhanyakude, KwaZulu-Natal, South Africa. a DO-ART Trial Sub Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Nsika Sithole ◽  
Maryam Shahmanesh ◽  
Olivier Koole ◽  
Meighan Krows ◽  
Torin Schaafsma ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Testing ◽  
Large Scale ◽  
Hiv Care ◽  
Confirmatory Test ◽  
Hiv Positive ◽  
Advisory Boards ◽  
Self Testing ◽  
Kwazulu Natal ◽  
Study Team

Background: KwaZulu–Natal, South Africa has one of the highest HIV prevalence rates globally. Persons <35 years and men have lower rates of HIV testing. HIV self-testing (HIVST) may overcome many barriers of facility-based HIV testing in order to identify HIV positive young persons and men and link them to care. We investigated whether HIVST distribution was a feasible approach to reach men and assessed the proportion of participants who reported their HIVST results, tested positive and linked to care.Methods: Teams comprised of a nurse, clinic research assistant, and recruiters distributed HIVST kits in rural uMkhanyakude, KwaZulu-Natal from August—November 2018 with a focus on testing men. Workplaces (farms), social venues, taxi ranks, and homesteads were used as HIVST kit distribution points following community sensitisation through community advisory boards and community leaders. HIVST kits, demonstration of use, and small incentives to report testing outcomes were provided. The Department of Health provided confirmatory testing and HIV care at clinics.Results: Over 11 weeks in late 2018, we distributed 2,634 HIVST kits of which 2,113 (80%) were distributed to persons aged <35 years, 2,591 (98%) to men and 356 (14%) to first time testers. Of the HIVST distributed, 2,107 (80%) reported their results to the study team, and 157 (7%) tested positive. Of persons who tested positive, 107/130 (82%) reported having a confirmatory test of which 102/107 (95%) were positive and initiated on ART. No emergencies or social harms were reported.Conclusion: Large scale distribution of HIVST kits targeting men in rural KwaZulu-Natal is feasible and highly effective in reaching men, including those who had not previously tested for HIV. While two-thirds of persons who tested HIV positive initiated ART, additional linkage strategies are needed for those who do not link after HIVST. HIVST should be used as a tool to reach men in order to achieve 95% coverage in the UNAIDS testing and care cascade in KwaZulu-Natal.

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