A multi-site intervention study comparing health outcomes of MAMA South Africa users versus standard of care

2019 ◽  
Author(s):  
Jesse Coleman
Keyword(s):  
South Africa ◽  
Health Outcomes ◽  
Intervention Study ◽  
Standard Of Care

scholarly journals Evaluation of adherence monitoring system using evriMED with a differentiated response compared to standard of care among drug-sensitive TB patients in three provinces in South Africa: a protocol for a cluster randomised control trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Noriah Maraba ◽  
Catherine Orrell ◽  
Candice M. Chetty-Makkan ◽  
Kavindhran Velen ◽  
Rachel Mukora ◽  
...  
Keyword(s):  
South Africa ◽  
Treatment Success ◽  
Standard Of Care ◽  
Treatment Completion ◽  
Phone Call ◽  
Randomised Control Trial ◽  
Improve Medication Adherence ◽  
Tb Treatment ◽  
Differentiated Care

Abstract Background South Africa has achieved drug-susceptible TB (DS-TB) treatment success of only 77% among people with new and previously treated TB. Alternative approaches are required to improve medication adherence and treatment completion to limit transmission, TB relapse and the development of resistance. This study aims to implement and evaluate the use of adherence medication monitors (Wisepill evriMED 1000) with a differentiated response to patient care, among DS-TB patients in three provinces of South Africa. Methods In total, 18 public health clinics across three provinces were selected. Clinics were randomised to intervention or standard of care clinics. In each clinic, approximately 145 DS-TB patients are being enrolled to reach a total of 2610. All patients have their daily adherence monitored using medication monitors. In the intervention arm, patients are receiving medication monitor reminders and differentiated care in response to adherence data. This weekly review of daily real-time monitoring will be undertaken from a central database. The differentiated care model includes automated SMS reminders with a missed dose, research staff-initiated phone call to the patient with a second or third missed dose, a home visit if four or more doses are missed, and motivational counselling if four or more doses are missed repeatedly. Fidelity of the intervention will be measured through process evaluation. Patients in control clinics will receive medication monitors for adherence tracking, standard of care TB education, and normal clinic follow-up procedures. The primary outcome is the proportion of patients by arm with >80% adherence, as measured by the medication monitor. The feasibility and acceptability of the intervention will be assessed by in-depth interviews with patients, stakeholders, and study staff. A cost effectiveness analysis of the intervention and standard of care clinics will be conducted. Significance This trial will provide evidence for the use of an intervention, including medication monitors and differentiated care package, to improve adherence to TB treatment. Improved adherence should also improve TB treatment completion rates, thus reducing loss to follow-up rates, and TB relapse among people with TB. The intervention is intended to ultimately improve overall TB control and reduce TB transmission in South Africa. Trial registration Pan African Trial Registry PACTR201902681157721. Registered on 11 February 2019.

scholarly journals Engaging the ‘Missing Men’ in the HIV Treatment Cascade: Creating a Tailored Intervention to Improve Men’s Uptake of HIV Care Services in Rural South Africa: A Study Protocol

2021 ◽  
Vol 18 (7) ◽  
pp. 3709
Author(s):  
Oluwafemi Adeagbo ◽  
Kammila Naidoo
Keyword(s):  
South Africa ◽  
Health Outcomes ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Treatment Cascade ◽  
Hiv Care Cascade ◽  
Care Services ◽  
The Social ◽  
Hiv Treatment Cascade ◽  
Male Specific

Men, especially young men, have been consistently missing from the HIV care cascade, leading to poor health outcomes in men and ongoing transmission of HIV in young women in South Africa. Although these men may not be missing for the same reasons across the cascade and may need different interventions, early work has shown similar trends in men’s low uptake of HIV care services and suggested that the social costs of testing and accessing care are extremely high for men, particularly in South Africa. Interventions and data collection have hitherto, by and large, focused on men in relation to HIV prevention in women and have not approached the problem through the male lens. Using the participatory method, the overall aim of this study is to improve health outcomes in men and women through formative work to co-create male-specific interventions in an HIV-hyper endemic setting in rural KwaZulu-Natal, South Africa.

The global effectiveness of fact-checking: Evidence from simultaneous experiments in Argentina, Nigeria, South Africa, and the United Kingdom

2021 ◽  
Vol 118 (37) ◽  
pp. e2104235118 ◽  
Author(s):  
Ethan Porter ◽  
Thomas J. Wood
Keyword(s):  
South Africa ◽  
United Kingdom ◽  
Health Outcomes ◽  
False Beliefs ◽  
Point Scale ◽  
Analytic Procedure ◽  
The United Kingdom ◽  
Fact Checking ◽  
Checking Experiments

The spread of misinformation is a global phenomenon, with implications for elections, state-sanctioned violence, and health outcomes. Yet, even though scholars have investigated the capacity of fact-checking to reduce belief in misinformation, little evidence exists on the global effectiveness of this approach. We describe fact-checking experiments conducted simultaneously in Argentina, Nigeria, South Africa, and the United Kingdom, in which we studied whether fact-checking can durably reduce belief in misinformation. In total, we evaluated 22 fact-checks, including two that were tested in all four countries. Fact-checking reduced belief in misinformation, with most effects still apparent more than 2 wk later. A meta-analytic procedure indicates that fact-checks reduced belief in misinformation by at least 0.59 points on a 5-point scale. Exposure to misinformation, however, only increased false beliefs by less than 0.07 points on the same scale. Across continents, fact-checks reduce belief in misinformation, often durably so.

scholarly journals Family-centered postnatal training and adherence to newborn care practices in district hospitals in two Indian states: A quasi-experimental intervention study

2021 ◽  
Author(s):  
Sehj Kashyap ◽  
Amanda F Spielman ◽  
Nikhil Ramnarayan ◽  
Sahana SD ◽  
Rashmi Pant ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Intervention Study ◽  
Intervention Group ◽  
Newborn Care ◽  
Post Intervention ◽  
Indian States ◽  
District Hospitals ◽  
Quasi Experimental ◽  
Care Practices ◽  
Family Centered

Background and Objectives: Globally, 2.5 million newborns die within the first month of life annually. The majority of deaths occur in low- and middle-income countries (LMICs), and many of these deaths happen at home. The study assessed if the Care Companion Program (CCP) an in-hospital, skills-based training given to families improves post-discharge maternal and neonatal health outcomes. Methods: This quasi-experimental pre-post intervention study design compared self-reported behavior and health outcomes among families before and after the CCP intervention. Intention to treat analysis included families regardless of their exposure to the intervention. Mixed effects logistic regression model, adjusted for confounders, was fit for all observations. Effects were expressed as Relative Risks (RR) with 95% Confidence Intervals (CI). Results: At 2-weeks post-delivery, telephone surveys were conducted in the pre (n = 3510) and post-intervention (n = 1474) groups from 11 district hospitals in the states of Karnataka and Punjab. The practice of dry cord care improved significantly by 4%, (RR = 1.04, 95%CI [1.04,1.06]) and skin to skin care by 78% (RR=1.78, 95%CI [1.37,2.27]) in the post-intervention group as compared to pre-intervention group. Furthermore, newborn complications reduced by 16% (RR=0.84, 95%CI [0.76,0.91]), mother complications by 12% (RR=0.88, 95%CI [0.79,0.97]) and newborn readmissions by 56% (RR=0.44, 95%CI [0.31,0.61]). Outpatient visits increased by 27% (RR=1.27, 95%CI [1.10,1.46]). However, outcomes of breastfeeding, mothers diet, hand-hygiene, and process indicator of being instructed on warning signs were not different. Conclusion: Postnatal care should incorporate pre-discharge multi-pronged training of families to improve essential maternal and newborn care practices. The CCP model runs on a public-private partnership and is integrated into existing health systems. Our findings demonstrate that it is possible to improve outcomes through a family-centered approach in India. The CCP model can be integrated into formalised hospital processes to relieve overburdened healthcare systems in LMIC settings.

scholarly journals Health Outcomes for Children Born to Teen Mothers in Cape Town, South Africa

2015 ◽  
Vol 63 (3) ◽  
pp. 589-616 ◽  
Author(s):  
Nicola Branson ◽  
Cally Ardington ◽  
Murray Leibbrandt
Keyword(s):  
South Africa ◽  
Health Outcomes ◽  
Cape Town ◽  
Teen Mothers ◽  
Outcomes For Children

Cost-effectiveness and budget impact of flucytosine as induction therapy in the treatment of cryptococcal meningitis in HIV-infected adults in South Africa

2020 ◽  
Author(s):  
Jacqui Miot ◽  
Trudy Leong ◽  
Simbarashe Takuva ◽  
Andrew Parrish ◽  
Halima Dawood
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Amphotericin B ◽  
Induction Therapy ◽  
Cryptococcal Meningitis ◽  
Budget Impact ◽  
Cost Effective ◽  
Standard Of Care ◽  
Sub Saharan Africa ◽  
Oral Regimen

Abstract Background Cryptococcal meningitis in HIV-infected patients in sub-Saharan Africa accounts for three-quarters of the global cases and 135 000 deaths per annum. Current treatment includes the use of fluconazole and amphotericin B. Recent evidence has shown that the synergistic use of flucytosine improves efficacy and reduces toxicity, however affordability and availability has hampered access to flucytosine in many countries. This study investigated the evidence and cost implications of introducing flucytosine as induction therapy for cryptococcal meningitis in HIV-infected adults in South Africa. Methods A decision analytic cost-effectiveness and budget impact model was developed based on survival estimates from the ACTA trial and local costs for flucytosine as induction therapy in HIV-infected adults with cryptococcal meningitis in a public sector setting in South Africa. The model considered four treatment arms: (a) standard of care; 2-week course of amphotericin B/fluconazole (2wk AmBd/Flu), (b) 2-week course of amphotericin B/flucytosine (2wk AmBd/5FC), (c) short course; 1-week course amphotericin B/flucytosine (1wk AmBd/5FC) and (d) oral course; 2-week oral fluconazole/flucytosine (oral). A sensitivity analysis was conducted on key variables. Results The highest total treatment costs were in the 2-week AmBd/5FC arm followed by the 2-week oral regimen, then the 1-week AmBd/5FC with the lowest cost in the standard of care arm. Compared to standard of care the 1-week flucytosine course is most cost-effective at USD31/QALY, followed by the oral 2-week course at USD155/QALY and the 2-week flucytosine course at USD568/QALY. The budget impact analysis shows that the 1-week course has the lowest incremental cost, followed by the oral course and then the 2-week flucytosine course compared to what is currently spent on standard of care. Sensitivity analyses suggest that the model is most sensitive to the price of flucytosine and hospital costs, particularly length of stay. Conclusions The addition of flucytosine as induction therapy for the treatment of cryptococcal meningitis in patients infected with HIV is cost-effective regardless of whether it is used as a 1-week, 2-week or oral regimen. Savings could be achieved with early discharge of patients as well as a reduction in the price of flucytosine.

scholarly journals Demographics and health profile on precursors of non-communicable diseases in adults testing for HIV in Soweto, South Africa: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e030701 ◽  
Author(s):  
Kathryn L Hopkins ◽  
Khuthadzo Hlongwane ◽  
Kennedy Otwombe ◽  
Janan Dietrich ◽  
Mireille Cheyip ◽  
...  
Keyword(s):  
South Africa ◽  
Health Outcomes ◽  
Communicable Disease ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Transmitted Infection ◽  
Cross Sectional ◽  
Infected People ◽  
Sexually Transmitted ◽  
Group Sex

ObjectivesThis cross-sectional study investigated the burden of HIV-non-communicable disease (NCD) precursor comorbidity by age and sex. Policies stress integrated HIV-NCD screenings; however, NCD screening is poorly implemented in South African HIV testing services (HTS).SettingWalk-in HTS Centre in Soweto, South Africa.Participants325 voluntary adults, aged 18+ years, who provided written or verbal informed consent (with impartial witness) for screening procedures were enrolled.Primary and secondary outcomesData on sociodemographics, tuberculosis and sexually transmitted infection symptoms, blood pressure (BP) (≥140/90=elevated) and body mass index (<18.5 underweight; 18.5–25.0 normal; >25 overweight/obese) were stratified by age-group, sex and HIV status.ResultsOf the 325 participants, the largest proportions were female (51.1%; n=166/325), single (71.5%; n=231/323) and 25–34 years (33.8%; n=110/325). Overall, 20.9% (n=68/325) were HIV infected, 27.5% (n=89/324) had high BP and 33.5% (n=109/325) were overweight/obese. Among HIV-infected participants, 20.6% (14/68) had high BP and 30.9% (21/68) were overweight/obese, as compared with 29.3% (75/256) and 12.1% (31/256) of the HIV-uninfected participants, respectively. Females were more likely HIV-infected compared with males (26.5% (44/166) vs 15.1% (24/159); p=0.012). In both HIV-infected and uninfected groups, high BP was most prevalent in those aged 35–44 years (25% (6/24) vs 36% (25/70); p=0.3353) and >44 years (29% (4/14) vs 48% (26/54); p=0.1886). Males had higher BP than females (32.9% (52/158) vs 22.3% (37/166); p=0.0323); more females were overweight/obese relative to males (45.8% (76/166) vs 20.8% (33/159); p<0.0001). Females were more likely to be HIV infected and overweight/obese.ConclusionAmong HTS clients, NCD precursors rates and co-morbidities were high. Elevated BP occurred more in older participants. Targeted integrated interventions for HIV-infected females and HIV-infected people aged 18–24 and 35–44 years could improve HIV public health outcomes. Additional studies on whether integrated HTS will improve the uptake of NCD treatment and improve health outcomes are required.

scholarly journals Assessing joint spatial autocorrelations between mortality rates due to cardiovascular conditions in South Africa

2019 ◽  
Vol 14 (2) ◽  
Author(s):  
Timotheus B. Darikwa ◽  
Samuel Manda ◽  
‘Maseka Lesaoana
Keyword(s):  
Heart Failure ◽  
South Africa ◽  
Heart Disease ◽  
Health Outcomes ◽  
Empirical Bayes ◽  
Spatial Clustering ◽  
Mortality Rates ◽  
Noncommunicable Diseases ◽  
Co Morbidity ◽  
Dependent Mortality

South Africa is experiencing an increasing burden of noncommunicable diseases (NCDs). There is evidence of co-morbidity of several NCDs at small geographical areas in the country. However, the extent to which this applies to joint spatial autocorrections of NCDs is not known. The objective of this study was to derive and quantify multivariate spatial autocorrections for NCDrelated mortality in South Africa. The study used mortality attributable to cerebrovascular, ischaemic heart failure and hypertension captured by the country’s Department of Home Affairs for the years 2001, 2007 and 2011. Both univariate and pairwise spatial clustering measures were derived using observed, empirical Bayes smoothed and age-adjusted standardised mortality rates. Cerebrovascular and ischaemic heart co-clustering was significant for the years 2001 and 2011. Cerebrovascular and hypertension co-clustering was significant for the years 2007 and 2011, while hypertension and ischaemic heart co-clustering was significant for the year 2011. Co-clusters of cerebrovascular-ischaemic heart disease are the most profound and located in the south-western part of the country. It was successfully demonstrated that bivariate spatial autocorrelations can be derived for spatially dependent mortality rates as exemplified by mortality rates attributed to three cardiovascular conditions. The identified co-clusters of spatially dependent health outcomes may be targeted for an integrated intervention and monitoring programme.

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