scholarly journals Accessing HIV care may lead to earlier ascertainment of comorbidities in health care clients in Khayelitsha, Cape Town

2021 ◽  
Vol 1 (12) ◽  
pp. e0000031
Author(s):  
Richard Osei-Yeboah ◽  
Tsaone Tamuhla ◽  
Olina Ngwenya ◽  
Nicki Tiffin
Keyword(s):  
South Africa ◽  
Health Care ◽  
Maternal Care ◽  
Disease Onset ◽  
Cape Town ◽  
Public Health Care ◽  
Hiv Care ◽  
Hiv Positive ◽  
Health Care Planning ◽  
Hiv Negative

Successful antiretroviral rollout in South Africa has greatly increased the health of the HIV-positive population, and morbidity and mortality in PLHIV can increasingly be attributed to comorbidities rather than HIV/AIDS directly. Understanding this disease burden can inform health care planning for a growing population of ageing PLHIV. Anonymized routine administrative health data were analysed for all adults who accessed public health care in 2016–2017 in Khayelitsha subdistrict (Cape Town, South Africa). Selected comorbidities and age of ascertainment for comorbidities were described for all HIV-positive and HIV-negative healthcare clients, as well as for a subset of women who accessed maternal care. There were 172 937 adult individuals with a median age of 37 (IQR:30–48) years in the virtual cohort, of whom 48% (83 162) were HIV-positive. Median age of ascertainment for each comorbidity was lower in HIV-positive compared to HIV-negative healthcare clients, except in the case of tuberculosis. A subset of women who previously accessed maternal care, however, showed much smaller differences in the median age of comorbidity ascertainment between the group of HIV-positive and HIV-negative health care clients, except in the case of chronic kidney disease (CKD). Both HIV-positive individuals and women who link to maternal care undergo routine point-of-care screening for common diseases at younger ages, and this analysis suggests that this may lead to earlier diagnosis of common comorbidities in these groups. Exceptions include CKD, in which age of ascertainment appears lower in PLHIV than HIV-negative groups in all analyses suggesting that age of disease onset may indeed be earlier; and tuberculosis for which age of incidence has previously been shown to vary according to HIV status.

scholarly journals Distribution of Human Papillomavirus Genotypes among HIV-Positive and HIV-Negative Women in Cape Town, South Africa

2014 ◽  
Vol 4 ◽  
Author(s):  
Alicia C. McDonald ◽  
Ana I. Tergas ◽  
Louise Kuhn ◽  
Lynette Denny ◽  
Thomas C. Wright
Keyword(s):  
South Africa ◽  
Human Papillomavirus ◽  
Cape Town ◽  
Hiv Positive ◽  
Hiv Negative

scholarly journals Quality of care for tuberculosis and HIV in the private health sector: a cross-sectional, standardised patient study in South Africa

2021 ◽  
Vol 6 (5) ◽  
pp. e005250
Author(s):  
Jody Boffa ◽  
Sizulu Moyo ◽  
Jeremiah Chikovore ◽  
Angela Salomon ◽  
Benjamin Daniels ◽  
...  
Keyword(s):  
South Africa ◽  
Cape Town ◽  
Hiv Care ◽  
Hiv Positive ◽  
Hiv Status ◽  
Clinical Practices ◽  
History Of ◽  
Knowledge And Practice ◽  
The Difference

BackgroundSouth Africa has high burdens of tuberculosis (TB) and TB-HIV, yet the quality of patient care in the private sector is unknown. We describe quality of TB and TB-HIV care among private general practitioners (GPs) in two South African cities using standardised patients (SPs).MethodsSixteen SPs presented one of three cases during unannounced visits to private GPs in selected high-TB burden communities in Durban and Cape Town: case 1, typical TB symptoms, HIV-positive; case 2, TB-specified laboratory report, HIV-negative and case 3, history of incomplete TB treatment, HIV-positive. Clinical practices were recorded in standardised exit interviews. Ideal management was defined as relevant testing or public sector referral for any reason. The difference between knowledge and practice (know-do gap) was assessed through case 1 vignettes among 25% of GPs. Factors associated with ideal management were assessed using bivariate logistic regression.Results511 SP visits were completed with 212 GPs. Respectively, TB and HIV were ideally managed in 43% (95% CI 36% to 50%) and 41% (95% CI 34% to 48%) of case 1, 85% (95% CI 78% to 90%) and 61% (95% CI 73% to 86%) of case 2 and 69% (95% CI 61% to 76%) and 80% (95% CI 52% to 68%) of case 3 presentations. HIV status was queried in 35% (95% CI 31% to 39%) of visits, least with case 1 (24%, 95% CI 18% to 30%). The difference between knowledge and practice was 80% versus 43% for TB and 55% versus 37% for HIV, resulting in know-do gaps of 37% (95% CI 19% to 55%) and 18% (95% CI −1% to 38%), respectively. Ideal TB management was associated with longer visit time (OR=1.1, 95% CI 1.1 to 1.2), female GPs (3.2, 95% CI 2.0 to 5.1), basic symptom inquiry (2.0, 95% CI 1.7 to 2.3), HIV-status inquiry (OR=11.2, 95% CI 6.4 to 19.6), fewer medications dispensed (OR=0.6, 95% CI 0.5 to 0.7) and Cape Town (OR=2.2, 95% CI 1.5 to 3.1). Similar associations were observed for HIV.ConclusionsPrivate providers ideally managed TB more often when a diagnosis or history of TB was implied or provided. Management of HIV in the context of TB was less than optimal.

scholarly journals Exploring Factors Associated with Diabetic Retinopathy Treatment Compliance Behaviour in Cape Town, South Africa

2021 ◽  
Vol 18 (22) ◽  
pp. 12209
Author(s):  
Annalie Wentzel ◽  
Zandile June-Rose Mchiza
Keyword(s):  
Public Health ◽  
South Africa ◽  
Health Care ◽  
Diabetic Retinopathy ◽  
Cape Town ◽  
Treatment Compliance ◽  
Public Health Care ◽  
Public Health Care System ◽  
Key Informants ◽  
Factors Associated

Complete patient adherence to treatment for diabetic retinopathy (DR) is critical to limit vision loss. There is a dearth of evidence regarding the reasons why South African patients referred for suspected vision-threatening DR stay compliant to or default their treatment. The current study sought to explore factors associated with treatment compliance among patients living with diabetes who have been referred for suspected vision-threatening DR in the Northern/Tygerberg sub-Structure (NTSS) public health care system of Cape Town, South Africa. A qualitative research approach was used where semi-structured in-depth interviews were conducted with 13 adult patients living with DR, and 2 key informants who are primary eye care providers. Thematic data analysis was conducted using taguette.org. Fear of going blind was the most notable patient-related factor associated with compliance. Notable patient-related barriers reported were forgetfulness and a poor state of health. Notable institution-related barriers included suboptimal information received from health care service providers, poor referral management by the organisation delivering retinal screening services, as well as the inaccessibility of the main NTSS hospital via telephone calls. All these factors were confirmed by the key informants of the current study. Finally, all patients and key informants agreed that SARS-CoV-2 negatively affected patients’ adherence to their DR treatment. Hence, scaling up of health care, referral, and appointment setting services could increase the uptake of treatment and retinal screenings among patients attending the Cape Town, NTSS public health care system.

The Etiology of Intraocular Inflammation in HIV Positive and HIV Negative Adults at a Tertiary Hospital in Cape Town, South Africa

2018 ◽  
Vol 27 (2) ◽  
pp. 203-210 ◽  
Author(s):  
Derrick P. Smit ◽  
Tonya M. Esterhuizen ◽  
David Meyer ◽  
Joke H. de Boer ◽  
Jolanda D. F. de Groot-Mijnes
Keyword(s):  
South Africa ◽  
Cape Town ◽  
Tertiary Hospital ◽  
Intraocular Inflammation ◽  
Hiv Positive ◽  
Hiv Negative

scholarly journals Effect of HIV Infection and Antiretroviral Treatment on Pregnancy Rates in the Western Cape Province of South Africa

2019 ◽  
Vol 221 (12) ◽  
pp. 1953-1962 ◽  
Author(s):  
Leigh F Johnson ◽  
Themba Mutemaringa ◽  
Alexa Heekes ◽  
Andrew Boulle
Keyword(s):  
South Africa ◽  
Hiv Infection ◽  
Antiretroviral Treatment ◽  
Incidence Rates ◽  
Hiv Care ◽  
Hiv Positive ◽  
Western Cape ◽  
Western Cape Province ◽  
Hiv Positive Women ◽  
Hiv Negative

Abstract Background Previous studies suggest that untreated human immunodeficiency virus (HIV) infection is associated with a reduced incidence of pregnancy, but studies of the effect of antiretroviral treatment (ART) on pregnancy incidence have been inconsistent. Methods Routine data from health services in the Western Cape province of South Africa were linked to identify pregnancies during 2007–2017 and maternal HIV records. The time from the first (index) pregnancy outcome date to the next pregnancy was modeled using Cox proportional hazards models. Results During 2007–2017, 1 042 647 pregnancies were recorded. In all age groups, pregnancy incidence rates were highest in women who had started ART, lower in HIV-negative women, and lowest in ART-naive HIV-positive women. In multivariable analysis, after controlling for the most recent CD4+ T-cell count, pregnancy incidence rates in HIV-positive women receiving ART were higher than those in untreated HIV-positive women (adjusted hazard ratio, 1.63; 95% confidence interval, 1.59–1.67) and those in HIV-negative women. Conclusion Among women who have recently been pregnant, receipt of ART is associated with high rates of second pregnancy. Better integration of family planning into HIV care services is needed.

scholarly journals Prevalence and determinants of unplanned pregnancy in HIV-positive and HIV-negative pregnant women in Cape Town, South Africa: a cross-sectional study

BMJ Open ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. e019979 ◽  
Author(s):  
Victoria Iyun ◽  
Kirsty Brittain ◽  
Tamsin K Phillips ◽  
Stanzi le Roux ◽  
James A McIntyre ◽  
...  
Keyword(s):  
South Africa ◽  
Pregnant Women ◽  
Unplanned Pregnancy ◽  
Cape Town ◽  
Cross Sectional Study ◽  
Hiv Positive ◽  
Sectional Study ◽  
Cross Sectional ◽  
Hiv Negative

scholarly journals Spatiotemporal modelling and mapping of cervical cancer incidence among HIV positive women in South Africa: a nationwide study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Dhokotera Tafadzwa ◽  
Riou Julien ◽  
Bartels Lina ◽  
Rohner Eliane ◽  
Chammartin Frederique ◽  
...  
Keyword(s):  
South Africa ◽  
Health Care ◽  
Cervical Cancer ◽  
South African ◽  
Access To Health Care ◽  
Health Facilities ◽  
Hiv Positive ◽  
The South ◽  
Hiv Positive Women ◽  
Access To Health

Abstract Background Disparities in invasive cervical cancer (ICC) incidence exist globally, particularly in HIV positive women who are at elevated risk compared to HIV negative women. We aimed to determine the spatial, temporal, and spatiotemporal incidence of ICC and the potential risk factors among HIV positive women in South Africa. Methods We included ICC cases in women diagnosed with HIV from the South African HIV cancer match study during 2004–2014. We used the Thembisa model, a mathematical model of the South African HIV epidemic to estimate women diagnosed with HIV per municipality, age group and calendar year. We fitted Bayesian hierarchical models, using a reparameterization of the Besag-York-Mollié to capture spatial autocorrelation, to estimate the spatiotemporal distribution of ICC incidence among women diagnosed with HIV. We also examined the association of deprivation, access to health (using the number of health facilities per municipality) and urbanicity with ICC incidence. We corrected our estimates to account for ICC case underascertainment, missing data and data errors. Results We included 17,821 ICC cases and demonstrated a decreasing trend in ICC incidence, from 306 to 312 in 2004 and from 160 to 191 in 2014 per 100,000 person-years across all municipalities and corrections. The spatial relative rate (RR) ranged from 0.27 to 4.43 in the model without any covariates. In the model adjusting for covariates, the most affluent municipalities had a RR of 3.18 (95% Credible Interval 1.82, 5.57) compared to the least affluent ones, and municipalities with better access to health care had a RR of 1.52 (1.03, 2.27) compared to municipalities with worse access to health. Conclusions The results show an increased incidence of cervical cancer in affluent municipalities and in those with more health facilities. This is likely driven by better access to health care in more affluent areas. More efforts should be made to ensure equitable access to health services, including mitigating physical barriers, such as transportation to health centres and strengthening of screening programmes.

scholarly journals A mixed reception: perceptions of pregnant adolescents’ experiences with health care workers in Cape Town, South Africa

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Ronel Sewpaul ◽  
Rik Crutzen ◽  
Natisha Dukhi ◽  
Derrick Sekgala ◽  
Priscilla Reddy
Keyword(s):  
South Africa ◽  
Health Care ◽  
Antenatal Care ◽  
Health Care Workers ◽  
Cape Town ◽  
Pregnant Adolescents ◽  
High Quality ◽  
Care Workers ◽  
Antenatal Clinics ◽  
Antenatal Services

Abstract Background Maternal mortality among adolescent mothers in South Africa is higher than many middle-income countries. This is largely attributable to conditions that can be prevented or managed by high quality antenatal care. The way in which pregnant adolescents are treated at antenatal clinics influences their timely utilization of antenatal services. This qualitative study reports on the experiences of pregnant adolescents with health care workers when accessing antenatal care. Methods Pregnant girls aged 13–19 (n = 19) who attended public health care facilities that provide Basic Antenatal Care (BANC) services in Cape Town, South Africa were recruited. Four face to face in-depth interviews and four mini focus group discussions were undertaken, facilitated by a topic guide. Thematic analyses were used to analyse the data. Results Experiences that reinforce antenatal attendance, such as respectful and supportive treatment, were outweighed by negative experiences, such as victimization; discrimination against being pregnant at a young age; experiencing disregard and exclusion; inadequate provision of information about pregnancy, health and childbirth; clinic attendance discouragement; and mental health turmoil. Conclusions There is evidence of a discordant relationship between the health care workers and the pregnant adolescents. Adolescents feel mistreated and discriminated against by the health care workers, which in turn discourages their attendance at antenatal clinics. Maternal health care workers need to receive support and regular training on the provision of youth friendly antenatal care and be regularly evaluated, to promote the provision of fair and high quality antenatal services for adolescent girls.

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