Linkage to care of HIV positive clients in a community based HIV counselling and testing programme: A success story of non-governmental organisations in a South African district

Abstract Objective: Despite the high HIV associated burden, Mozambique lacks data on HIV counselling and testing (HCT) costs. To help guide national HIV/AIDS programs, we estimated the cost per test for voluntary counselling and testing (VCT) from the patient’s perspective and the costs per person tested and per HIV-positive individual linked to care to the healthcare provider for VCT, provider-initiated counselling and testing (PICT) and home-based testing (HBT). We also assessed the cost-effectiveness of these strategies for linking patients to care.Methods: Data from a cohort study conducted in the Manhiça District were used to derive costs and linkage-to-care outcomes of the three HCT strategies. A decision tree was used to model HCT costs according to the likelihood of HCT linking individuals to care and to obtain the incremental cost-effectiveness ratios (ICERs) of PICT and HBT with VCT as the comparator. Sensitivity analyses were performed to assess robustness of base-case findings. Findings: Average and median VCT costs to the patient per individual tested were US$1.34 and US$1.08, respectively. Costs per individual tested were greatest for HBT (US$11.07), followed by VCT (US$7.79), and PICT (US$7.14). The costs per HIV-positive individual linked to care followed a similar trend. PICT was not cost-effective in comparison with VCT at a willingness-to-accept threshold of US$4.53, but only marginally given a corresponding base-case ICER of US$4.15, while HBT was dominated, with higher costs and lower impact than VCT. Base-case results for the comparison between PICT and VCT presented great uncertainty, whereas findings for HBT were robust.Conclusion: PICT and VCT are likely equally cost-effective in Manhiça. We recommend that VCT be offered as the predominant HCT strategy in Mozambique, but expansion of PICT could be considered in limited-resource areas. HBT without facilitated linkage or reduced costs is unlikely to be cost-effective.

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Social franchising of community-based HIV counselling and testing services to increase HIV testing and linkage to care in Tshwane, South Africa: study protocol for a non-randomised implementation trial

BMC Public Health ◽

10.1186/s12889-020-8231-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Simukai Shamu ◽

Charles Chasela ◽

Jean Slabbert ◽

Thato Farirai ◽

Geoffrey Guloba ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Study Protocol ◽

Linkage To Care ◽

Community Based ◽

Social Franchising ◽

Hiv Counselling And Testing ◽

Implementation Trial

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Mental health intervention with premature infants and their mothers in a South African community based hospital

PsycEXTRA Dataset ◽

10.1037/e579192013-368 ◽

2012 ◽

Author(s):

S. Maharaj ◽

J. Koursaris

Keyword(s):

Mental Health ◽

South African ◽

Premature Infants ◽

Health Intervention ◽

Mental Health Intervention ◽

Community Based ◽

African Community

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Complementing the ICC Efforts to Curb the Impunity of International Crimes in Africa

10.1093/oso/9780198810568.003.0015 ◽

2017 ◽

Author(s):

Pacifique Manirakiza

Keyword(s):

South African ◽

International Criminal ◽

Criminal Court ◽

Potential Contribution ◽

African Continent ◽

Community Based ◽

Academic Literature ◽

International Crimes ◽

Set Up ◽

Thabo Mbeki

A matter raised consistently by eminent personalities asked to report on atrocities in Africa, such as former South African President Thabo Mbeki, is the utilization of traditional justice mechanisms known to Africans. Their use has been limited to Gacaca courts in Rwanda, set up in haste and subject to much criticism. However, there exist several types and models of traditional justice mechanisms at the African level. The contribution of these sui generis mechanisms towards accountability for heinous crimes is largely unaddressed in academic literature. This chapter intends to fill this gap by exploring their potential contribution towards accountability for heinous crimes, alongside the International Criminal Court (ICC). In short, the chapter explores how community-based judicial mechanisms and the ICC, two types of accountability mechanisms with different methodologies and approaches, can work side by side to eradicate impunity regarding, and also to prevent, mass atrocities on the African continent.

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

International Journal of Health Geographics ◽

10.1186/s12942-021-00283-z ◽

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.

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