Use of interactive messaging to reduce pre-diagnosis loss to follow-up for TB care

OBJECTIVE: To investigate the uptake and usage of a WhatsApp-based interactive communication strategy to avert pre-diagnosis loss to follow-up (LTFU) from TB care in a high-incidence setting.METHODS: We enrolled adults (≥18 years) who underwent routine sputum TB testing in two primary healthcare clinics in Khayelitsha, Cape Town, South Africa. The intervention consisted of structured WhatsApp-based reminders (prompts) sent prior to a routine clinic appointment scheduled 2–3 days after the diagnostic visit. Pre-diagnosis LTFU was defined as failure to return for the scheduled appointment and within 10 days.RESULTS: We approached 332 adults with presumptive TB, of whom 103 (31%) were successfully enrolled; 213 (64%) did not own a WhatsApp-compatible phone. Of 103 participants, 74 (72%) actively responded to WhatsApp prompts; 69 (67%) opted to include a close contact in group communication to co-receive reminders. Pre-diagnosis LTFU was low overall (n = 7, 6.8%) and was not associated with failure to respond to WhatsApp prompts.CONCLUSION: In this high-incidence setting, enrolment in a WhatsApp-based communication intervention among adults with presumptive TB was low, mainly due to low availability of WhatsApp-compatible phones. Among participants, we observed high message response rates and low LTFU, suggesting potential for interactive messaging services to support pre-diagnosis TB care.

Assessing the impact of simplified HCV care on linkage to care amongst high-risk patients at primary healthcare clinics in Malaysia: a prospective observational study

IntroductionTo achieve the elimination of hepatitis C virus (HCV), substantial scale-up in access to testing and treatment is needed. This will require innovation and simplification of the care pathway, through decentralisation of testing and treatment to primary care settings and task-shifting to non-specialists. The objective of this study was to evaluate the feasibility and effectiveness of decentralisation of HCV testing and treatment using rapid diagnostic tests (RDTs) in primary healthcare clinics (PHCs) among high-risk populations, with referral of seropositive patients for confirmatory viral load testing and treatment.MethodsThis observational study was conducted between December 2018 and October 2019 at 25 PHCs in three regions in Malaysia. Each PHC was linked to one or more hospitals, for referral of seropositive participants for confirmatory testing and pretreatment evaluation. Treatment was provided in PHCs for non-cirrhotic patients and at hospitals for cirrhotic patients.ResultsDuring the study period, a total of 15 366 adults were screened at the 25 PHCs, using RDTs for HCV antibodies. Of the 2020 (13.2%) HCV antibody-positive participants, 1481/2020 (73.3%) had a confirmatory viral load test, 1241/1481 (83.8%) were HCV RNA-positive, 991/1241 (79.9%) completed pretreatment assessment, 632/991 (63.8%) initiated treatment, 518/632 (82.0%) completed treatment, 352/518 (68.0%) were eligible for a sustained virological response (SVR) cure assessment, 209/352 (59.4%) had an SVR cure assessment, and SVR was achieved in 202/209 (96.7%) patients. A significantly higher proportion of patients referred to PHCs initiated treatment compared with those who had treatment initiated at hospitals (71.0% vs 48.8%, p<0.001).ConclusionsThis study demonstrated the effectiveness and feasibility of a simplified decentralised HCV testing and treatment model in primary healthcare settings, targeting high-risk groups in Malaysia. There were good outcomes across most steps of the cascade of care when treatment was provided at PHCs compared with hospitals.

Experiences of nursing students regarding clinical placement and support in primary healthcare clinics: Strengthening resilience

Background: This research addressed the need to have a deeper understanding of nursing students’ experiences of clinical placement and support in primary healthcare (PHC) settings.Aim: To explore and describe the experiences of nursing students’ clinical placement in PHC settings.Setting: The study was conducted at PHC clinics in a specific province in South Africa.Method: A qualitative, exploratory, descriptive and contextual research design was used. The population comprised fourth-year nursing students selected using purposive sampling. Five semi-structured focus group interviews were conducted. Data saturation determined the sample size which comprised 25 nursing students. Thematic data analysis produced four main themes.Results: The main themes were (1) the meaning of placement, (2) experiences of clinical placement, (3) needs for support, and (4) resilience of nursing students.Conclusions: Nursing students encountered negative and positive experiences. Both experiences confirmed that PHC settings can be valuable learning opportunities for nursing students. Nursing students appreciated the supervision of professional nurses who created an atmosphere conducive for teaching and learning by welcoming and encouraging nursing students’ independence. Recommendations include: appointing a professional nurse specifically for supervision of nursing students, tutor support before summative examinations, improvement of services, including the availability of resources.Contribution: This article contributes to awareness of how nursing students manage to stay resilient irrespective of negative experiences during clinical placement and how tutors and professional nurses can support them. The study’s recommendations can guide professional nurses, nurse educators, nurse managers and other healthcare PHC workers to support nursing students.

Midwives’ acceptance of mHealth applications in the dissemination of maternal health education in primary healthcare clinics

Health education improves pregnancy outcomes, with mHealth increasing its access; however, barriers to delivering messages exist. The study aimed to describe midwives’ (N = 104) acceptance of mHealth in health educating pregnant women during and between antenatal visits at primary healthcare clinics in a sub-district of eThekwini, KwaZulu-Natal, South Africa. Yakubu and Dasuki's, self-administered questionnaire consisting of six subscales and based on the UTAUT model, guided the study. The response rate was 88.5% ( n = 92). Performance Expectancy was the highest of the six mHealth subscales, showing that midwives were willing to connect pregnant women to mHealth applications and finding them useful. Conversely, Facilitating Conditions, was lowest indicating lesser technical infrastructure to encourage the use of the system. A significant association ( p = .016) between age groups and Behavioural Intention was driven by older respondents’ (51 + years.) lower level of intent. Path analysis showed Actual Usage of the mHealth programmes was significantly associated with both Behavioral Intentions and Facilitating Conditions. If pregnant women's maternal health is to be adequately addressed, efficient use is to be made of mHealth programs, and barriers emanating from the senders (midwives), and organizational structures need identification.

Estimating the contribution of transmission in primary healthcare clinics to community-wide TB disease incidence, and the impact of infection prevention and control interventions, in KwaZulu-Natal, South Africa

Background There is a high risk of Mycobacterium tuberculosis (Mtb) transmission in healthcare facilities in high burden settings. Recent World Health Organization guidelines on tuberculosis infection prevention and control (IPC) recommend a range of measures to reduce transmission in healthcare and institutional settings. These were evaluated primarily based on evidence for their effects on transmission to healthcare workers in hospitals. To estimate the overall impact of IPC interventions, it is necessary to also consider their impact on overall community-wide tuberculosis incidence and mortality. Methods We developed an individual-based model of Mtb transmission between household members, in primary healthcare clinics (PHCs), and in other congregate settings; drug sensitive and multidrug resistant tuberculosis disease development and resolution; and HIV and antiretroviral therapy (ART) and their effects on tuberculosis. The model was parameterised using data from a high HIV prevalence, rural/peri-urban community in KwaZulu-Natal, South Africa, including data on social contact in clinics and other settings by sex, age group, and HIV/ART status; and data on the prevalence of tuberculosis in clinic attendees and the general population. We estimated the proportion of disease in adults that resulted from transmission in PHC clinics in 2019, and the impact of a range of IPC interventions in clinics on community-wide TB incidence and mortality. Results We estimate that 7.6% (plausible range 3.9-13.9%) of drug sensitive and multidrug resistant tuberculosis in adults resulted from transmission in PHC clinics in the study community in 2019. The proportion is higher in HIV-positive people, at 9.3% (4.8%-16.8%), compared to 5.3% (2.7%-10.1%) in HIV-negative people. We estimate that IPC interventions could reduce the number of incident TB cases in the community in 2021-2030 by 3.4-8.0%, and the number of deaths by 3.0-7.2%. Conclusions A non-trivial proportion of tuberculosis results from transmission in PHC clinics in the study communities, particularly in HIV-positive people. Implementing IPC interventions could lead to moderate reductions in disease burden. We therefore recommend that IPC measures in clinics should be implemented both for their benefits to staff and patients, but also for their likely effects on TB incidence and mortality in the surrounding community.

Availability and Use of Mobile Health Technology for Disease Diagnosis and Treatment Support by Health Workers in the Ashanti Region of Ghana: A Cross-sectional Survey

Background: Mobile health (mHealth) technologies have been identified as promising strategies for improving access to healthcare delivery and patient outcomes. However, the extent of availability and use of mHealth among healthcare professionals in Ghana is not known. The main objective of this study is to determine the availability and use of mHealth for disease diagnosis and treatment support by health professionals in the Ashanti Region of Ghana. Methods: A cross-sectional survey was carried out among 285 healthcare professionals across 100 primary healthcare clinics in the Ashanti Region, Ghana. We obtained data on the participants' background, available health infrastructure, healthcare workforce competency, ownership of a mobile wireless device, usefulness of mHealth, ease of use of mHealth, user satisfaction, and behavioural intention to use mHealth. Descriptive statistics were conducted to characterize healthcare professionals' demographics and clinical features. Multivariate logistic regression analysis was performed to explore the influence of the demographic factors on the availability and use of mHealth for disease diagnosis and treatment support. STATA version 15 was used to compute all the statistical analyses. Findings: Out of the 285 healthcare professionals, 62.8% indicated that mHealth applications are available to them, while 37.2% had no access to mHealth. Of the 185 healthcare professionals who had access to mHealth, 98.4% are currently using mHealth to support healthcare delivery. Logistic regression model analysis significantly (p< 0.05) identified factors associated with the availability and use of mHealth applications for disease diagnosis and treatment support. There was a significant association between the availability and use of mHealth for disease diagnosis and treatment support from the chi-square test analysis. Conclusion: The findings demonstrate a low-level use of mHealth for disease diagnosis and treatment support by healthcare professionals at the rural primary healthcare clinics. We encourage policymakers to promote the implementation of mHealth in rural primary health clinics.

Factors Influencing Patient Experience in Primary Healthcare Clinics within the eThekwini Municipality in KwaZulu-Natal

Patient experience is seen as a fundamental measure for healthcare evaluation, which fuels the debate regarding the most relevant factors influencing patient experience. Limited empirical knowledge exists concerning the factors that influence patient experience from the users’ perspective in South Africa. This study addresses the research gap by determining the factors influencing patient experience among primary healthcare users in Waterloo, Grove-End and Stonebridge communities in the eThekwini Municipality of KwaZulu-Natal. The study is quantitative, descriptive and cross-sectional, and utilises a self-administered questionnaire that was distributed among 280 primary healthcare users. They strongly agreed (> 90%) that all the factors presented in the study are contributors to their patient experience. The factor analysis determined the relevance of the factors as perceived by the respondents. It was found that the doctor’s role (0.970), clinic cleanliness (0.943), coordination and continuity of care (0.943), and waiting time (0.914) are the most significant influencers of patient experience. Education (0.898), nurses (0.882), medication (0.854) and the quality of care (0.853) serve as moderate influencers. Access (0.745), family/friend involvement (0.722) and the physical state of the infrastructure (0.714) are mild influencers of patient experience. Patient-centred care (0.639), management effectiveness (0.637), communication (0.596) and information (0.443) were non-influencers of patient experience. User experience is multifaceted and each factor represents a varying level of influence. It is recommended that a patient-experience framework should be developed that can be linked to improvement initiatives within South Africa in an effort to support quality improvement.