Repository logo

Doctoral Degrees (Public Health)

Permanent URI for this collectionhttps://hdl.handle.net/10413/6970

Browse

Browsing Doctoral Degrees (Public Health) by Author "Chimbari, Moses John."

Filter results by typing the first few letters
Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Acceptability and effectiveness of rapid ART initiation: patients’ and healthcare workers’ perspectives.
    (2022) Govere, Sabina May.; Chimbari, Moses John.
    The Joint United Nations Programme on HIV/AIDS is leading the global effort to end AIDS as a public health threat by 2030. In achieving these goals, emphasis has been on the 95–95–95 targets that by 2030, 95% of people living with HIV know their HIV status. However, the focus is on achieving the second 95 and third 95; having 95% of people diagnosed with HIV initiating on treatment within the expected timeframe and 95% of those on treatment obtaining a suppressed viral load. Commendable efforts have been made in increasing HIV testing numbers however, same day initiation on treatment and achieving viral load suppression remains a challenge. According to the WHO recommendations; same day (ART) initiation should be offered to all people living with HIV following a confirmed diagnosis. This study determined the factors influencing the acceptability and implementation of Universal Test and Treat by both patients and healthcare workers. Universal Test and Treat is a prevention strategy encourages that if a person tests HIV positive, irrespective of the persons CD4 count and clinical staging at the time of testing they will have to begin treatment immediately. Furthermore, patient’s clinical outcomes following test and treat in eThekwini municipality in KwaZulu-Natal were determined. This study was cross-sectional and used prospective - mixed methodology to collect data from 403 patients who either accepted or deferred same day ART initiation from June 2020 to May 2021. A structured questionnaire was used to collect demographic information, sexual behaviour, acceptance of same day ART initiation and knowledge of Universal Test and Treat on the day of HIV diagnosis. Key informant in-depth interviews were conducted with healthcare workers and patients were followed up at 6 months after HIV diagnosis to determine clinical outcomes for both groups, rapid and deferred ART initiators using medical charts and electronic databases. Two different analysis univariate and multivariate logistic regression were performed to examine associations between same day ART initiation and several explanatory factors. Logistic regression was performed to examine associations between same day ART initiation and several explanatory factors, retention in care, clinical outcomes and facility related factors. Thematic analysis was used to assess experiences, knowledge and observations of healthcare workers in implementing the Universal Test and Treat policy. Among the 403 participants same-day initiation was 69.2% (n=279). In an adjusted analysis (age, gender, level of education were adjusted at 0.5 significance level in univariate level) number of sexual partners (aOR: 0.35; 95% CI: 0.15-0.81), HIV status of the partner (aOR: 5.03; 95% CI: 2.74-9.26), knowledge of universal test and treat (aOR: 1.97; 95% CI: 1.34-2.90), support from non-governmental organizations (chi-square = 10.18; p-value= 0.015 and provision of clinic staff (chi-square = 7.51; p value = 0.006) were identified as major factors influencing uptake of same-day ART initiation. In the bivariate analysis; gender (OR: 1.672; 95% CI: 1.002–2.791), number of sexual partners (OR: 2.092; 95% CI: 1.07–4.061), age (OR: 0.941; 95% CI: 0.734–2.791), ART start date (OR: 0.078; 95% CI: 0.042–0.141) and partner HIV status (OR: 0.621; 95% CI: 0.387–0.995) were significantly associated with viral load detection and retention in care. (All variables that were significant at e.g. 0.5 level in univariate). Our results suggest a steady increase in uptake of same day ART initiation with poor retention in care. The results also emphasise a vital need to not only streamline processes to increase immediate ART uptake further but also ensure retention in care in order to meet the 95-95-95 targets. The findings of the study contribute to knowledge useful for strengthening rapid ART initiation implementation by considering individual patient factors, healthcare workers’ perspectives and facility level factors. The qualitative findings revealed variations in UTT knowledge, experiences and observations among diverse healthcare workers from the four clinics in different geographical settings. While training on UTT and SDI of ART initiation was conducted at the inception of the implementation phase, the understanding and interpretation varied especially between clinicians and non-clinical healthcare providers. Denial, feeling healthy, fear of disclosure, limited knowledge about ART, fear of ART side effects, fear of stigma and discrimination were some of the factors HCW observed as hindering uptake of SDI. These findings relate to some of the reasons given by patients with fear of disclosure frequently mentioned by those who deferred SDI of ART.
  • Thumbnail Image
    Item
    Evaluation of health promotion roles and services offered by health workers in the Nelson Mandela Bay Municipality of Eastern Cape, South Africa.
    (2022) Melariri, Herbert Ikechukwu.  ; Chimbari, Moses John.
    Background: Various factors affect the role of healthcare workers (HCWs) in health promotion (HP). The Nelson Mandela Bay Municipality (NMBM) public health service is overstretched and there is minimal evidence of health promoting healthcare services. This research project evaluated the roles and services of HCWs on HP as well as the views of patients regarding the HP services they received from HCWs in the municipality. Methods: A phased quantitative cross-sectional study was conducted to address the study aim and objectives. In phase one, 495 HCWs randomly sampled from 23 healthcare facilities in NMBM completed a structured questionnaire. In phase two, 500 patients completed a structured questionnaire regarding the quality of HP services received using the interview method. Descriptive and inferential analyses were conducted using StataIC 15. Results: Three groups of indicators classified as facility related indicators (FRI), healthcare workers’ related indicators (HRI), and outcome related indicators (ORI) emerged for measuring HP. The study identified thirteen categories of enablers and eight categories of hindrances. Eleven enablers and six hindrances were associated with tertiary hospitals, and none was recorded for the other health care levels. Collaboration among disciplines and organizations (Coeff: 2.16, 95% CI: 1.28 - 3.66) and programme planning (Coeff: 0.375, 95% CI: 0.23 - 0.62) were the predictors of HP and disease prevention (DP) enablers among medical doctors. On the other hand, ‘healthcare facilities promoting treatment more than DP’ (Coeff: 2.03, 95% CI: 1.30-3.14) and ‘absence of practice guidelines incorporating HP’ (Coeff: 2.79, 95% CI: 1.66-4.70) were the predictors of HP and DP hindrances among medical doctors and allied health workers (AHWs), respectively. Furthermore, most of the HCWs (75.78%; n=363) reported absence of coordinated HP training for staff in their facilities. Similarly, the attitude that ‘HP is a waste of time’ (adjusted Coeff 0.51, 95% CI 0.31 - 0.83) influenced the practice for AHWs. Results of the second phase study were categorized into three phases namely - pre-admission phase (PAP), admission phase (ADP), and post admission phase (POP). The ADP showed that patients’ health behaviours improved by 1.54 times by their interactions with nurses compared to their interactions with medical doctors. Conclusion: This study shows that the healthcare system is more committed to biomedical care as against health promotion services at all levels of healthcare. The implementation of HP services requires changes in HCWs behaviour, patients’ attitude and very importantly, structural reorganization and reprioritization.
  • Thumbnail Image
    Item
    The role of community engagement and involvement for community empowerment in health settings: the case of Ingwavuma community, KwaZulu-Natal, South Africa.
    (2023) Mthembu , Zinhle.; Chimbari, Moses John.
    Community Engagement (CE) in health research can improve a community's ability to address its own health needs and health inequalities, while ensuring that researchers understand community priorities. However, if effective CE processes are not used, communities will not be empowered to make effective decisions about their own health and wellbeing. This study is based on community-based health research projects; the Malaria and Bilharzia in South Africa (MABISA) and Tackling Infections Disease Burden in Africa-South Africa (TIBA-SA) implemented by the KwaZulu-Natal Ecohealth Program (KEP). I evaluated CE processes and outcomes, with a focus on schistosomiasis and malaria in a rural community of Ingwavuma, uMkhanyakude district in KwaZulu-Natal. The research approach was both qualitative and quantitative (mixed methods) with data collected through 34 in-depth interviews, 4 focus group discussions and 338 household questionnaires. Data was collected from heads of households, community advisory board members, community research assistants, primary school principal and KEP research team (including the project principal investigator and administrators). Data was collected in line with the five-stages of Community Engagement Vancouver Coastal Health framework. Data was analysed using QSR International Pty Ltd, NVivo 12 Pro and Chi-square tests were performed to assess associations between demographic variables and respondents’ knowledge and information of projects. The Principal Investigators informed the community about the project through community leaders (headmen) before the project commencement. As community members were involved at every stage of the process, from conceptualisation to dissemination, the study provided empirical evidence that collaborative partnerships lead to win-win outcomes. Involving headmen (indunas), CAB members, and CRAs in the project ensured shared goals, reciprocity, and mutual benefit, demonstrating the project's intention to help the community. Nearly half (48%) of the surveyed community members had never heard of MABISA. Ninety-four percent (94%) and ninety-seven percent (97%) of respondents had heard of bilharzia and malaria. Nearly the same proportions knew how both diseases are transmitted, thus demonstrating empowerment of community members on schistosomiasis and malaria issues. This study contributed to the understanding of best practices for community empowerment. The study provided information on how communities can positively influence their lives and manage their health problems. Such information can be extracted from the thesis and presented in vernacular language from the area. Furthermore, the thesis provided information of empowering researchers on how they can empower communities through effective engagement. Policy briefs that can be generated from the thesis provided useful information on community empowerment to policymakers and other stakeholders.