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Masters Degrees (Public Health)

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Browsing Masters Degrees (Public Health) by Subject "AIDS (Disease)"

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    An implementation evaluation study of a nurse initiated and managed antiretroviral therapy (NIMART) program in primary health care clinics in the Ugu district of KwaZulu-Natal.
    (2016) Xaba, Pearl.; Kerr, Jane.
    AIM The purpose of this study was to conduct an implementation evaluation study of Nurse Initiated and Managed Antiretroviral Therapy (NIMART) program in Primary Health Care (PHC) clinics in the Ugu district of KwaZulu-Natal. METHOD A quantitative non-experimental descriptive approach and evaluative design consisting of self-administered questionnaires was used to conduct the study to evaluate the availability of the latest Antiretroviral Therapy Guidelines, to evaluate the implementation of the Nurse Initiated and Managed Antiretroviral Therapy (NIMART) program and to evaluate the knowledge and practice of professional nurses towards the NIMART program in the 56 clinics of the Ugu district. Information leaflets were given to the participants and informed consent was obtained from each participant. The number of participants that were enrolled in the study was 52 because they met the inclusion criteria of working in the PHC clinics in the Ugu district and were trained in the NIMART course. The other 4 participants were not trained in the NIMART course and were excluded according to the exclusion criteria. RESULTS The study revealed that in 98% (n=51) of the clinics in the Ugu district, nurses were initiating adults on ART and only 2% (n=1) were still being initiated by the doctor. Furthermore, the majority of respondents indicated that children were initiated on ART in their clinics, while some respondents reported that in their clinics children are still initiated by the clinic visiting doctor or hospital doctor. The findings indicated that 98% (n=51) of clinics have the latest ART Guidelines available, while only 2% (n=1) of clinics indicated that they have outdated ART Guidelines available in the clinic. The study revealed that most respondents knew the correct ART regimens, ART eligibility criteria and when blood for CD4 count and viral load is taken, while there were still some respondents who did not know. CONCLUSIONS AND RECOMMENDATIONS The District HAST Manager and clinics’ Operational Managers must ensure that the latest 2015 National Consolidated Guidelines for PMTCT are available in all the PHC clinics. More nurses should be trained in NIMART. All the nurses that are NIMART trained should receive mentorship after the training so that they become competent and confident in initiating and managing HIV-positive patients on ART. The findings of this study revealed that there were some gaps in nurse’s knowledge around ART regimens, blood tests and eligibility criteria. This study can be used as a baseline to evaluate all the professional nurses trained in NIMART in Ugu district. The District Training Coordinator must arrange a workshop regarding the 2015 National Consolidated Guidelines to refresh NIMART nurses about ART regimens, about blood tests to be done and about the ART eligibility criteria.
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    A review of the use of lay counsellors and rapid HIV tests in a voluntary counselling and testing service in UGU South ProTest pilot site.
    (2002) Campbell, Laura.
    This study aimed to review the use of lay counsellors and rapid HIV tests in a voluntary testing and counselling (VCT) service in the UGU South health district of KwaZulu Natal. The study ran from September 1999 to April 2001. In early 1999, UGU South was selected as a pilot site as part of an international initiative. This initiative aimed to promote testing for HIV by using VCT service as an entry point into a range of HIV/AIDS and TB prevention and care programmes and was termed the ProTEST Initiative. Four such ProTEST sites were developed in South Africa and all offered rapid HIV testing and prophylactic drugs (Isoniazid and Cotrimoxazole) for HIV infected people. VCT was prioritised at all sites, however UGU South was unique in providing lay counsellors. Traditionally a lay counsellor (who is not a trained health care worker), offered only pre and post- test counselling. Lay counsellors had been used in South Africa, however their impact had not been formally assessed. In accordance with the Health Professional Council ruling on testing blood, lay counsellors could not carry out a rapid HIV test procedure. The decision to use lay counsellors in UGU South, was based on a review of the capacity of existing health care workers to expand a VCT service. Ten female lay counsellors, who fulfilled pre-employment selection criteria, were employed. In 1999, VCT was prioritised by the South African Department of Health and a Strategic Plan on HIV/AIDS & STDs was developed. The aim was to test 12.5% of the adult population for HIV before the year 2005. The proposed VCT service was to be based at health facilities and was to utilize existing health care workers. The capacity of existing health care workers to cope with an expansion in VCT services had not been explored. The reasons why clients accessed VCT and the demographic profiles of such clients were poorly understood. The Department of Health also planned to use rapid HIV tests at health facilities. Literature on the use of rapid HIV tests in South Africa was limited. This study aimed to address gaps in knowledge around VCT in South Africa and specific objectives were to: * Assess the capacity of existing health care workers to expand a VCT service *Review the need for rapid HIV tests *Develop and evaluate a training, support and mentorship programme for lay counsellors *Review the reason why clients use a VCT service and the demographic profiles of such clients *Monitor the impact of lay counsellors on numbers of cases of TB diagnosed and treated *Make recommendations for the use of lay counsellors and rapid HIV tests in an expanded integrated HIV/TB Control Programme. The study was prospective, descriptive and was based at ten health facilities in UGU South. The health facilities offered counselling, rapid HIV tests and prophylaxis for HIV infected people (Isoniazid or Cotrimoxazole). The study population was all nurses, lay counsellors and clients involved with the VCT service at these sites. Both qualitative and quantitative methods of study were employed in this study including: *Postal survey * Interviews *Focus group discussion *Review of patient records, literature and questionnaires * Analysis of registers from the National TB Control Programme. Results from three independent reviews clearly indicated that nurses in UGU South did not have the capacity to offer an expanded VCT service due to a heavy workload commitment. The nurses considered that VCT was a necessary service and supported the introduction of lay counsellors. Quantitative reviews concluded that a third of people tested for HIV using a hospital based testing system never returned for their results and that the turn-around time for an HIV test result was as much as three weeks. Rapid HIV tests increased access to an HIV test result and were acceptable to health care workers. There was no review of the opinions of clients on the rapid HIV tests. A training, support and mentorship programme was developed for lay counsellors and both nurses and counsellors considered that the programme was largely effective. The lay counsellors were trained to offer a more comprehensive service than traditional lay counsellors; in particular lay counsellors were expected to screen clients for symptoms of TB disease and support clients taking TB medication. Evaluation of the programme concluded that the content should be more practical and there should be a dedicated supporter for the lay counsellors available at their place of work. Results suggested that access to VCT services increased due to the presence of lay counsellors. The lay counsellors were acceptable to health staff, however there was no review of the opinions of clients on the lay counsellors. Half of the 7 475 people tested were infected with HIV. Most clients were medically referred for VCT and had "AIDS defining" illnesses. The clients who self-referred were ill or knew someone who had died recently. The proportion of clients who self-referred increased and health education was the main reason why people self-presented. More women than men were tested and women were more likely to test HIV positive. Review of the TB registers indicated that the TB Control Programme in UGU South was not optimal. The impact of lay counsellors on numbers of TB cases diagnosed and on treatment could not be determined from this study. Before the use of lay counsellors is expanded, there should further review of the capacity of other health care workers to offer VCT. Issues such as conditions of employment, salaries and a job description for lay counsellors should be clarified. There should be an independent assessment of the quality of counselling offered and a review of the cost of the lay counsellors. The impact of using men and younger lay counsellors should be reviewed. VCT services should be based at clinics, rather than hospitals and consideration should be given to developing freestanding VCT sites. Education programmes on VCT should be expanded beyond health facilities. Prior to expanding the use of rapid HIV tests, there should be a review of the cost of rapid HIV tests and systems should be in place for ordering, delivery and for stock control. The opinions of clients on rapid HIV testing should be ascertained. Consideration should be given to lay counsellors performing the rapid HIV test or an alternative method of testing (not involving blood) should be introduced. There should be ongoing training in TB and monitoring of the TB Control Programme in UGU South. Specific indicators should be developed to monitor the impact of lay counsellors on the diagnosis and treatment of TB and to measure collaboration between HIV/AIDS and TB Control Programmes.