Integration of HIV/ AIDS, Tuberculosis and Patients’ Services into the General Health Care Systems: Implementation Challenges and Impact on TB Control Programme in O.R. Tambo District, Eastern Cape, South Africa.
- Authors: Dlatu, Ntandazo
- Date: 2024-08
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/11260/12987 , vital:76186
- Description: Tuberculosis (TB), a disease of poverty and inequality, is a leading cause of severe illness and death among people with human immunodeficiency virus (HIV). In South Africa, both TB and HIV epidemics have been closely related and persistent, posing a significant burden for healthcare provision. Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with fully integrated, people-centered models of care. Studies have observed that TB and HIV integration reduces mortality. However, the operational implementation of integrated services is still challenging. Gaps exist between the challenges of combining TB and HIV control with evidence-based knowledge, affecting the implementation process of this highly recommended strategy. Despite the policy, frameworks for integration exist; integration of TB and HIV services is far from ideal in many resource-limited countries, including South Africa. Few studies have examined the advantages and disadvantages of integrated TB and HIV care in public health facilities, and even fewer have proposed conceptual models for proven integration. Objectives: The goals of this study consisted of: (i) investigating the associations between socio-economic deprivation and tuberculosis (TB) treatment outcomes, alongside well-known TB risk factors. The effects of healthcare expenditures and their growth on trends in TB incidence from 2009 to 2013 were also assessed. (ii) Exploring patients’ and healthcare workers’ perceptions of TB and HIV integration as well as a strategy for integrating these programs. (iii) Describing patients’ perceptions on barriers to scaling up of TB-HIV integration services at selected health facilities; and (iv) Developing a paradigm for integrating TB, HIV, and patient services in a single facility and highlighting the importance of TB-HIV services for greater accessibility under one roof. Methods: In Phase 1 of the study, secondary data analysis was performed on data obtained from various sources including governmental, non-governmental, and research institutions. Indicators for TB treatment outcomes included TB death rate, TB rate among the household contacts of the Index TB cases, TB treatment failure, HIV-associated TB death rate, TB defaulter rate, and new TB smear-positive cases. Analysis of variance (ANOVA) and Turkey’s tests for post-hoc analysis were used to P a g e xvii | compare means of variables of interest considering a type I error rate of 0.05. , Thesis (PhD) -- Faculty of Medicine and Health Sciences, 2024
- Full Text:
- Date Issued: 2024-08
- Authors: Dlatu, Ntandazo
- Date: 2024-08
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/11260/12987 , vital:76186
- Description: Tuberculosis (TB), a disease of poverty and inequality, is a leading cause of severe illness and death among people with human immunodeficiency virus (HIV). In South Africa, both TB and HIV epidemics have been closely related and persistent, posing a significant burden for healthcare provision. Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with fully integrated, people-centered models of care. Studies have observed that TB and HIV integration reduces mortality. However, the operational implementation of integrated services is still challenging. Gaps exist between the challenges of combining TB and HIV control with evidence-based knowledge, affecting the implementation process of this highly recommended strategy. Despite the policy, frameworks for integration exist; integration of TB and HIV services is far from ideal in many resource-limited countries, including South Africa. Few studies have examined the advantages and disadvantages of integrated TB and HIV care in public health facilities, and even fewer have proposed conceptual models for proven integration. Objectives: The goals of this study consisted of: (i) investigating the associations between socio-economic deprivation and tuberculosis (TB) treatment outcomes, alongside well-known TB risk factors. The effects of healthcare expenditures and their growth on trends in TB incidence from 2009 to 2013 were also assessed. (ii) Exploring patients’ and healthcare workers’ perceptions of TB and HIV integration as well as a strategy for integrating these programs. (iii) Describing patients’ perceptions on barriers to scaling up of TB-HIV integration services at selected health facilities; and (iv) Developing a paradigm for integrating TB, HIV, and patient services in a single facility and highlighting the importance of TB-HIV services for greater accessibility under one roof. Methods: In Phase 1 of the study, secondary data analysis was performed on data obtained from various sources including governmental, non-governmental, and research institutions. Indicators for TB treatment outcomes included TB death rate, TB rate among the household contacts of the Index TB cases, TB treatment failure, HIV-associated TB death rate, TB defaulter rate, and new TB smear-positive cases. Analysis of variance (ANOVA) and Turkey’s tests for post-hoc analysis were used to P a g e xvii | compare means of variables of interest considering a type I error rate of 0.05. , Thesis (PhD) -- Faculty of Medicine and Health Sciences, 2024
- Full Text:
- Date Issued: 2024-08
Voices from the Patients: A Qualitative Study of the Integration of Tuberculosis, Human Immunodeficiency Virus and Primary Healthcare Services in O.R. Tambo District, Eastern Cape, South Africa
- Dlatu, Ntandazo, Oladimeji, Elizabeth Kelechi, Apalata, Teke
- Authors: Dlatu, Ntandazo , Oladimeji, Elizabeth Kelechi , Apalata, Teke
- Date: 2023/10
- Subjects: TB-HIV integration , Challenges and barriers , Patients , O.R. Tambo district , Eastern Cape , South Africa
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/11260/13590 , vital:78959 , DOI: https://doi.org/10.3390/idr15020017
- Description: Tuberculosis (TB), a disease of poverty and inequality, is a leading cause of severe illness and death among people with human immunodeficiency virus (HIV). In South Africa, both TB and HIV epidemics have been closely related and persistent, posing a significant burden for healthcare provision. Studies have observed that TB-HIV integration reduces mortality. The operational implementation of integrated services is still challenging. This study aimed to describe patients’ perceptions on barriers to scaling up of TB-HIV integration services at selected health facilities (study sites) in Oliver Reginald (O.R) Tambo Municipality, Eastern Cape province, South Africa. We purposely recruited twenty-nine (29) patients accessing TB and HIV services at the study sites. Data were analyzed using qualitative content analysis and presented as emerging themes. Barriers identified included a lack of health education about TB and HIV; an inadequate counselling for HIV and the antiretroviral drugs (ARVs); and poor quality of services provided by the healthcare facilities. These findings suggest that the O.R. Tambo district needs to strengthen its TB-HIV integration immediately.
- Full Text:
- Date Issued: 2023/10
- Authors: Dlatu, Ntandazo , Oladimeji, Elizabeth Kelechi , Apalata, Teke
- Date: 2023/10
- Subjects: TB-HIV integration , Challenges and barriers , Patients , O.R. Tambo district , Eastern Cape , South Africa
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/11260/13590 , vital:78959 , DOI: https://doi.org/10.3390/idr15020017
- Description: Tuberculosis (TB), a disease of poverty and inequality, is a leading cause of severe illness and death among people with human immunodeficiency virus (HIV). In South Africa, both TB and HIV epidemics have been closely related and persistent, posing a significant burden for healthcare provision. Studies have observed that TB-HIV integration reduces mortality. The operational implementation of integrated services is still challenging. This study aimed to describe patients’ perceptions on barriers to scaling up of TB-HIV integration services at selected health facilities (study sites) in Oliver Reginald (O.R) Tambo Municipality, Eastern Cape province, South Africa. We purposely recruited twenty-nine (29) patients accessing TB and HIV services at the study sites. Data were analyzed using qualitative content analysis and presented as emerging themes. Barriers identified included a lack of health education about TB and HIV; an inadequate counselling for HIV and the antiretroviral drugs (ARVs); and poor quality of services provided by the healthcare facilities. These findings suggest that the O.R. Tambo district needs to strengthen its TB-HIV integration immediately.
- Full Text:
- Date Issued: 2023/10
Developing a Model for Integrating of Tuberculosis, Human Immunodeficiency Virus and Primary Healthcare Services in Oliver Reginald (O.R) Tambo District, Eastern Cape, South Africa
- Dlatu, Ntandazo, Longo-Mbenza, Benjamin, Oladimeji, Elizabeth Kelechi, Apalata, Teke
- Authors: Dlatu, Ntandazo , Longo-Mbenza, Benjamin , Oladimeji, Elizabeth Kelechi , Apalata, Teke
- Date: 2023/07
- Subjects: Model developement , TB-HIV integrated model , TB and HIV , Quantitative and qualitative data
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/11260/13643 , vital:78964 , DOI: https://doi.org/10.3390/ijerph20115977
- Description: Despite the policy, frameworks for integration exist; integration of TB and HIV services is far from ideal in many resource-limited countries, including South Africa. Few studies have examined the advantages and disadvantages of integrated TB and HIV care in public health facilities, and even fewer have proposed conceptual models for proven integration. This study aims to fill this vacuum by describing the development of a paradigm for integrating TB, HIV, and patient services in a single facility and highlights the importance of TB-HIV services for greater accessibility under one roof. Development of the proposed model occurred in several phases that included assessment of the existing integration model for TB-HIV and synthesis of quantitative and qualitative data from the study sites, which were selected public health facilities in rural and peri-urban areas in the Oliver Reginald (O.R.) Tambo District Municipality in the Eastern Cape, South Africa. Secondary data on clinical outcomes from 2009–2013 TB–HIV were obtained from various sources for the quantitative analysis of Part 1. Qualitative data included focus group discussions with patients and healthcare workers, which were analyzed thematically in Parts 2 and 3. The development of a potentially better model and the validation of this model shows that the district health system was strengthened by the guiding principles of the model, which placed a strong emphasis on inputs, processes, outcomes, and integration effects. The model is adaptable to different healthcare delivery systems but requires the support of patients, providers (professionals and institutions), payers, and policymakers to be successful.
- Full Text:
- Date Issued: 2023/07
- Authors: Dlatu, Ntandazo , Longo-Mbenza, Benjamin , Oladimeji, Elizabeth Kelechi , Apalata, Teke
- Date: 2023/07
- Subjects: Model developement , TB-HIV integrated model , TB and HIV , Quantitative and qualitative data
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/11260/13643 , vital:78964 , DOI: https://doi.org/10.3390/ijerph20115977
- Description: Despite the policy, frameworks for integration exist; integration of TB and HIV services is far from ideal in many resource-limited countries, including South Africa. Few studies have examined the advantages and disadvantages of integrated TB and HIV care in public health facilities, and even fewer have proposed conceptual models for proven integration. This study aims to fill this vacuum by describing the development of a paradigm for integrating TB, HIV, and patient services in a single facility and highlights the importance of TB-HIV services for greater accessibility under one roof. Development of the proposed model occurred in several phases that included assessment of the existing integration model for TB-HIV and synthesis of quantitative and qualitative data from the study sites, which were selected public health facilities in rural and peri-urban areas in the Oliver Reginald (O.R.) Tambo District Municipality in the Eastern Cape, South Africa. Secondary data on clinical outcomes from 2009–2013 TB–HIV were obtained from various sources for the quantitative analysis of Part 1. Qualitative data included focus group discussions with patients and healthcare workers, which were analyzed thematically in Parts 2 and 3. The development of a potentially better model and the validation of this model shows that the district health system was strengthened by the guiding principles of the model, which placed a strong emphasis on inputs, processes, outcomes, and integration effects. The model is adaptable to different healthcare delivery systems but requires the support of patients, providers (professionals and institutions), payers, and policymakers to be successful.
- Full Text:
- Date Issued: 2023/07
Models of integration of TB and HIV services and factors associated with perceived quality of TB-HIV integrated service delivery in O.R Tambo District, South Africa
- Dlatu, Ntandazo, Longo-Mbenza, Benjamin, Apalata, Teke
- Authors: Dlatu, Ntandazo , Longo-Mbenza, Benjamin , Apalata, Teke
- Date: 2023/07
- Subjects: Tuberculosis , HIV , HIV/TB integration , Healthcare services
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/11260/13560 , vital:78954 , DOI: https://doi.org/10.1186/s12913-023-09748-2
- Description: Background Tuberculosis is the leading infectious cause of death among people living with HIV. Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with fully integrated, people-centered models of care. Methods This is a qualitative study design using principles of ethnography and the application of aggregate complexity theory. A total of 54 individual interviews with healthcare workers and patients took place in five primary healthcare facilities in the O.R. Tambo district. The participants were purposively selected until the data reached saturation point, and all interviews were tape-recorded. Quantitative analysis of qualitative data was used after coding ethnographic data, looking for emerging patterns, and counting the number of times a qualitative code occurred. A Likert scale was used to assess the perceived quality of TB/HIV integration. Regression models and canonical discriminant analyses were used to explore the associations between the perceived quality of TB and HIV integrated service delivery and independent predictors of interest using SPSS® version 23.0 (Chicago, IL) considering a type I error of 0.05. Results Of the 54 participants, 39 (72.2%) reported that TB and HIV services were partially integrated while 15 (27.8%) participants reported that TB/HIV services were fully integrated. Using the Likert scale gradient, 23 (42.6%) participants perceived the quality of integrated TB/HIV services as poor while 13 (24.1%) and 18 (33.3%) perceived the quality of TB/HIV integrated services as moderate and excellent, respectively. Multiple linear regression analysis showed that access to healthcare services was significantly and independently associated with the perceived quality of integrated TB/HIV services following the equation: Y=3.72–0.06X (adjusted R2=23%, p-value=0.001). Canonical discriminant analysis (CDA) showed that in all 5 municipal facilities, long distances to healthcare facilities leading to reduced access to services were significantly more likely to be the most impeding factor, which is negatively influencing the perceived quality of integrated TB/HIV services, with functions’ coefficients ranging from 9.175 in Mhlontlo to 16.514 in KSD (Wilk’s Lambda=0.750, p=0.043).
- Full Text:
- Date Issued: 2023/07
- Authors: Dlatu, Ntandazo , Longo-Mbenza, Benjamin , Apalata, Teke
- Date: 2023/07
- Subjects: Tuberculosis , HIV , HIV/TB integration , Healthcare services
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/11260/13560 , vital:78954 , DOI: https://doi.org/10.1186/s12913-023-09748-2
- Description: Background Tuberculosis is the leading infectious cause of death among people living with HIV. Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with fully integrated, people-centered models of care. Methods This is a qualitative study design using principles of ethnography and the application of aggregate complexity theory. A total of 54 individual interviews with healthcare workers and patients took place in five primary healthcare facilities in the O.R. Tambo district. The participants were purposively selected until the data reached saturation point, and all interviews were tape-recorded. Quantitative analysis of qualitative data was used after coding ethnographic data, looking for emerging patterns, and counting the number of times a qualitative code occurred. A Likert scale was used to assess the perceived quality of TB/HIV integration. Regression models and canonical discriminant analyses were used to explore the associations between the perceived quality of TB and HIV integrated service delivery and independent predictors of interest using SPSS® version 23.0 (Chicago, IL) considering a type I error of 0.05. Results Of the 54 participants, 39 (72.2%) reported that TB and HIV services were partially integrated while 15 (27.8%) participants reported that TB/HIV services were fully integrated. Using the Likert scale gradient, 23 (42.6%) participants perceived the quality of integrated TB/HIV services as poor while 13 (24.1%) and 18 (33.3%) perceived the quality of TB/HIV integrated services as moderate and excellent, respectively. Multiple linear regression analysis showed that access to healthcare services was significantly and independently associated with the perceived quality of integrated TB/HIV services following the equation: Y=3.72–0.06X (adjusted R2=23%, p-value=0.001). Canonical discriminant analysis (CDA) showed that in all 5 municipal facilities, long distances to healthcare facilities leading to reduced access to services were significantly more likely to be the most impeding factor, which is negatively influencing the perceived quality of integrated TB/HIV services, with functions’ coefficients ranging from 9.175 in Mhlontlo to 16.514 in KSD (Wilk’s Lambda=0.750, p=0.043).
- Full Text:
- Date Issued: 2023/07
The integration of mental health care services into primary health care system at King Sabata Dalindyebo Municipality Clinics
- Authors: Dlatu, Ntandazo
- Date: 2012
- Subjects: Community mental health services South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: vital:18478 , http://hdl.handle.net/11260/d1008290
- Description: Introduction: Primary Health care refers to care which is based on the needs of population. Mental health care provided within general primary care services is the first level of care within the formal health system. There is no research in King Sabata Dalindyebo, carried out on issues around integration of mental health with primary health care. The present study is initiated to overcome this gap. Aim of the study: The aim of the study was to investigate the level of knowledge, implementation and barriers of integrating mental health care services into primary health care system at King Sabata Dalindyebo clinics, in Mthatha region. Methods: This descriptive cross-sectional study was conducted at King Sabata Dalindyebo Clinics, between January 2010 and December 2011. A 10% random sample of all health professionals from King Sabata Dalindyebo was interviewed concerning their demographic characteristics, education/ qualifications, general and further training in psychiatry, awareness about Mental Health Care Act 17 of 2002 and mental health care services characteristic related to the integration of mental health care services into primary health care system. For data analysis, the means of continuous variables across 2 groups were compared using Student-t test. The proportions (%) of the categorical variable across 2 groups were compared using Chi-square test. Results: A total of 52 health professionals (40.4% males, 59.6 females, 59.6 married, 3 doctors, 49 nurses, mean age 36.9± 8 years range 23 years-52 years), were surveyed. The participants were characterized by low level of qualification in specialization, further training in psychiatry, and by very low awareness about Mental Health Care Act 17 of 2002. Furthermore, there was no implication of expects (Regional psychiatrist, psychologist, social worker) and co-ordination of mental health care services. Working in remote and disadvantaged area, health workers with lower education qualification, absence of a coordinator for mental health care services and absence of workshop on Mental Health Care Act 17 of 2002 were determinants of lower awareness about Mental Health Care Act 17 of 2002. However, there was a good to excellent framework for potential implementation of mental health care services into primary health care system. The government support in infrastructures, drugs availability, transport and equipment was evident. Patients were helped within abroad based ethical, human rights and psycho-social framework. Conclusion: There is a lack of improving human capacity for mental health in terms of continuous training in mental health issues, policies, organisation and development. Globally, the integration of mental health care service in King Sabata Dalindyebo is non-optimal.
- Full Text:
- Date Issued: 2012
- Authors: Dlatu, Ntandazo
- Date: 2012
- Subjects: Community mental health services South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: vital:18478 , http://hdl.handle.net/11260/d1008290
- Description: Introduction: Primary Health care refers to care which is based on the needs of population. Mental health care provided within general primary care services is the first level of care within the formal health system. There is no research in King Sabata Dalindyebo, carried out on issues around integration of mental health with primary health care. The present study is initiated to overcome this gap. Aim of the study: The aim of the study was to investigate the level of knowledge, implementation and barriers of integrating mental health care services into primary health care system at King Sabata Dalindyebo clinics, in Mthatha region. Methods: This descriptive cross-sectional study was conducted at King Sabata Dalindyebo Clinics, between January 2010 and December 2011. A 10% random sample of all health professionals from King Sabata Dalindyebo was interviewed concerning their demographic characteristics, education/ qualifications, general and further training in psychiatry, awareness about Mental Health Care Act 17 of 2002 and mental health care services characteristic related to the integration of mental health care services into primary health care system. For data analysis, the means of continuous variables across 2 groups were compared using Student-t test. The proportions (%) of the categorical variable across 2 groups were compared using Chi-square test. Results: A total of 52 health professionals (40.4% males, 59.6 females, 59.6 married, 3 doctors, 49 nurses, mean age 36.9± 8 years range 23 years-52 years), were surveyed. The participants were characterized by low level of qualification in specialization, further training in psychiatry, and by very low awareness about Mental Health Care Act 17 of 2002. Furthermore, there was no implication of expects (Regional psychiatrist, psychologist, social worker) and co-ordination of mental health care services. Working in remote and disadvantaged area, health workers with lower education qualification, absence of a coordinator for mental health care services and absence of workshop on Mental Health Care Act 17 of 2002 were determinants of lower awareness about Mental Health Care Act 17 of 2002. However, there was a good to excellent framework for potential implementation of mental health care services into primary health care system. The government support in infrastructures, drugs availability, transport and equipment was evident. Patients were helped within abroad based ethical, human rights and psycho-social framework. Conclusion: There is a lack of improving human capacity for mental health in terms of continuous training in mental health issues, policies, organisation and development. Globally, the integration of mental health care service in King Sabata Dalindyebo is non-optimal.
- Full Text:
- Date Issued: 2012
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