BackgroundLengthy antiretroviral treatment (ART) preparation contributes to high losses to care between communicating ART eligibility and initiating ART. To address this shortfall, Médecins Sans Frontières implemented a revised approach to ART initiation counselling preparation (integrated for TB co-infected patients), shifting the emphasis from pre-initiation sessions to addressing common barriers to adherence and strengthening post-initiation support in a primary healthcare facility in Khayelitsha, South Africa.MethodsAn observational cohort study was conducted using routinely collected data for all ART-eligible patients attending their first counselling session between 23 July 2012 and 30 April 2013 to assess losses to care prior to and post ART initiation. Viral load completion and suppression rates of those retained on ART were also calculated.ResultsOverall, 449 patients enrolled in the study, of whom 3.6% did not return to the facility to initiate ART. Of those who were initiated, 96.7% were retained at their first ART refill visit and 85.9% were retained 6 months post ART initiation. Of those retained, 80.2% had a viral load taken within 6 months of initiating ART, with 95.4% achieving viral load suppression.ConclusionsAdapting counselling to enable rapid ART initiation is feasible and has the potential to reduce losses to care prior to ART initiation without increasing short-term losses thereafter or compromising patient adherence.

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Background The Post Natal Club (PNC) model assures comprehensive care, including HIV and Maternal and Child Health care, for postpartum women living with HIV and their infants during an 18-month postnatal period. The PNC model was launched in 2016 in Town Two Clinic, a primary health care facility in Khayelitsha, South Africa. This qualitative research study aims to understand how participation in PNCs affected knowledge transmission, peer support, behaviour change and satisfaction with the care provided. Methods We conducted ten in-depth interviews; three focus group discussions and participant observation with PNC members, health-care workers and key informants selected through purposive sampling. Seventeen PNC members between 21 and 38 years old, three key informants and seven staff working in PNC participated in the research. All participants were female, except for one of the three key informants who was male. Data was collected until saturation. The data analysis was performed in an inductive way and involved an iterative process, using Nvivo11 software. Results PNC members acquired knowledge on HIV, ART, adherence, infant feeding, healthy eating habits, follow up tests and treatment for exposed infants. Participants believed that PNC created strong relationships among members and offered an environment conducive to sharing experience and advice. Most interviewees stated that participating in PNC facilitated disclosure of their HIV status, enhanced support network and provided role models. PNC members said that they adapted their behaviour based on advice received in PNCs related to infant feeding, ART adherence, monitoring of symptoms and stimulation of early childhood development. The main benefits were believed to be comprehensive care for mother-infant pairs, time-saving and the peer dynamic. The main challenge from the perspective of key informants was the sustainability of dedicating human resources to PNC. Conclusion The PNC model was believed to improve knowledge acquisition, behaviour change and peer support. Participants, staff and the majority of key informants expressed a high level of satisfaction with the PNC model. Sustainability and finding adequate human resources for PNCs remained challenging. Strategies to improve sustainability may include handing over some PNC tasks to members to increase their sense of ownership.

Drug-resistant tuberculosis (DR-TB), defined as TB with at least rifampicin resistance, is increasing in prevalence and incidence worldwide. [1] South Africa (SA) has reported some of the highest numbers of DR-TB cases globally: in 2012 alone there were 14 161 laboratorynotified cases of multidrug-resistant TB (MDR-TB) and 1 545 cases of extensively drug-resistant TB (XDR-TB). [2] Regimens available for DR-TB are expensive, toxic, and require a minimum treatment duration of 20 months. In addition, currently available medications often cause multiple side-effects that impact on patients' ability to maintain their usual daily activities. [3] The burden of treatment regimens contributes to poor DR-TB programme outcomes, including high rates of loss from treatment (LFT) and stagnant treatment success rates. A study conducted in the Western Cape Province, SA, found an LFT rate of 27%, which is comparable to LFT rates observed in other DR-TB treatment cohorts in SA. [4] National Department of Health (NDoH) data from 2012 reflect a 40% treatment success rate for MDR-TB and less than 20% treatment success for XDR-TB. [2] It is imperative that strategies to provide structured patient support are developed and implemented to promote retention in care. Setting Khayelitsha, a township in the Western Cape, is home to approximately 500 000 people and has one of the highest rates of

La partie méridionale d’une installation agricole de la fin du premier Âge du Fer a été mise au jour en 2009 sur le site de La Chapelle d’Armentières « Route Nationale - RD 933 » (59). Celle-ci est délimitée par un enclos fossoyé curviligne qui définit un vaste espace clos de plus de 4 500 m². Le fossé semble avoir été doté d’un talus interne. À l’intérieur, sur le pourtour, s’agence une dizaine de bâtiments construits sur poteaux. Les deux habitations principales à deux nefs sont positionnées à l’ouest, face à l’entrée, et autour gravitent de petits bâtiments destinés au stockage des récoltes et aux activités agricoles. Ce site est le premier exemple régional clairement identifié pour la période d’habitat enclos.