Background Faith-based organizations have expanded access to antiretroviral therapy (ART) in community clinics across South Africa. Loss to follow-up (LTFU), however, limits both the potential individual and population treatment benefits and is an obstacle to optimal care. Objective To identify patient characteristics associated with LTFU six months after starting ART in patients in a large South African community clinic. Methods Patients initiating ART between April 2004 and October 2006 in one Catholic Relief Services HIV treatment clinic who had at least one follow-up visit were included in the analysis. Standardized instruments were used for data collection. Routine monitoring was performed every 6 months following ART initiation. Rates of LTFU over time were estimated by the Kaplan-Meier method. The log-rank test was used to examine the impact of age, baseline CD4 count, HIV RNA, gender and pregnancy status for women on LTFU. Cox proportional hazard regression was performed to analyze hazard ratios for LTFU. Results Data from 925 patients (age > 14 years), median age 36 years, 70% female (16% pregnant) were included in the analysis. Fifty one patients (6%) were lost to follow-up six months after ART initiation. When stratified by baseline CD4 count, gender and pregnancy status, pregnant women with lower baseline CD4 count (≤200 /μl) had 6.06 times (95% CI: 2.20 – 16.71) the hazard of LTFU compared to men. Conclusions HIV-infected pregnant women initiating ART are significantly more likely to be lost to follow-up in a community clinic in South Africa. Interventions to successfully retain pregnant women in care are urgently needed.

BackgroundMany HIV treatment programs in resource-limited settings are plagued by high rates of loss to follow-up (LTFU). Most studies have not distinguished between those who briefly interrupt, but return to care, and those more chronically lost to follow-up.MethodsWe conducted a retrospective cohort study of 11,397 adults initiating antiretroviral therapy (ART) in 71 Southern African Catholic Bishops Conference/Catholic Relief Services HIV treatment clinics between January 2004 and December 2008. We distinguished among patients with early death, within the first 7 months on ART; patients with interruptions in laboratory monitoring (ILM), defined as missing visits in the first 7 months on ART, but returning to care by 12 months; and those LTFU, defined as missing all follow-up visits in the first 12 months on ART. We used multilevel logistic regression models to determine patient and clinic-level characteristics associated with these outcomes.ResultsIn the first year on ART, 60% of patients remained in care, 30% missed laboratory visits, and 10% suffered early death. Of the 3,194 patients who missed laboratory visits, 40% had ILM, resuming care by 12 months. After 12 months on ART, patients with ILM had a 30% increase in detectable viremia compared to those who remained in care. Risk of LTFU decreased with increasing enrollment year, and was lowest for patients who enrolled in 2008 compared to 2004 [OR 0.49, 95%CI 0.39–0.62].ConclusionsIn a large community-based cohort in South Africa, nearly 30% of patients miss follow-up visits for CD4 monitoring in the first year after starting ART. Of those, 40% have ILM but return to clinic with worse virologic outcomes than those who remain in care. The risk of chronic LTFU decreased with enrollment year. As ART availability increases, interruptions in care may become more common, and should be accounted for in addressing program LTFU.

Background and aim Given the myriad occupational stressors of nursing itself, plus the challenges of moonlighting, we aimed to investigate the emotional well‐being of moonlighting nurses and their work engagement. Well‐being was defined by levels of general health, mental health, emotional exhaustion, personal accomplishment, compassion satisfaction and compassion fatigue. Design A cross‐sectional descriptive survey (December 2017 to March 2018) at private health care facilities in a Metropolitan Municipality, South Africa. Methods Two hundred and fifty‐one nurses completed self‐administered questionnaires, which comprised of validated scales. Results Nurses were at low risk for emotional exhaustion (M=12.8; SD=11.23) and scored high on compassion satisfaction (M=42.34; SD=7.22) and work engagement (M=4.87, SD=1.18). Personal accomplishment (t= 2.535; P<.05) compassion satisfaction (t= 6.790; P=.000) and mental health (t=3.206; P<.05) made a statistically significant unique contribution to the prediction of work engagement. Nurses who had considered leaving the profession scored significantly higher on emotional exhaustion and compassion fatigue. Conclusion Nurses who moonlighted in private health care facilities reported low risk for burnout and high levels of compassion satisfaction and work engagement. Further research is needed to explore the reasons for these findings. Attention must be given to ensuring the occupational well‐being of nurses in order to retain them in the profession.

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The backbone of a caring nurse is compassion, when nurses have feelings of empathy for the suffering of others and understand patients' personal feelings or experiences without being judgemental. [1] As a result, nursing is particularly stressful, [2][3][4] as nurses not only cope with their personal stress but also with secondary forms of stress due to the nature of their interaction with patients and their families. Nursing students may be more vulnerable to the harmful effects of secondary stress, as they are developing the skills necessary to fulfil their professional roles effectively. [5] They are also faced with academic stressors, [5][6][7][8][9][10][11] such as practical training in environments characterised by high patient loads, insufficient resources and long working hours; [12] lack of professional knowledge and skills; [5] and unclear roles and responsibilities. [8,10] While nursing education fosters empathy and compassion in the student nurse to prepare them for their professional role of caring for others, [13] ongoing empathetic and compassionate behaviour and stress pave the way for burnout and compassion fatigue. [12,13] Burnout is a combination of negative behavioural, attitudinal and physical changes in response to work-related stress. [14] Burnout or compassion fatigue among nursing students may result in students failing to acquire the knowledge and skills needed to care for their patients. This situation has a domino effect on the quality of care, which could expose patients to healthcare-related risks. [15] With this in mind, this article describes the emotional wellbeing of undergraduate and postgraduate nursing students at a university in South Africa (SA). Wellbeing was defined by levels of emotional exhaustion, personal accomplishment, compassion satisfaction, compassion fatigue and perceived stress. More specifically, the objectives of the study were to: • describe levels of emotional exhaustion, personal accomplishment, compassion fatigue, compassion satisfaction and perceived stress experienced by nursing students • compare levels of emotional exhaustion, personal accomplishment, compassion satisfaction, compassion fatigue and perceived stress of undergraduate and postgraduate nursing students • determine the influence of compassion fatigue, perceived stress and disengaged coping on emotional exhaustion of undergraduate and postgraduate nursing students. Methods Design and sampleA cross-sectional descriptive survey was undertaken at a purposively selected SA university. There was a total of 685 registered under graduate (n=333) and postgraduate (n=352) nursing students at the university. Four hundred and seventy-one questionnaires (258 undergraduate and 213 postgraduate) were returned (68.8% response rate), of which 27 were discarded owing to extensive missing data, leaving a total of 444 completed questionnaires (252 undergraduate and 192 postgraduate).Background. Nursing students face dual stress from a combination of academic and clinical demands, which may affect their emotion...