Correction to: Expansion of a national differentiated service delivery model to support people living with HIV and other chronic conditions in South Africa: a descriptive analysis

Liu, Lingrui; Christie, Sarah; Munsamy, Maggie; Roberts, Philip J. W.; Pillay, Merlin; Shenoi, Sheela; Desai, Mayur M.; Linnander, Erika

doi:10.1186/s12913-021-06561-7

Cited by 4 publications

(4 citation statements)

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“…This policy and service delivery guidelines seek to address issues in non-adherence to long-term therapies amidst the expansion of ART programmes and the rising burden of NCDs ( 47 ). Certain aspects of the programme implementation related to this policy have been positively evaluated ( 48 , 49 ). Another part of their strategy was to focus on linkage to care and to implement screening activities to identify diseases early for intervention.…”

Section: Discussionmentioning

confidence: 99%

Multimorbidity Patterns in a National HIV Survey of South African Youth and Adults

Roomaney

Wyk

Cois

et al. 2022

Front. Public Health

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IntroductionInformation pertaining to multimorbidity is frequently informed by studies from high income countries and it is unclear how these findings relate to low and middle income countries, where the burden of infectious disease is high. South Africa has a quadruple burden of disease which includes a high HIV prevalence and a growing burden of non-communicable diseases. This study aimed to analyse the prevalence and patterns (disease classes or clusters) of multimorbidity in South Africa.MethodsA secondary analysis of individuals over the age of 15 years who participated in the Fifth South African National HIV Prevalence, Incidence, Behavior and Communication Survey, 2017 (SABSSM 2017) was done. Six disease conditions were identified in the analysis (cancer, diabetes, heart disease, hypertension/high blood pressure, tuberculosis, and HIV). Chi-square tests were used to test for the differences in disease prevalence by sex. Common disease patterns were identified using a latent class analysis.ResultsThe sample included 27,896 participants, of which 1,837 had comorbidity or multimorbidity. When taking population-weighting into account, multimorbidity was present in 5.9% (95% CI: 5.4–6.4) of the population The prevalence of multimorbidity tended to be higher among females and increased with age, reaching 21.9% in the oldest age group (70+). The analyses identified seven distinct disease classes in the population. The largest class was “Diabetes and Hypertension” (36.3%), followed by “HIV and Hypertension” (31.0%), and “Heart disease and Hypertension” (14.5%). The four smaller classes were: “HIV, Diabetes, and Heart disease” (6.9%), “TB and HIV” (6.3%), “Hypertension, TB, and Cancer” (2.8%), and “All diseases except HIV” (2.2%).ConclusionAs the South African population continues to age, the prevalence of multimorbidity is likely to increase which will further impact the health care system. The prevalence of multimorbidity in the population was relatively low but reached up to 20% in the oldest age groups. The largest disease cluster was the combination of diabetes and hypertension; followed by HIV and hypertension. The gains in improving adherence to antiretrovirals amongst treatment-experienced people living with HIV, should be expanded to include compliance with lifestyle/behavioral modifications to blood pressure and glucose control, as well as adherence to anti-hypertension and anti-diabetic medication. There is an urgent need to improve the early diagnosis and treatment of disease in the South African population.

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Section: Discussionmentioning

confidence: 99%

Multimorbidity Patterns in a National HIV Survey of South African Youth and Adults

Roomaney

Wyk

Cois

et al. 2022

Front. Public Health

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“…Whilst 43% of countries reported disruptions in prescription renewals for chronic medications and challenges with essential medicine (27,30), our study participants did not perceive much of a difference in medicine availability when compared to pre-COVID-19. The CCMDD program, initiated in 2014, saw rapid scale-up for chronic patients (45)(46)(47)(48) and was well-received by both HCWs and CMs due to increases in efficiency and convenience and decreases in patient load and financial impact on patients (46). Nevertheless, service delivery and utilization were negatively impacted by the fear of contracting COVID-19 as expressed by HCWs and CMs.…”

Section: Discussionmentioning

confidence: 99%

Essential health services delivery in South Africa during COVID-19: Community and healthcare worker perspectives

Lalla-Edward

Mosam²,

Hove³

et al. 2022

Front. Public Health

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BackgroundBetween May 2020 and February 2022, South Africa's health system bore strain as it battled mitigating the coronavirus pandemic. The country's pandemic response was scrutinized. This period also brought into focus pre-existing shortcomings in the healthcare system and its governing bodies. Contextually, there is a paucity in literature on the experiences of healthcare providers and users. This study aimed to contribute information on COVID-19, with the intention of providing guidance on preparing for future infectious disease outbreaks.MethodsCross sectional exploratory qualitative methodology was employed using semi-structured interviews and focus group discussions with community members (CM) and healthcare workers (HCW) from two South African study sites: (a) rural Bushbuckridge (run by Agincourt Health and Socio-Demographic Surveillance Site) and (b), Regions D and F in Johannesburg Metropole.ResultsAfter interviewing 42 CMs and 43 HCWs, it emerged that mandated process changes while minimizing COVID-19 exposure, necessitated healthcare personnel focusing on critical care treatment at the expense of less acute ones. COVID-19 isolation protocols, extensive absenteeism and HCWs with advanced skills being perceived as more adept to treat COVID-19 patients contributed to HCWs experiencing higher workloads. Fears regarding contracting and transmitting COVID-19, suffering financial losses, and not being able to provide adequate advice to patients were recurrent themes. Dissemination of relevant information among healthcare facility personnel and communities suffered due to breakdowns in communication.ConclusionConcessions and novel strategies to avail medication to patients had to be created. Since providence was lacking, government needs to formulate health intervention strategies that embrace health literacy, alternate methods of chronic medication dispensation, improved communication across health care platforms and the use of telehealth, to circumvent the threats of possible further infectious disease outbreaks.

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“…As a result of the COVID-19 pandemic, facility-based HTS face new barriers in South Africa and elsewhere [8,9]. Currently, several approaches are promising in relieving some of the strain PHC facilities face, including HIV self-testing (HIVST), Chronic Medicines Dispensing and Distribution, community-based adherence clubs, and quick pharmacy pickups [7,[10][11][12]. Despite these critically important and valuable initiatives, we suggest that, rather than incremental improvements within the existing framework of primary care, what is required is a reimagination of primary care that places digital services at the entry point of the health system instead of relying exclusively on human resources.…”

Section: Introductionmentioning

confidence: 99%

The Feasibility and Acceptability of an mHealth Conversational Agent Designed to Support HIV Self-testing in South Africa: Cross-sectional Study

et al. 2022

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Background HIV testing rates in sub-Saharan Africa remain below the targeted threshold, and primary care facilities struggle to provide adequate services. Innovative approaches that leverage digital technologies could improve HIV testing and access to treatment. Objective This study aimed to examine the feasibility and acceptability of Nolwazi_bot. It is an isiZulu-speaking conversational agent designed to support HIV self-testing (HIVST) in KwaZulu-Natal, South Africa. Methods Nolwazi_bot was designed with 4 different personalities that users could choose when selecting a counselor for their HIVST session. We recruited a convenience sample of 120 consenting adults and invited them to undertake an HIV self-test facilitated by the Nolwazi_bot. After testing, participants completed an interviewer-led posttest structured survey to assess their experience with the chatbot-supported HIVST. Results Participants (N=120) ranged in age from 18 to 47 years, with half of them being men (61/120, 50.8%). Of the 120 participants, 111 (92.5%) had tested with a human counselor more than once. Of the 120 participants, 45 (37.5%) chose to be counseled by the female Nolwazi_bot personality aged between 18 and 25 years. Approximately one-fifth (21/120, 17.5%) of the participants who underwent an HIV self-test guided by the chatbot tested positive. Most participants (95/120, 79.2%) indicated that their HIV testing experience with a chatbot was much better than that with a human counselor. Many participants (93/120, 77.5%) reported that they felt as if they were talking to a real person, stating that the response tone and word choice of Nolwazi_bot reminded them of how they speak in daily conversations. Conclusions The study provides insights into the potential of digital technology interventions to support HIVST in low-income and middle-income countries. Although we wait to see the full benefits of mobile health, technological interventions including conversational agents or chatbots provide us with an excellent opportunity to improve HIVST by addressing the barriers associated with clinic-based HIV testing.

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Correction to: Expansion of a national differentiated service delivery model to support people living with HIV and other chronic conditions in South Africa: a descriptive analysis

Cited by 4 publications

References 1 publication

Multimorbidity Patterns in a National HIV Survey of South African Youth and Adults

Multimorbidity Patterns in a National HIV Survey of South African Youth and Adults

Essential health services delivery in South Africa during COVID-19: Community and healthcare worker perspectives

The Feasibility and Acceptability of an mHealth Conversational Agent Designed to Support HIV Self-testing in South Africa: Cross-sectional Study

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