Enhancing value and lowering costs of care: a qualitative exploration of a randomized linkage to care intervention in South Africa

Jain, Kriti; Mshweshwe-Pakela, Nolundi; Charalambous, Salome; Mabuto, Tonderai; Hoffmann, Christopher J.

doi:10.1080/09540121.2018.1503636

Cited by 4 publications

(6 citation statements)

References 15 publications

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“…The main motivation was receiving immediate treatment due to the elimination of loss or delay of results. This study corroborates findings of POC CD4 testing in South Africa and Zimbabwe where patients appreciated receiving rapid results for quicker clinical decision-making [30,31]. Numerous studies in African cohorts [12,[32][33][34][35] have described poor rates of linkage to care for those eligible for ART due to several attrition challenges in the continuum of care pathway [22,36], including the unavailability of a CD4 test result [22,37].…”

Section: Discussionsupporting

confidence: 81%

Assessment of the Impact of Rapid Point-of-Care CD4 Testing in Primary Healthcare Clinic Settings: A Survey Study of Client and Provider Perspectives

et al. 2020

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Background: The high burden of disease in South Africa presents challenges to public health services. Point-of-care (POC) technologies have the potential to address these gaps and improve healthcare systems. This study ascertained the acceptability and impact of POC CD4 testing on patients’ health and clinical management. Methods: We conducted a qualitative survey study with patients (n = 642) and healthcare providers (n = 13) at the Lancers Road (experienced POC) and Chesterville (non-experienced POC) primary healthcare (PHC) clinics from September 2015 to June 2016. Results: Patients (99%) at Lancers and Chesterville PHCs were positive about POC CD4 testing, identifying benefits: No loss/delay of test results (6.4%), cost/time saving (19.5%), and no anxiety (5.1%), and 58.2% were ready to initiate treatment. Significantly more patients at Chesterville than Lancers Road PHC felt POC would provide rapid clinical decision making (64.7% vs. 48.1%; p < 0.0001) and better clinic accessibility (40.4% vs. 24.7%; p < 0.0001) respectively. Healthcare providers thought same-day CD4 results would impact: Clinical management (46.2%), patient readiness (46.2%), and adherence (23.0%), and would reduce follow-up visits (7.7%), while 38.5% were concerned that further tests and training (15.4%) were required before antiretroviral therapy (ART) initiation. Conclusion: The high acceptability of POC CD4 testing and the immediate health, structural, and clinical management benefits necessitates POC implementation studies.

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Section: Discussionsupporting

confidence: 81%

Assessment of the Impact of Rapid Point-of-Care CD4 Testing in Primary Healthcare Clinic Settings: A Survey Study of Client and Provider Perspectives

et al. 2020

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“…"We knew that when we go for bloods I would come back [home] knowing what is happening with my life and … that would encourage us to take medication on time" (POC female client, [20][21][22][23][24][25][26][27][28][29][30].…”

Section: Meaning Of Resultsmentioning

confidence: 99%

“…The emergence of patient selfregulation through the monitoring of blood test results has been described elsewhere as a 'disciplinary technology', where blood results are used to monitor patients' adherence to treatment and as 'gatekeepers' to extended benefits such as CCMDD for those adhering well [28,29]. Studies of POC CD4 testing in Zimbabwe and South Africa found that clients appreciated receiving quicker results which improved their understanding of CD4 counts [16,30] and also motivated behavior change [30].…”

Section: Discussionmentioning

confidence: 99%

Acceptability of point-of-care viral load testing to facilitate differentiated care: a qualitative assessment of people living with HIV and nurses in South Africa

Msimango

Gibbs

Shozi

et al. 2020

BMC Health Serv Res

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Background Providing viral load (VL) results to people living with HIV (PLHIV) on antiretroviral therapy (ART) remains a challenge in low and middle-income countries. Point-of-care (POC) VL testing could improve ART monitoring and the quality and efficiency of differentiated models of HIV care. We assessed the acceptability of POC VL testing within a differentiated care model that involved task-shifting from professional nurses to less highly-trained enrolled nurses, and an option of collecting treatment from a community-based ART delivery programme. Methods We undertook a qualitative sub-study amongst clients on ART and nurses within the STREAM study, a randomized controlled trial of POC VL testing and task-shifting in Durban, South Africa. Between March and August 2018, we conducted 33 semi-structured interviews with clients, professional and enrolled nurses and 4 focus group discussions with clients. Interviews and focus groups were audio recorded, transcribed, translated and thematically analysed. Results Amongst 55 clients on ART (median age 31, 56% women) and 8 nurses (median age 39, 75% women), POC VL testing and task-shifting to enrolled nurses was acceptable. Both clients and providers reported that POC VL testing yielded practical benefits for PLHIV by reducing the number of clinic visits, saving time, travel costs and days off work. Receiving same-day POC VL results encouraged adherence amongst clients, by enabling them to see immediately if they were ‘good’ or ‘bad’ adherers and enabled quick referrals to a community-based ART delivery programme for those with viral suppression. However, there was some concern regarding the impact of POC VL testing on clinic flows when implemented in busy public-sector clinics. Regarding task-shifting, nurses felt that, with extra training, enrolled nurses could help decongest healthcare facilities by quickly issuing ART to stable clients. Clients could not easily distinguish enrolled nurses from professional nurses, instead they highlighted the importance of friendliness, respect and good communication between clients and nurses. Conclusions POC VL testing combined with task-shifting was acceptable to clients and healthcare providers. Implementation of POC VL testing and task shifting within differentiated care models may help achieve international treatment targets. Trial registration NCT03066128, registered 22/02/2017.

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“…Two studies from South Africa reported qualitative results from multiple interventions. One evaluating integrated POC CD4 cell count testing, transport support and care facilitation reported improved psychosocial support from care facilitation that promoted engagement in care [85]. However, though transport cost reimbursement was appreciated by many participants, it was not the only means for managing transport costs for those who could either walk to the clinic or borrow money to pay for transport.…”

Section: Qualitative Values and Preferencesmentioning

confidence: 99%

Understanding effective post‐test linkage strategies for HIV prevention and care: a scoping review

Wamuti,

Jamil,

Siegfried

et al. 2024

J Int AIDS Soc.

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IntroductionFollowing HIV testing services (HTS), the World Health Organization recommends prompt linkage to prevention and treatment. Scale‐up of effective linkage strategies is essential to achieving the global 95‐95‐95 goals for maintaining low HIV incidence by 2030 and reducing HIV‐related morbidity and mortality. Whereas linkage to care including same‐day antiretroviral therapy (ART) initiation for all people with HIV is now routinely implemented in testing programmes, linkage to HIV prevention interventions including behavioural or biomedical strategies, for HIV‐negative individuals remains sub‐optimal. This review aims to evaluate effective post‐HTS linkage strategies for HIV overall, and highlight gaps specifically in linkage to prevention.MethodsUsing the five‐step Arksey and O'Malley framework, we conducted a scoping review searching existing published and grey literature. We searched PubMed, Cochrane Library, CINAHL, Web of Science and EMBASE databases for English‐language studies published between 1 January 2010 and 30 November 2023. Linkage interventions included as streamlined interventions—involving same‐day HIV testing, ART initiation and point‐of‐care CD4 cell count/viral load, case management—involving linkage coordinators developing personalized HIV care and risk reduction plans, incentives—financial and non‐financial, partner services—including contact tracing, virtual—like social media, quality improvement—like use of score cards, and peer‐based interventions. Outcomes of interest were linkage to any form of HIV prevention and/or care including ART initiation.ResultsOf 2358 articles screened, 66 research studies met the inclusion criteria. Only nine linkage to prevention studies were identified (n = 9/66, 14%)—involving pre‐exposure prophylaxis, voluntary medical male circumcision, sexually transmitted infection and cervical cancer screening. Linkage to care studies (n = 57/66, 86%) focused on streamlined interventions in the general population and on case management among key populations.DiscussionDespite a wide range of HIV prevention interventions available, there was a dearth of literature on HIV prevention programmes and on the use of messaging on treatment as prevention strategy. Linkage to care studies were comparatively numerous except those evaluating virtual interventions, incentives and quality improvement.ConclusionsThe findings give insights into linkage strategies but more understanding of how to provide these effectively for maximum prevention impact is needed.

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Enhancing value and lowering costs of care: a qualitative exploration of a randomized linkage to care intervention in South Africa

Cited by 4 publications

References 15 publications

Assessment of the Impact of Rapid Point-of-Care CD4 Testing in Primary Healthcare Clinic Settings: A Survey Study of Client and Provider Perspectives

Assessment of the Impact of Rapid Point-of-Care CD4 Testing in Primary Healthcare Clinic Settings: A Survey Study of Client and Provider Perspectives

Acceptability of point-of-care viral load testing to facilitate differentiated care: a qualitative assessment of people living with HIV and nurses in South Africa

Understanding effective post‐test linkage strategies for HIV prevention and care: a scoping review

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