HIV Care Profiling and Delivery Status in the Mobile Health Clinics of eThekwini District in KwaZulu Natal, South Africa: A Descriptive Evaluation Study

Ngcobo, Silingene Joyce; Makhado, Lufuno; Sehularo, Leepile Alfred

doi:10.3390/nursrep13040129

Cited by 3 publications

(1 citation statement)

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“…MHCs are a community-based intervention that functions specifically as a delivery model for various medical services, including primary care and screening, preventative specialty care, and social interventions [ 1 , 2 ]. Registered nurses in the South African public health system are the main drivers that operate the MHCs [ 3 ], which are also used as an additional healthcare delivery approach aimed at HIV program expansion, without misplacing their initial inception purpose of serving general populations with healthcare access challenges [ 4 ]. Instead MHCs have been officially acknowledged and accepted as primary health care (PHC) service extension for remote areas within the local district health system [ 2 ] offering various healthcare services including HIV care, which is the focus of this study.…”

Section: Introductionmentioning

confidence: 99%

Registered nurses’ experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics of eThekwini Municipality in KwaZulu-Natal

Ngcobo,

Makhado,

Sehularo

2024

BMC Nurs

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Background Registered nurses working in the mobile health clinics (MHCs) play an important role in enabling HIV care access to populations in remote areas through Nurse Initiated Antiretroviral Therapy program (NIMART). Aim To explore and describe the nurses’ experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics (MHCs) of eThekwini Municipality in KwaZulu Natal. Methods Qualitative Exploratory Descriptive (QED) method was used after permission was granted from North-West University Human Research Ethics Committee provincial and local health authorities. Data saturation informed sample size of thirteen MHCs nurses were purposefully sampled to participate. Audio-recorded, semi-structured, online, one-on-one interviews guided by open-ended questions were done for data collection, and including demographic profile. The interview transcripts were analysed using Atlas-TI and SPSS descriptive statistics was used for demographics. Results Eleven subthemes emerged under patient-related, nurse-related, and organisational-related themes which influence the operational factors in the MHCs, namely: patient defaulting treatment, lack of privacy, unavailability of phones, stressful and demotivating MHCs, nurses feel unsafe, lack of support from management, lack of budget, unavailability of computers, shortage of medical equipment, shortage of nursing staff and absence of data capturers. Conclusion Structured contextual coaching and support program for nurses is imperative to ensure effective and strengthened operations in MHCs, further supported by improvement in human resource for health allocation for MHCs in light of expanding health care programs Contributions Evaluation of health care programmes, and human resource for health quality improvement needs in the clinical practice of HIV care of MHCs nurses which advocate for specific policy formulations.

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Section: Introductionmentioning

confidence: 99%

Registered nurses’ experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics of eThekwini Municipality in KwaZulu-Natal

Ngcobo,

Makhado,

Sehularo

2024

BMC Nurs

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An observational cohort study evaluating PrEP reach, engagement and persistence through a community‐based mobile clinic in Miami‐Dade County, Florida

Doblecki‐Lewis,

Johnson,

Klose

et al. 2024

J Int AIDS Soc.

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IntroductionBarriers to pre‐exposure prophylaxis (PrEP) access have limited its reach to priority populations. Community‐based mobile clinics have potential to broaden PrEP engagement. We evaluated reach and persistence for fixed and mobile clinic cohorts in Miami‐Dade County, Florida.MethodsThis observational cohort study analysed data from 1896 clients engaged through our fixed or mobile clinic from August 2018 to March 2023. Services were offered at no cost to clients. The same staff and package of barrier‐lowering strategies was deployed across fixed and mobile clinic sites. Chi‐square and Fisher's exact test or the Kruskal–Wallis test were used to test for differences in characteristics across sites as well as across services sought. Kaplan–Meier curves were generated to evaluate persistence on PrEP and in care, defined as completion of at least one clinic visit (including PrEP prescribing, for PrEP persistence, or for any reason, for persistence in care) within 24 weeks of the prior visit. Cox proportional hazards models were used to evaluate risk factors for discontinuation of PrEP or clinic care by 48 weeks by gender, race, ethnicity, insurance status and site.ResultsThe fixed and mobile clinics reached 781 and 1109 clients, respectively, during the study period. The median client age was 35 years; the majority (70.4%) of clients were cisgender men, identified as Hispanic/Latino (62.5%) and were men who have sex with men (54.5%). The mobile clinic extended reach to a higher proportion of cisgender women (32.1% mobile vs. 12.9% for fixed clinic), Black clients (34.5% vs. 13.1%) and older clients (median 37 vs. 33 years) compared with the fixed setting. Uninsured individuals, men and those who initiated services in the mobile clinic were more likely to continue PrEP to 48 weeks (HR: 1.20, p = 0.01; HR: 2.02, p<0.01; HR: 1.68, p<0.01, respectively). Persistence did not differ by race or ethnicity.ConclusionsA mobile clinic strategy for PrEP engagement can increase reach to key populations underrepresented in HIV prevention care including cisgender women and Black clients. Persistence in PrEP was increased for the mobile clinic cohort, suggesting an additional benefit to this modality beyond other barrier‐lowering strategies employed in our fixed and mobile clinics.

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Accessibility of TB diagnostic services at primary healthcare clinics in the eThekwini district, South Africa: a geospatial analysis

Dlangalala,

Musekiwa,

Mckelly

et al. 2024

BMJ Open

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BackgroundImproving geographic access can aid in managing tuberculosis (TB) by enabling early diagnosis and treatment initiation. Although geospatial techniques have been used to map the transmission patterns of drug-resistant TB in South Africa, fewer studies have investigated the accessibility of TB diagnostic services. This study evaluated the accessibility of TB diagnostic services and disease distribution in the eThekwini district of South Africa.MethodsIn this cross-sectional study, population data for 2021 were disaggregated into smaller analysis units and then re-aggregated through the dasymetric mapping technique. Data on notified TB patients, including Global Positioning System coordinates of clinics, were obtained from the District of Health Information System, exported to ArcGIS 10.8.2 and used to calculate distances to the nearest clinics and hospitals.Results92% of the population (3 730 494 people) in eThekwini could access TB diagnostic services within 5 km. Patients travelled an average distance of 4.7 km (range: 0.1–26.9 km). TB diagnostic services were highly accessible in the Northern and Central regions and moderately accessible in the predominately rural Western and Southern regions. The smallest population of eThekwini resides in rural areas; however, 40.7% of its residents live >5 km from a diagnosing facility, with patients in the South having to travel up to 44.5 km. TB incidence was higher in the predominately rural West and South regions compared with the Central and North regions which are mainly comprised of urban and suburban areas. Our findings also showed that 98.4% of the clinics in eThekwini were located within 30 km of a hospital at an average distance of 9.6 km within the district. However, the distribution of these hospitals does not demonstrate equitable access as the majority are located within the Central region, and fewer are found in the other three regions of eThekwini.ConclusionsAddressing the disparities in access to TB diagnostic services is required in the eThekwini district. Leveraging the existing mobile health clinics can assist with this, particularly, in rural areas with inadequate access. Additionally, active-case finding should be intensified in these regions since they had a higher TB burden per population. Prioritising interventions in these areas is crucial for reducing the impact of the disease on affected communities.

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HIV Care Profiling and Delivery Status in the Mobile Health Clinics of eThekwini District in KwaZulu Natal, South Africa: A Descriptive Evaluation Study

Cited by 3 publications

References 75 publications

Registered nurses’ experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics of eThekwini Municipality in KwaZulu-Natal

Registered nurses’ experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics of eThekwini Municipality in KwaZulu-Natal

An observational cohort study evaluating PrEP reach, engagement and persistence through a community‐based mobile clinic in Miami‐Dade County, Florida

Accessibility of TB diagnostic services at primary healthcare clinics in the eThekwini district, South Africa: a geospatial analysis

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