Voices from the front lines: A qualitative study of integration of HIV, tuberculosis, and primary healthcare services in Johannesburg, South Africa

Lince-Deroche, Naomi; Leuner, Rahma; Kgowedi, Sharon; Moolla, Aneesa; Madlala, Sinethemba; Manganye, Pertunia; Xhosa, Barbara; Govathson, Caroline; Ndwanya, Takiyah White; Long, Lawrence

doi:10.1371/journal.pone.0230849

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…This emphasizes the importance of raising TB awareness in PLWH. In South Africa, TB and HIV services are often co-located and integrated [50]. However, a detailed analysis in South Africa of the challenges faced by PLWH who had MDR-TB highlighted similar issues to those described here for all TB patients, such as fear, stigma, dissociation from family and social networks, poor provider support, drug adverse events, and financial insecurity [51].…”

Section: Discussionsupporting

confidence: 54%

Living with tuberculosis: a qualitative study of patients’ experiences with disease and treatment

et al. 2022

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Background Although tuberculosis (TB) is a curable disease, treatment is complex and prolonged, requiring considerable commitment from patients. This study aimed to understand the common perspectives of TB patients across Brazil, Russia, India, China, and South Africa throughout their disease journey, including the emotional, psychological, and practical challenges that patients and their families face. Methods This qualitative market research study was conducted between July 2020 and February 2021. Eight TB patients from each country (n = 40) completed health questionnaires, video/telephone interviews, and diaries regarding their experiences of TB. Additionally, 52 household members were interviewed. Patients at different stages of their TB treatment journey, from a range of socioeconomic groups, with or without TB risk factors were sought. Anonymized data underwent triangulation and thematic analysis by iterative coding of statements. Results The sample included 23 men and 17 women aged 13–60 years old, with risk factors for TB reported by 23/40 patients. Although patients were from different countries and cultural backgrounds, experiencing diverse health system contexts, five themes emerged as common across the sample. 1) Economic hardship from loss of income and medical/travel expenses. 2) Widespread stigma, delaying presentation and deeply affecting patients’ emotional wellbeing. 3) TB and HIV co-infection was particularly challenging, but increased TB awareness and accelerated diagnosis. 4) Disruption to family life strained relationships and increased patients’ feelings of isolation and loneliness. 5) The COVID-19 pandemic made it easier for TB patients to keep their condition private, but disrupted access to services. Conclusions Despite disparate cultural, socio-economic, and systemic contexts across countries, TB patients experience common challenges. A robust examination of the needs of individual patients and their families is required to improve the patient experience, encourage adherence, and promote cure, given the limitations of current treatment.

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Section: Discussionsupporting

confidence: 54%

Living with tuberculosis: a qualitative study of patients’ experiences with disease and treatment

et al. 2022

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“…These mixed findings, combined with a previous review of integration identifying limitations in the data [37,103], suggest that additional work is needed to systematically implement, evaluate, and disseminate integrated care models, such as the IDEAL clinics across SSA. Furthermore, like all systems interventions, they are difficult to sustain since systems regress too readily-but where they are sustained, patients report a much higher level of satisfaction with services received [104].…”

Section: A South African Modelmentioning

confidence: 99%

Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa

Brault

Vermund

Aliyu

et al. 2021

IJERPH

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In Sub-Saharan Africa, communicable and other tropical infectious diseases remain major challenges apart from the continuing HIV/AIDS epidemic. Recognition and prevalence of non-communicable diseases have risen throughout Africa, and the reimagining of healthcare delivery is needed to support communities coping with not only with HIV, tuberculosis, and COVID-19, but also cancer, cardiovascular disease, diabetes, and depression. Many non-communicable diseases can be prevented or treated with low-cost interventions, yet implementation of such care has been limited in the region. In this Perspective piece, we argue that deployment of an integrated service delivery model is an urgent next step, propose a South African model for integration, and conclude with recommendations for next steps in research and implementation. An approach that is inspired by South African experience would build on existing HIV-focused infrastructure that has been developed by Ministries of Health with strong support from the U.S. President’s Emergency Response for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. An integrated chronic healthcare model holds promise to sustainably deliver infectious disease and non-communicable disease care. Integrated care will be especially critical as health systems seek to cope with the unprecedented challenges associated with COVID-19 and future pandemic threats.

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“…Policy changes steered away from vertical programs administered by government and nongovernmental organizations to embrace integrative services that dissolved standalone (one disease focus) services. Governmental policy of service integration led to increased responsibilities for PHN to initiate TB and HIV treatment (Lince‐Deroche et al., 2020). For PHN in rural healthcare settings, integration of healthcare service delivery added an additional burden due to, amongst various constraining factors, limited infrastructure and human resources (Igumbor et al., 2016).…”

Section: Discussionmentioning

confidence: 99%

Public health and hospital‐based nursing intersection: Case study of drug‐resistant tuberculosis patients

Pietersen

Anderson

Heijden

2022

Public Health Nursing

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Objective Public health nurses (PHN) are key partners in continuity of care for drug‐resistant tuberculosis (DR‐TB) patients. We examined complexities in DR‐TB care transition between community‐ and hospital‐based care. Design We conducted a case study using medical record data. Four patients were purposively selected to illustrate intersectional complexities in DR‐TB care transition involving PHN. Results Case A (HIV negative male) received PHN care at a community‐based facility 124 km from Cape Town. Cases B, C, and D (males living with HIV) received PHN community‐based care, averaging 25 km from the hospital. Treatment failed in cases A, B, and C; they subsequently died. Case D was cured. All cases were granted leave of absence at least once while hospitalized. None returned when expected mainly due to lack of transport funds. PHN played critical roles regarding patients’ return by conducting home visits, interacting with relatives, and assisting emergency officers to transport patients back to the hospital. PHN supported relatives to endure protracted patient hospitalizations. Conclusion The role of PHN in continuity of DR‐TB care in low‐middle income countries is unambiguous. PHN are key partners in the DR‐TB care cascade, namely facilitating retention in care between hospital and community‐based care. Effective DR‐TB control relies on effective partnerships among healthcare personnel, patients, and their families.

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Voices from the front lines: A qualitative study of integration of HIV, tuberculosis, and primary healthcare services in Johannesburg, South Africa

Cited by 6 publications

References 20 publications

Living with tuberculosis: a qualitative study of patients’ experiences with disease and treatment

Living with tuberculosis: a qualitative study of patients’ experiences with disease and treatment

Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa

Public health and hospital‐based nursing intersection: Case study of drug‐resistant tuberculosis patients

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