Women's perceptions with use of Implanon® contraceptive device at a primary healthcare facility in KwaZulu-Natal

Background: Early 2014, subdermal contraceptive implant was introduced in South Africa, Implanon® NXT, aiming to expand the method mix, increase effectiveness and availability to long-acting contraceptives. The initial uptake was extremely high, but concerns have been raised with treatment failure and high number of removals reported. Aim: The study focuses on describing women's perceptions with use of Implanon® at a primary health care (PHC) facility in KwaZulu-Natal. Setting: This study was conducted at a selected primary health care (PHC) facility in KwaZuluNatal. Methods: A quantitative, descriptive study design was used. Through purposive sampling, a sample of 60 women from 15 to 50 years old were recruited. Data were gathered through a structured questionnaire and analysed using SPSS 24 software. Results: Study findings show that slightly above half of respondents, 32 or 58.1% expressed satisfaction towards the implant, 20 or 40.9% had stopped using the implant as a result of its major implications. It was found that an edge above half of respondents continued using the implant 28 or 50.9%, while close to half had abandoned it (27 or 49.1%). Some respondents reported that they were experiencing heavy menstrual bleeding and low sex drive as serious unwanted side effects forcing them to stop using Implanon®. Conclusion: Side-effects and poor screening, counselling and support are major reasons for early removal. It is imperative to develop an effective screening tool and to re-train healthcare workers on Implanon® NXT. Contributions: This article contributes to increase awareness of women's perceptions about Implanon® contraceptive.

Healthcare workers' perceptions and experiences of implementing voluntary medical male circumcision in KwaZulu-Natal, South Africa

Background: Voluntary Medical Male Circumcision (VMMC) is an effective HIV prevention strategy prioritized by the World Health Organisation (WHO) for regions of high HIV prevalence, South Africa (SA) and in particular KwaZulu-Natal (KZN) is one of such regions. Since the roll out of VMMC in 2010 there has been little research conducted on the implementation of this service. Existing studies on the uptake of VMMC have mainly focused on service users resulting in a paucity of data on health care workers perspectives on the intervention. Aim: To analyse health care workers' perceptions and experiences of implementing voluntary medical male circumcision in KZN, SA. Setting: The study took place at six different health districts and their six respective rural clinics in the KZN province of SA. Methods: A qualitative approach using a phenomenographic design was employed. Data were collected from a sample of 18 participants comprising of health care providers (n = 12) and health policy makers (n = 6). Individual, face-to-face interviews were conducted using a semi-structured interview guide. An audiotape was used to record the data, which were transcribed verbatim and then analysed using a step-wise phenomenographic data analysis procedure. Results: Participants reported that VMMC was implemented by the department of health with support from non-governmental organisations and private general practitioners. Negative perceptions and negative experiences regarding VMMC and implementation were reported. Conclusion: The implementation of VMMC is compromised due to poor preparation and training of healthcare workers for implementing the service. Addressing health care workers' needs for training and preparation is crucial for successful implementation of VMMC

Evidence of interventions for improving healthcare access for lesbian, gay, bisexual and transgender people in South Africa: a scoping review

Background: The lesbian, gay, bisexual and transgender (LGBT) populations have unique health risks including an increased risk of mental health problems, high usage of recreational drugs and alcohol, and high rates of infection with human immunodeficiency virus (HIV). Healthcare workers' heteronormative attitudes compromise the quality of care to the LGBT population. Aim: The objective of this study was to provide an overview of documented evidence on South Africa interventions aimed at improving healthcare access for LGBT individuals using a systematic scoping review. Setting: This is a secondary literature review. Methods: An electronic search was conducted using the following databases: EBSCOhost, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar. Abstract and full article data were screened using inclusion and exclusion criteria by two researchers. Data extracted from the eligible studies were analysed using thematic analysis. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool, version 2011. Results: Seventeen articles of the initial 151 hits were selected for review and an additional five files were identified through bibliographical search. Most studies had small sample sizes and focused on sexual health, targeting gay men and men who have sex with men in urban areas. Lesbians and bisexual women were not prioritised. Discussion: It emerged from the review that LGBT issues were not covered in the healthcare worker curriculum. Further it was noted that there is a paucity of data on the South African LGBT population, as sexual orientation does not form part of the routine data set. The findings of this review indicate gaps in the literature, practice guidelines and policies in LGBT healthcare in South Africa

Transgender population's experiences with regard to accessing reproductive health care in Kwazulu-Natal, South Africa: A qualitative study

Background: The transgender population has unique health risks, including increased risk of mental illness, substance abuse, suicide and a high prevalence of human immunodeficiency virus (HIV). Worldwide studies indicate that this population is marginalised and faces barriers in accessing health care. In South Africa, there is limited information and research on the transgender population's interaction with health services. Aim: The purpose of this study was to examine the experiences of the transgender population in accessing health care facilities for sexual and reproductive needs. Setting: The study took place in KwaZulu-Natal province of South Africa. Methods: A qualitative study combining phenomenological and critical ethnographic approaches was conducted to explore the experiences of the transgender population in the health care setting. Critical ethnography was chosen because it is an emancipatory method that highlights the plight of disenfranchised groups, and phenomenology was used to illuminate experiences of the transgender population. Purposive snowball sampling was applied to select nine transgender participants who had experiences of contact with a health care setting. Data collection was performed through semi-structured interviews and a focus group discussion. Results: Participants provided details about the paucity of facilities, resources and targeted programmes to cater for the transgender populations' sexual and reproductive health needs. The participants engage in high-risk behaviour, comprising unprotected sex and use of cross-gender hormones without medical supervision. Furthermore, the participants reported experiences of hostile and discriminatory behaviour by healthcare workers. Conclusion: It emerged that there is a paucity of resources and knowledge to provide appropriate health care services to the transgender population, resulting in adverse experiences. Policies on transgender care and training of health workers will contribute towards improvement of health care access for the transgender population

Bachelor of Nursing students' HIV and AIDS knowledge in KwaZulu-Natal province: An evaluation study

Background: Currently, human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS) education and training in nursing suffer from various inadequacies and lack any real formalisation in their governance. As a result, Bachelor of Nursing students find themselves challenged in providing effective HIV and AIDS healthcare management, largely because of the deficit in training identified. An HIV and AIDS education intervention programme was introduced at a selected KwaZulu-Natal university to assist in bridging the perceived knowledge gap. This article communicates programme evaluation findings.Objectives: The aim of this article was to determine levels of HIV knowledge achieved following an HIV education intervention programme.Methods: A pure, descriptive quantitative research design was employed, using total population sampling (N = 133). A modified G3658-11 Collecting Evaluation Data: End-of-Session Questionnaire, developed by the University of Wisconsin­Extension, was administered for data collection.Results: Females predominated in the study, and most participants were African with 1 to 3 years of education programme exposure. Perceived HIV knowledge increase was evident: pathophysiology (n = 93, 70.2%); immunology (n = 97, 72.9%); transmission (n = 116, 87.5%); diagnosis (n = 109, 81.8%); prevention strategies (n = 118, 88.4%); staging and monitoring (n = 106, 80%); pre- and post-test counselling (n = 104, 78%). Conclusion: Pre- and ongoing in-service HIV and AIDS training can improve perceived HIV knowledge levels for both nursing students and professionals. Mandatory HIV and AIDS healthcare management training is therefore recommended in planning for its effective impartation by nursing educators