Awareness of the ward based outreach team and the services offered by the programme in the tshwane health district, South Africa

Background: The Ward Based Outreach Team (WBOT) is an organised team approach to a healthcare system based on theprinciples of epidemiology, primary health care, preventive medicine and health promotion. Globally, it has become a primary care response to many health challenges such as universal health coverage. The beneficiaries are community members, also referred to as households.Methods: The study assessed the awareness of the WBOT and the servicesoffered by the programme in the Tshwane health district of South Africa. This was a cross-sectional survey conducted in all seven sub-districts of the health district. The health district is further sub-divided into 150 health wards. Eighty-five health wards were randomly selected for the study. Using the sample size calculator, with a confidence interval of 5% and confidence level of 99%, the sample size of participants was 654. However, during the data collection process there was over-sampling of up to 764. Participants were recruited by convenience sampling. Data werecollected between October 12 and December 3, 2015, using a pre-piloted, structured questionnaire administered by 14 trained field workers. Results: The study obtained 6 288 responses from the 764 participants. The responses were grouped into two sections, 'Yes' and 'No'. A summary of the responses showed that the number of 'yes' responses, the number of participants who were aware of the WBOT and the services offered by the programme were higher than the number of participants who were unaware of the programme. The figures were 5 590 (88.8%) 'yes' responses and 698 (11.1%) 'no' responses.Conclusion: In summary, the awareness of the WBOT and the services offered by the programme in the Tshwane health district, South Africa is evaluated to be 88.8%

Perceptions of community health workers on their training, teamwork and practice: a cross-sectional study in Tshwane district, Gauteng, South Africa

Background: In 2011, South Africa established ward-based outreach teams (WBOTs) comprising Community Health Workers as part of strategies to strengthen primary healthcare. The new community health workers (CHWs) lacked experience of the programme. This study aimed at assessing perceptions of community health workers on their training, teamwork and practice.Methods: This was a cross-sectional study conducted among CHWs in the seven regions of Tshwane health district between October and November 2015. Data were collected from 431 CHWs in eight Community Health Centres and 11 clinics using a pre-tested, self-administered questionnaire. Outcome measures were CHWs' perceptions on training, teamwork and practice regarding WBOT programme.Results: A total of 431 CHWs formed the study sample. Participants had a mean age of 36 years (SD ± 9.46). The majority (88.2%) were female. Some 77% had completed secondary school. Overall, most CHWs perceived their training (86.4%), teamwork (87.6%) and practices (67.7%) to be good (p = 0.001). The majority were able to provide efficient health care despite the challenges experienced, which were lack of equipment, walking long distances, and safety on the streets and in households with patients who had mental health problems among others. Fisher's exact test showed a significant association between training and work challenges (p = 0.006).Conclusion: The study findings showed that most CHWs had good perceptions regarding their training, teamwork and practice. Several concerns raised by CHWs suggest the need for stakeholders to ensure availability of resources for optimal functioning of CHWs

Community healthcare workers' satisfaction with ward-based outreach team services in Tshwane district, South Africa

Background: The incorporation of community healthcare worker (CHW) involvement in the management of patients is in line with the 2006 World Health Report, which advocates increased community participation and the systematic delegation of tasks to less specialised cadres. For CHWs to function optimally, satisfaction in their duties is paramount to promote quality healthcare. The health minister included ward-based outreach teams (WBOT) as part of the National Health Insurance. 1 CHWs form an important link between healthcare facilities and the communities. This study aimed to measure the satisfaction level of the CHWs with WBOT services in the Tshwane district of South Africa. Method: A cross-sectional study on CHWs was conducted in seven sub-districts. Data were obtained by trained data collectors using a piloted self-administered structured questionnaire from October 12 to November 3, 2015 in three local official languages. The study population of CHWs was 1 600. Using a 95% confidence level and 5% confidence interval, the sample size was 310. However, we over-sampled to 431 participants. Results: The mean age was 36 years (SD ± 9.46). The majority were females (82.1%); more than three-quarters (77%) had secondary education. The majority were satisfied with the WBOT services whereby 59.8% was the lowest score and 98.4% the highest score. Close to two-thirds (62%) were not satisfied with their monthly stipends. The majority of the younger members of the team (20­40 years) were not valued by their co-workers (70% or 181/255) [p= 0.03]. The overall satisfaction(n= 8593) was 73.4% (p< 0.001).Conclusion: Overall satisfaction of CHWs with WBOT is good news. Dissatisfaction regarding stipend/compensation must be addressed. CHWs should be valued and motivated

The Experience and Psychosocial Needs of Patients with Traumatic Fractures Treated for more than Six Months at Doctors on Call for Service Hospital; Goma; Democratic Republic of Congo

Background: Trauma-related consultations; admissions and complications are the leading problems at Doctors on Call for Service (DOCS) Hospital; Goma; Democratic Republic of Congo; and yet no studies have been carried out to document the experience of long-stay traumatic-fracture patients in this hospital. Aim: The aim of this study was to explore the experience and psychosocial needs of patients with traumatic fractures treated for more than six months at DOCS Hospital. Methods: Six free-attitude interviews were conducted with purposively selected patients. The interviews were recorded with a tape recorder and transcribed verbatim; and content analysis was used to identify themes from the interviews. Results: All patients could clearly connect the injury experience to severe pain that lingered on for weeks or months for some patients; accompanied by other symptoms such as insomnia; poor appetite and psychological symptoms. Most patients felt disabled; were abandoned by relatives or friends and experienced financial problems. Some benefited from the injury by way of strengthened marital links. Some patients complained of poor information about their illness and the management plan and did not appreciate the treatment from caregivers; while some disclosed their needs and expectations and appreciated the caregivers who showed interest in them. Conclusions: The experience of long-term trauma has negative effects on the whole person of the patient; including his or her work and family; and some patients continue to suffer from the effects of the traumatic event up to six months later. The needs of patients suffering from trauma include reassurance by physicians and nurses; more information and participation in the decision-making process; regular visits from friends and family; and better bedside manners from caregivers

Understanding Participation in a Hospital-Based HIV Support Group in Limpopo Province; South Africa

Background: Support groups are an appropriate way of delivering psychosocial support to people living with HIV/AIDS; especially in low-resource countries. The aim of the study was to understand why people with HIV attended psychosocial support groups. Methods: This was a qualitative study design using focus-group discussions in which support-group members volunteered to participate. Five focus groups were involved in the study. Results: The participants attended because they were referred by a health-care worker; wanted information; wanted emotional support; accompanied an ill relative or knew about the support group. Perceived benefits included receiving psychological support; accepting one's HIV status; reducing stigma and isolation; increasing hope; forging new friendships; helping others; obtaining HIV-related information; developing strategies to change behaviour; gaining access to medical care at the adjoining HIV clinic and receiving food donations. Negative aspects of attending the support group included the large size of the support group; long queues at the HIV clinic; concerns about confidentiality and negative staff attitudes towards the participants. Leaders were concerned about conflict; burn-out and impractical protocols. Access to disability grants was also a concern. Conclusions: Support groups can assist members to cope with the various challenges associated with living with HIV/ AIDS through offering structured emotional; informational; instrumental and material support. Support group sizes should be limited. A structured curriculum containing up-to-date information about ART should also be offered to support groups. Social workers should furthermore be involved to facilitate access to appropriate social grants. Finally; support group leaders should receive appropriate training and regular debriefing

Emotional Reactions of Medical Doctors and Students Following the Loss of Their Patients at the Dr George Mukhari Hospital Emergency Unit; South Africa

Background: Studies on death and dying predominantly emphasise the needs of the dying patient and the process of bereavement. Few studies have focused on the reactions of medical doctors and students when the patients they have cared for die. Methods: The aim of the study was to explore the thoughts and feelings of doctors and medical students who have lost patients while under their care at the Dr George Mukhari Hospital emergency unit in Ga-Rankuwa; South Africa. The participants included 10 medical doctors and final-year medical students. A qualitative study methodology using a phenomenological approach was used. Results: Meanings were formulated from transcriptions and themes were identified. The following themes emerged: emotional reactions; which included anger; helplessness; guilt and pain; recurrent thoughts about the incident; blame; perceived incompetence; detachment from emotions; religion; death of a paediatric patient; medical training; psychological services; work environment; coping with the family of the deceased; and facing mortality. Conclusion: From the study it was concluded that doctors needed enhanced training in communication skills and communicating death to the patients' families. Bereavement counselling and debriefing should be available to provide them with an opportunity to share emotional responses and reflect on patients' fatality

Personality Profile and Coping Resources of Family Medicine Vocational Trainees at the University of Limpopo; South Africa

Background: Doctors are exposed to various stress factors in their personal and family lives; as well as in the workplace. Stress inherent to the responsibilities and challenges of the medical field may become a health hazard and threaten the well-being of the medical practitioner. Methods: The aim of this study was to investigate the personality traits and coping resources that contribute to the wellbeing of medical practitioners. A cross-sectional study of 44 out of 45 (98response rate) family medicine vocational trainees at the Medical University of Southern Africa (now known as the University of Limpopo) was conducted. A biographic questionnaire was utilised to obtain specific information regarding the participants. The principal researcher used the Coping Resources Inventory (CRI) questionnaire to assess coping resources; and the 16PF personality analysis (16PF) to establish a personality profile of the participants. Results: The majority of participants (81.8) indicated that they mainly experienced work-related stress. Thirty-two participants (72.72) self-medicated. Fourteen participants (31.81) claimed to experience burn-out and twenty (45.45) reported fatigue. In terms of their coping resources; 24 male participants (54.54) did not cope socially (p . 0.008) and eight (18.18) also did not cope physically (p . 0.024). Conclusions: The medical practitioners had a universal personality profile. They lacked insight regarding the symptoms they were experiencing that warranted management; e.g. depression and anxiety. The medical practitioners in this study did not utilise their social and physical coping resources optimally and reported poor help-seeking behaviour

Management of Snakebites at a Rural South African Hospital

Background: Snakebites remain a source of considerable morbidity and mortality in many countries with an estimated global true incidence of envenomation exceeding five million per year; with about 100 000 of these cases developing severe sequelae. Despite the availability of polyvalent snake antivenom; inappropriate first aid; the regional effects of envenomation; and inappropriate use of antivenom result in significant and at times potentially avoidable; morbidity and mortality - particularly in children. The study was undertaken in Ellisras (now Lephalale) hospital; Limpopo province due to the frequency of snake bites managed at the hospital. Methods: This was a record-based retrospective study in which patient files with the diagnosis of snake bite were reviewed. The objective of this study was to document the management of snakebites at Ellisras (now Lephalale) hospital; Limpopo; a rural hospital in South Africa. The hospital files of all patients managed at the hospital for snakebites from 1 January 1998 to 31 December 2001 were reviewed. Results: Seventy patients were treated for snakebites during the study period. The results showed a male preponderance (60) and a mean age of 27.3 years among the reported cases managed for snakebites. Twenty-nine patients (41.1) were bitten between dusk and dawn (18h00 and 06h00); 43 (61.4) were bitten on the lower limb and the mean duration of admission in the wards was 4.2 days. Twenty-one bites (30) were attributed to known poisonous snakes; 22 (31.4) received polyvalent antivenom; 42 (60) received promethazine which has not been shown to prevent anaphylactic reactions; 12 (17.1) developed complications; and 2 died (case fatality rate of 2.9). Conclusion: The findings of this study highlight gaps in the management of snake bites at this rural hospital where they occur frequently. It is crucial for primary care physicians to be familiar with the most common venomous snakes in South Africa and the management of their bites in humans. The importance of administering prophylactic antibiotic; tetanus toxoid in all confirmed snakebites; and close monitoring of all patients during and after antivenom administration form the basis of most clinical protocols on the management of snakebites

The Experiences of Family Caregivers Concerning their Care of HIV/AIDS Orphans

Introduction: The HIV/AIDS pandemic is reducing life expectancy and raising mortality. An increasing orphan population is perhaps the most tragic and long-term legacy of the HIV/AIDS pandemic. By 2010 sub-Saharan Africa is expected to have an estimated 50 million orphans and it will be staggered by this challenge. By the middle of 2006; 1.5 million children under the age of 18 years were maternal orphans in South Africa; and 66of these children had been orphaned as a result of HIV/AIDS. Although government and non-government organisations have responded by building orphanages; most of Africa's orphans have been absorbed into extended family networks. Many of these extended family caregivers are ageing and often impoverished grandparents. Methods: This was a descriptive; qualitative study using the free attitude interview technique. All family caregivers who consulted at the Hoekfontein Clinic; North West Province; South Africa between March and June 2006 formed the study population. A total of nine one-on-one interviews had been conducted by the time saturation of data was reached. Results: All nine caregivers were women; mostly grandmothers (67); and the orphans were between the ages of 5 and 20 years. Emergent themes were: poverty and lack of money; bureaucratic difficulties and lack of assistance from the social support services; lack of support (financial; physical and emotional) from other family members; frustrations of coping with rebellious orphans; pain of caring for the terminally ill family members; feelings of despondency (hopelessness); conflicts in the family; and the rejection of orphans by their fathers. Conclusions: The study showed that the family caregivers experienced a lack of welfare and family/emotional support in their care of HIV/AIDS orphans. It is recommended that health care workers; including social workers and home-based caregivers be trained on available social support from government and non-governmental organisations for caregivers of HIV/AIDS orphans

A Profile of Acute Poisoning at Selected Hospitals in South Africa

The aim of this study was to characterise acute poisoning cases admitted to a number of selected hospitals in South Africa. All cases admitted to eight hospitals; from January 2005 to June 2005; were evaluated retrospectively. Data obtained from the hospital medical records included the following: demographic characteristics; toxic agents; length of hospital stay; circumstances of poisoning; morbidity and mortality information on the poisoned patients. From a total of 424 patients admitted for treatment; whose median age was 17.6 years; 57.8were females; and 89.6black Africans. Fifty-nine percent of the poisonings were accidental; and the involved toxic agents were; in descending order: household chemicals (45.7); modern medicines (17.5); animal/insect bites (15.8); agrochemical chemicals (9.7); food poisoning (5.4); drugs of abuse (3.3); traditional medicines (2.4); and plants (0.2). Poisoning by drugs of abuse was commoner in males than females; but the percentage of females poisoned by all other toxic agents was higher than in males. Most patients spent less than two days in hospital; but more females (70.1) than males (29.9) stayed for more than two days. The overall case fatality rate was 2.4. Of those who died; 80were black Africans; aged 13 to 19 years and it was deliberate poisoning through drugs of abuse; carbon monoxide and agricultural chemicals. Acute poisoning reviewed in some selected hospitals in South Africa revealed that more black African females were involved; who spent more than two days hospitalised. The case fatality rate was 2.4; mainly due to drugs of abuse; carbon monoxide and agricultural chemicals. These findings suggest that further studies are needed to understand the motivation(s) for this emerging problem and that these should focus primarily on the female black African

A qualitative study on the relationship between doctors and nurses offering primary health at KwaNobuhle (Uitenhage)

"Background Primary health care; which was the domain of the nursing profession; was popularised by the introduction of free health services by the South African legislature. In addition; the district health system was developed with the aim of keeping people healthy by creating small management systems adapted to cater for local needs. These measures increased public access to healthcare centres; leading to an increased workload at primary health level. The government; being a large organisation; relies on groups that include doctors and nurses to accomplish its goals; and the effectiveness of these groups plays a major role in determining the effectiveness of the overall organization. ""The nurse has an ethical responsibility in the interest of the welfare of her patient to be a loyal and competent colleague to the doctor. The nurse and the doctor must be able to rely on each other. Mutual respect is vital."" Nurses have dependent; independent and interdependent roles in their interaction with doctors; and both professions should embrace the Patient's Rights Charter; which requires a good standard of practice and care of patients. International journals have published numerous letters citing doctor-nurse disagreements in their interactions. Historically; the doctor-nurse relationship is an unequal one characterised by the dominance of the doctor; with nurses assuming a position of lower status and dependence on physicians. One qualitative study showed that nurses perceive the quality of communication with doctors as being poor. Lack of teamwork in the relationship resulted from different expectations and a confusion of roles. Both professions have however demonstrated a willingness to promote teamwork in hospitals. A journal review on interventions to promote collaboration between nurses and doctors showed positive gains once collaboration was embraced. Method This was a descriptive qualitative study in which the experiences of Kwa-Nobuhle general practitioners and professional nurses were explored. An equal number of nurses and doctors (five each) were purposefully selected; for the free-attitude interviews used for data collection. All interviews were analysed using the thematic analysis method. Themes were integrated into a single model. Results Majority of respondents experienced a relatively good relationship. The positive factors were balanced by negative experiences by almost all respondents. The positives were personal growth; efficiency at work; opportunity for education and learning at the primary healthcare level. The negatives were doctors' inconsistent clinic visits; role confusion (with doctors being confused with policymakers); dominance of the doctor in the relationship; and lack of doctor-nurse forums for communication; with subsequent suspicion and tension. The impact of the conflicts was neutralised by the track record of the relationship and the behaviour of the participants towards each other. Conclusion This study showed congruence with other studies; where the doctor-nurse relationship was influenced by a power differential;collaboration; role confusion; impact of the respondents' com etence; the significance of recognising the nurses' hierarchy and continuity of the care they provide at the primary health level. Maximum variation; strict admission criteria and data validation through a member check addressed issues of bias in this study. The exploration of relationships is a sensitive issue and a different methodology may produce different results. The environment where this research was conducted may differ from others; leading to discrepancies in findings. Future research could further focus on team building and the essential elements to sustain the doctor-nurse-patient team."

Predictors of Topical Steroid Misuse among Patrons of Pharmacies in Pretoria

The misuse of topical steroids; i.e. the usage of these products for skin lightening; is a widespread phenomenon among African men and women. Studies have reported prevalence rates of 18.5to 70 among participants. Though women constitute the majority of users; people of various age groups; socioeconomic status; employment and marital status practise skin lightening. Besides topical steroid products; other commonly used products include preparations containing hydroquinone or mercury derivatives. The misuse of these products is associated with skin problems such as cellulitis; contact eczema; bacterial and fungal infections; Cushing's syndrome; acne; skin atrophy and pigmentation disorders. Although these effects are well documented; it seems that there is little wareness of them among the general public. Other less commonly reported problems include delaying the diagnosis of leprosy; and erythrodermic psoriasis. Data on the misuse and side effects of topical steroids have been gathered primarily from prescriptions; despite the fact that these products could be obtained over the counter; shared between relatives or friends; or come from other informal sources. Moreover; we found no community-based study that investigated the prevalence of the misuse of topical steroid products in South Africa. This survey was therefore conducted to examine the misuse of topical steroid products for skin lightening; among patrons of pharmacies in Pretoria and to determine the potential predictors of misuse.Methods: The aim of this study was to examine the misuse of topical steroid products for skin lightening by patrons of pharmacies in Pretoria and to determine the potential predictors of misuse. Exit interviews were conducted at 21 randomly selected pharmacies by trained interviewers using a structured questionnaire. A total of 1 228 patrons were approached; of which 225 gave verbal consent to be interviewed.Results: Of the 225 participants; 83 were female; 50.7 were 20-40 years old; 56 were employed; and 53.3 were married. The majority of participants (75.1) were black Africans. About half of them (50.2) had high school education. The prevalence of topical steroid misuse for skin lightening was 35.5. A logistic regression analysis revealed that being a black female African and initially being advised to use the products by a friend were the only parameters that significantly correlated with topical steroid misuse.Conclusion: In conclusion; the prevalence of the misuse of topical steroid products among the respondents was 35.5. The following predictors were associated with topical steroid misuse: being a black female African; not being aware of the side effects of these products; and initially being advised to use the products by a friend. In a logistic regression model; the last two predictors were the only parameters that significantly correlated with topical steroid misuse. (SA Fam Pract 2006; 48(1): 14)

A Qualitative Study on the Relationship between Doctors and Nurses Offering Primary Health at KwaNobuhle (Uitenhage)

"Background: Primary health care; which was the domain of the nursing profession; was popularised by the introduction of free health services by the South African legislature. In addition; the district health system was developed with the aim of keeping people healthy by creating small management systems adapted to cater for local needs. These measures increased public access to healthcare centres; leading to an increased workload at primary health level. The government; being a large organisation; relies on groups that include doctors and nurses to accomplish its goals; and the governess of these groups plays a major role in determining the effectiveness of the overall organization. ""The nurse has an ethical responsibility in the interest of the welfare of her patient to be a loyal and petent colleague to the doctor. The nurse and the doctor must be able to rely on each other. Mutual respect is vital."" Nurses have dependent; independent and interdependent roles in their interaction with doctors; and both professions should embrace the Patient's Rights Charter; which requires a good standard of practice and care of patients. International journals have published numerous letters citing doctor-nurse disagreements in their interactions. Historically; the doctor-nurse relationship is an unequal one characterised by the dominance of the doctor; with nurses assuming a position of lower status and dependence on physicians. One qualitative study showed that nurses perceive the quality of communication with doctors as being poor. Lack of teamwork in the relationship resulted from different expectations and a confusion of roles. Both professions have however demonstrated a willingness to promote teamwork in hospitals. A journal review on interventions to promote collaboration between nurses and doctors showed positive gains once collaboration was embraced.Method: This was a descriptive qualitative study in which the experiences of Kwa-Nobuhle general practitioners and professional nurses were explored. An equal number of nurses and doctors (five each) were purposefully selected; for the free-attitude interviews used for data collection. All interviews were analysed using the thematic analysis method. Themes were integrated into a single Model.Results: Majority of respondents experienced a relatively good relationship. The positive factors were balanced by negative experiences by almost all respondents. The positives were personal growth; efficiency at work; opportunity for education and learning at the primary healthcare level. The negatives were doctors' inconsistent clinic visits; role confusion (with doctors being confused with policymakers); dominance of the doctor in the relationship; and lack of doctor-nurse forums for communication; with subsequent suspicion and tension. The impact of the conflicts was neutralised by the track record of the relationship and the behaviour of the participants towards each other.Conclusion: This study showed congruence with other studies; where the doctor-nurse relationship was influenced by a power differential; collaboration; role confusion; impact of the respondents' competence; the significance of recognising the nurses' hierarchy and continuity of the care they provide at the primary health level. Maximum variation; strict admission criteria and data validation through a member check addressed issues of bias in this study. The exploration of relationships is a sensitive issue and a different methodology may produce different results. The environment where this research was conducted may differ from others; leading to discrepancies in findings. Future research could further focus on team building and the essential elements to sustain the doctor-nurse-patient team."

XDR TB in South Africa - What lies ahead?

The emergence of XDR TB coupled with the high prevalence of HIV/AIDS has intensified the need to identify new treatment strategies and accelerate research into antibiotics against XDR TB before the world is faced with a global public health crisis. This article gives a short overview on the important health implications of XDR-TB in South Africa

How the families of the victims suicide through self-incineration function before and after the event a qualitative assessment

Background Durkheim defines suicide as all death resulting directly or indirectly from a positive or negative act of the victim himself or herself; which he or she knows will produce this result. Suicide is as old as human history itself. It is most frequently seen as a fatal sequel of psychiatric illnesses and it is thought that suicide only occurs in a state of insanity; and that it is by itself a special form of insanity. Health workers; especially family practitioners; are constantly confronted by family tragedies; which they have to deal with competently. It is therefore imperative that a health worker contextually understand a family tragedy; such as when a family member commits suicide through self-incineration. Between 1987 and 1998; Matsulu Township; Mpumalanga experienced a high incidence of suicide through self-incineration. Each victim either ingested or doused him or herself with inflammable liquid (usually kerosene) and set his or her body alight. This gruesome form of suicide; and the increased frequency of occurrence; horrified the families and reverberated through the township. This phenomenon drew the principal researcher's attention and resulted in this study. The principal researcher was the only family practitioner in the township during this period. It was hoped that the knowledge gained from this study would form the basis for interventions in similarly affected families in the future. The focus was on the surviving family members; in order to learn about the family dynamics before and after the events; and how the family dealt with the event. Although studies that focused on the role of doctors in suicide prevention found that there is little predictive power for the suicide candidates; which means that there were no identifiable factors directly associated with suicide outcome; information gleaned from the affected families could be used profitably in community campaigns and by support groups. Methods The aim of the study was to understand how the families of those who committed suicide through self-incineration functioned before and after the event. In-depth interviews were conducted with six focus groups selected urposively from 36 affected families. Interviews were conducted in Siswati; audiotaped; transcribed and translated into eng. Themes and sub-themes were identified. To enhance the trustworthiness of the information gathered; the data were triangulated. Results Themes identified were a shocking experience; no chance of survival; triggering factors; mystery; emotional and physical scars; and coping strategies. The perception of witchcraft being responsible for suicide featured prominently in the data analysed. Conclusions The functioning of the families affected by the suicide of a member through self-incineration was markedly reduced after the events. It is recommended that attention be given especially to the perception of witchcraft being responsible for suicide; and that grief support groups be established in the community to assist affected families cope better with the loss

Adherence To HIV Antiretroviral Therapy Part II: Which Interventions Are Effective In Improving Adherence?

Interventions to support adherence to antiretroviral therapy (ART) can be classified into four categories: cognitive; beha-vioural and affective interventions and (modified) directly observed therapy (DOT.) Cognitive interventions improve HIV- and ART-related knowledge; but this is not consistently associated with better adhe-rence. Cognitive interventions that are combined with behavioural or psychological strategies are more effective in improving adherence; especially in patients who previously were less adherent. These include interventions that improve self-efficacy; provide stress management/expressive support therapy or motivational interviewing. As yet there is no evidence for the role of affective interventions and modified DOT to improve adherence to ART. When designing interventions to address adherence; it should be borne in mind that multi-component interventions are more effective than single-focus interventions. A combination of educational; behavioural and affective components is suggested to ensure optimum adherence.In countries with a high prevalence of HIV; such as South Africa; careful patient preparation; rather than selecting patients based on non-clinical predictors of adherence; seems an appropriate method for scaling up ART. South African guidelines focus on comprehensive adherence support to all patients; with additional support to patients with less than 80adherence. More research on the effectiveness of interventions aimed at improving adherence is urgently needed; especially in develo-ping countries