Effect of a ward-based outreach team and adherence game on retention and viral load suppression

Background: Only 66% of South African people living with HIV (PLWH) are virologically suppressed. Therefore, it is important to develop strategies to improve outcomes.Objectives: Assess the effect of interventions on 12-month retention in care and virological suppression in participants newly initiated on antiretroviral therapy.Method: Fifty-seven clinics were randomised into four arms: Ward-based primary health care outreach teams (WBPHCOTs); Game; WBPHCOT­Game in combination; and Control (standard of care). Sixteen clinics were excluded and four re-allocated because lay counsellors and operational team leaders failed to attend the required training. Seventeen clinics were excluded due to non-enrolment. Results: A total of 558 participants from Tshwane district were enrolled. After excluding ineligible participants, 467 participants were included in the analysis: WBPHCOTs (n = 72); Games (n = 126); WBPHCOT­Games (n = 85); and Control (n = 184). Retention in care at 12 months was evaluable in 340 participants (86.2%) were retained in care and 13.8% were lost to follow-up. The intervention groups had higher retention in care than the Control group, but this only reached statistical significance in the Games group (96.8% vs 77.8%; relative risk [RR] 1.25; 95% confidence interval [CI]: 1.13­1.38; P = 0.01). The 12 month virologic suppression rate was 75.3% and was similar across the four arms.Conclusion: This study demonstrated that an adherence game intervention could help keep PLWH in care.What this study adds: Evidence that interventions, especially Games, could improve retention in care

Hospital Reform and Staff Morale in South Africa: a Case Study of Dr Yusuf Dadoo Hospital

Objectives: This study explored major factors that influenced staff motivation at a district hospital in South Africa following hospital reforms and comparison of these factors across the two main staff categories. Design: This study was a cross-sectional descriptive survey. Settings and subjects: This study included all medical and nursing staff working at the district hospital. Outcome measures: A semi-structured questionnaire coded for anonymity was used. It comprised three sections: the introduction; demographic information and a list of factors to which participants responded by indicating their level of agreement or disagreement using the Likert's scale. The questionnaire's reliability was confirmed using Cronbach's coefficient alpha with a value of 0.9. Results: Of the 179 participants; 122 returned the questionnaires. This equated to a response rate of 68. The staff expressed more demotivation than motivation. Major factors that played a role were institutional in character; namely poor management and leadership; unfavourable institutional policies and administration practices with regard to staff development; conflictual inter- and intraprofessional relationships; a paucity of equipment and retention and recruitment strategies. The unique motivator was the individual value of the vocational aspect of the profession. Distance travelled to the workplace did not have any association with the identified motivating and demotivating factors. Conclusion: Staff mo tivation is crucial in any institution or organisation. Presently; the South African healthcare sector is undergoing transformation in terms of implementation of National Health Insurance. The effectiveness of the healthcare system in achieving its goals will be impacted by the prioritisation of institutional strategies that contribute to staff motivation. Managers' skills in healthcare facilities are critical to the success of the implementation of reforms in South Africa