The mechanics of setting up a COVID-19 response: Experiences of the COVID-19 epidemic from Groote Schuur Hospital, Cape Town, South Africa

The COVID-19 pandemic has challenged the provision of healthcare in ways that are unprecedented in our lifetime. Planning for the sheer numbers expected during the surge has required public hospitals to de-escalate all non-essential clinical services to focus on COVID-19. Western Cape Province was the initial epicentre of the COVID-19 epidemic in South Africa (SA), and the Cape Town metro was its hardest-hit geographical region. We describe how we constructed our COVID-19 hospital-wide clinical service at Groote Schuur Hospital, the University of Cape Town's tertiary-level teaching hospital. By describing the barriers and enablers, we hope to provide guidance rather than a blueprint for hospitals elsewhere in SA and in low-resource countries that face similar challenges now or during subsequent waves

HIV/AIDS and Mental Health Research in Sub-Saharan Africa: a Systematic Review

The relationship between mental illness and HIV/AIDS is complex and bidirectional. A significant amount of research has been performed in high-income countries but less is known about HIV and mental health in sub-Saharan Africa. The objectives of the review were to search the literature for quantitative studies conducted in sub-Saharan Africa on mental health and HIV and to critically evaluate and collate the studies in order to identify research needs and priorities. The databases Ovid; MEDLINE; PsycINFO and the Social Sciences Citation Index (SSCI) were searched for variations of search terms related to HIV/AIDS and mental health and studies limited to the populations of African countries. In addition; we hand-searched indexes of key journals and the databases of academic theses. We included 104 papers or research publications. The majority of these were published after 2005. The major topics covered were: mental-health-related HIV-risk behaviour; HIV in psychiatric populations; and mental illness in HIV-positive populations. The reported prevalence levels of mental illness among people living with HIV or AIDS (PLHIV) was high; with all but one study noting a prevalence of 19or higher. Neurocognitive changes in adults with HIV were also prevalent; with reported deficits of up to 99in symptomatic PLHIV and 33in non-symptomatic PLHIV. Research on HIV in relation to mental health is increasing; however; there is a need for good-quality prospective studies to investigate the bidirectional effects of mental illness and HIV on each other

Patients with Severe Mental Illness : a New Approach for Testing for HIV

Background :The prevalence of infection with the Human Immuno-deficiency Virus (HIV) in South Africa is approaching 20of young adults. In severely mentally ill people; it is probably higher. Testing for infection is subject to stringent ethical principles. Undiagnosed HIV infection in people with severe mental illness increases costs and morbidity. Since effective treatments are available; it is imperative to diagnose HIV infection early in this high risk population. Methods : a literature review established the prevalence of HIV infection in in-patient populations with HIV infection. The pattern of testing for HIV over three years at a major psychiatric hospital was investigated. We surveyed public sector psychiatrists in the Western Cape to establish their attitudes to HIV in their patients. Results The HIV reported seroprevalence in psychiatric in-patients ranges from 0-59.3; with a mean of 10. Data show a clear trend towards an increase in prevalence: Pre 1996 the mean HIV seroprevalence was 7.4; while post 1996 the mean was 15. State psychiatrists in the Western Cape do not test routinely for HIV infection; mainly due to ethical constraints: 14.6of patients at Lentegeur Hospital were tested in 2006. Conclusions The high prevalence of HIV infection in South Africa; that is probably higher in patients with severe mental illness (most of whom are not competent to provide informed consent) and the availability of effective treatment; requires debate and a clear policy regarding testing for HIV infection to be implemented. We recommend a new approach to HIV testing in these patients