Factors influencing treatment default among tuberculosis patients in a high burden province of South Africa.

OBJECTIVE: To determine and describe the factors influencing treatment default of tuberculosis (TB) patients in the Free State Province of South Africa. METHODS: A retrospective records review of pulmonary TB cases captured in the ETR.Net electronic TB register between 2003 and 2012 was performed. Subjects were >15 years of age and had a recorded pre-treatment smear result. The demographic and clinical characteristics of defaulters were described. Multivariate logistic regression analysis was used to determine factors associated with treatment default. The odds ratios (OR) together with their corresponding 95% confidence intervals (CI) were estimated. Statistical significance was considered at 0.05. RESULTS: A total of 7980 out of 110 349 (7.2%) cases defaulted treatment. Significantly higher proportions of cases were male (8.3% vs. female: 5.8%; p<0.001), <25 years old (9.1% vs. 25-34 years: 8.7%; 35-44 years: 7.0%; 45-54 years: 5.2%; 55-64 years: 4.4%; >64 years: 3.9%; p<0.001), undergoing TB retreatment (11.0% vs. new cases: 6.3%; p<0.001), had a negative pre-treatment sputum smear result (7.8% vs. positive smear results: 7.1%; p<0.001), were in the first 2 months of treatment (95.5% vs. >2 months: 4.8%; p<0.001), and had unknown HIV status (7.8% vs. HIV-positive: 7.0% and HIV-negative: 5.7%; p<0.001). After controlling for potential confounders, multivariate analysis revealed a two-fold increased risk of defaulting treatment when being retreated compared to being treated for the first time for TB (adjusted OR (AOR) 2.0, 95% CI 1.85-2.25). Female cases were 40% less likely to default treatment compared to their male counterparts (AOR 0.6, 95% CI 0.51-0.71). Treatment default was less likely among cases >24 years old compared to younger cases (25-34 years: AOR 0.8, 95% CI 0.77-0.87; 35-44 years: AOR 0.6, 95% CI 0.50-0.64; 45-54 years: AOR 0.4, 95% CI 0.32-0.49; 55-64 years: AOR 0.3, 95% CI 0.21-0.43; >64 years: AOR 0.3, 95% CI 0.19-0.35). Co-infected cases receiving antiretroviral therapy (ART) were 40% less likely to default TB treatment relative to those whose ART status was unknown (AOR 0.6, 95% CI 0.46-0.57). CONCLUSIONS: Salient factors influence TB patient treatment default in the Free State Province. Therefore, the strengthening of clinical and programmatic interventions for patients at high risk of treatment default is recommended. In particular, ART provision to co-infected cases facilitates TB treatment adherence and outcomes.

Integration of TB-HIV services at an ANC facility in Frances Baard District, Northern Cape, South Africa.

BACKGROUND: Integrated tuberculosis-human immunodeficiency virus (TB-HIV) service delivery as part of maternal health services, including antenatal care (ANC), is widely recommended. This study assessed the implementation of collaborative TB-HIV service delivery at a hospital-based ANC service unit. METHODS: A record review of a random sample of 308 pregnant women attending the ANC service between April 2011 and February 2012 was conducted. Data were extracted from registers and patient case notes. Outcomes included the proportion of women who underwent HIV counselling and testing (HCT), CD4 count testing, antiretroviral treatment (ART), cotrimoxazole preventive treatment (CPT), TB screening and isoniazid preventive treatment (IPT). Analysis measured variations in patient characteristics associated with service delivery. RESULTS: All women underwent HCT; 80% of those who tested HIV-positive were screened for TB. Most (85.9%) of the HIV-positive women received a CD4 count. However, only 12.9% of eligible women received ART prophylaxis onsite, only 35.7% were referred for initiation of ART, only 42.3% commenced IPT and none received CPT or further investigations for TB. HIV-negative women had 2.6 higher odds (95%CI 1.3-5.3) of receiving TB screening than their HIV-positive counterparts. CONCLUSIONS: Although the identification of HIV-positive women and TB suspects was adequate, implementation of other TB-HIV collaborative activities was sub-optimal.

Contexte : Une offre de services intégrée de tuberculose et du virus de l'immunodéficience humaine (TB-VIH)­en tant qu'élément des services de santé maternelle, notamment des consultations prénatales (ANC)­est largement recommandée. Cette étude a évalué la mise en œuvre d'une offre de services intégrée TB-VIH dans une unité hospitalière de CPN.Méthodes : Les dossiers d'un échantillon aléatoire de 308 femmes enceintes qui ont fréquenté le service ANC entre avril 2011 et février 2012 ont été revus. Les données ont été extraites à partir des registres ainsi que des dossiers des patients. Les résultats attendus comprenaient la proportion de femmes bénéficiant d'un conseil et test VIH (HCT), d'un comptage des CD4, d'un traitement antirétroviral (ART), d'un traitement préventif par cotrimoxazole (CPT), d'un dépistage de TB et d'un traitement préventif par isoniazide (IPT). L'analyse a mesuré les variations des caractéristiques des patients associées à l'offre de services.Résultats : Toutes les femmes ont bénéficié du HCT et 80% de celles ayant eu un test VIH positif ont eu un dépistage de TB. La majorité (85,9%) des femmes VIH-positives ont eu un comptage des CD4. Cependant, seulement 12,9% des femmes éligibles ont reçu une prophylaxie ART sur place ; seulement 35,7% ont été référées pour une mise en route de l'ART ; seulement 42.3% ont commencé l'IPT ; et aucune n'a reçu de CPT ni d'autres investigations relatives à la TB. Les femmes VIH négatives avaient 2,6 fois (IC95% 1,3­5,3) plus de chances de bénéficier d'un dépistage de TB que leurs homologues VIH positives.Conclusions: L'identification des femmes VIH positives et de celles suspectes de TB a été satisfaisante, mais la mise en œuvre des autres activités de collaboration TB-VIH a été insuffisante.

Marco de referencia: La prestación integrada de servicios de atención de la tuberculosis (TB) y la infección por el virus de la inmunodeficiencia humana (VIH) se recomienda ampliamente como parte de los servicios que se ofrecen a las madres durante la atención prenatal (ANC). En el presente estudio se evaluó la introducción de los servicios integrados de TB y VIH en una unidad hospitalaria de ANC.Método: Se examinaron las historias clínicas de una muestra aleatoria de 308 embarazadas que acudieron al servicio de ANC entre abril del 2011 y febrero del 2012. Se extrajeron datos de los registros y las historias clínicas de las pacientes. Los criterios de evaluación fueron la proporción de mujeres en quienes se practicó la orientación y las pruebas diagnósticas del VIH (HCT), el recuento de linfocitos CD4, el tratamiento antirretrovírico (ART), el tratamiento preventivo con cotrimoxazol (CPT), la detección sistemática de la TB y el tratamiento preventivo con isoniazida (IPT). En el análisis se midieron las variaciones en las características de las pacientes asociadas con la prestación de los servicios.Resultados: Todas las mujeres recibieron HCT y en 80% que obtuvieron un resultado positivo, se practicó la detección sistemática de la TB. En la mayoría de las pacientes positivas frente al VIH se practicó el recuento de linfocitos CD4 (85,9%). Sin embargo, solo 12,9% de las mujeres aptas recibieron la profilaxis ART en el lugar de la consulta; solo 35,7% se remitieron con el fin de comenzar el ART; apenas 42,3% de las pacientes comenzaron el IPT; y ninguna recibió CPT ni tuvo investigaciones complementarias por TB. Las mujeres con resultados negativos frente al VIH exhibieron un cociente de posibilidades 2,6 veces inferior de beneficiar de la detección sistemática de la TB, en comparación con las mujeres VIH positivas.Conclusión: Se constató una detección adecuada de las mujeres positivas frente al VIH y de casos con presunción clínica de TB, pero una prestación deficiente de las demás actividades de los servicios integrados del VIH y la TB.

A qualitative Exploration of Resilience in Pre-Adolescent AIDS Orphans Living in a Residential Care Facility

This article presents the findings of a study among a small group of South African AIDS orphans living in a residential care facility; Lebone Land. The research was conducted between June and September 2006. A qualitative; exploratory study consisting of in-depth; semistructured interviews with eight children and seven key informants aimed to identify and investigate developmental assets operating in the children's lives to help them cope amid exposure to adversities. The findings indicate that the developmental assets that facilitate coping and foster resilience in these children relate to four main components: external stressors and challenges; external supports; inner strengths and interpersonal and problem-solving skills. Emerging key themes relate to the experience of illness; death; poverty and violence; as well as the important roles of morality; social values; resistance skills; religion and faith in assisting these children in defining their purpose in life. To this end; constructive use of time; commitment to learning; goal-setting; problem-solving ability and self-efficacy are fundamental in the children's attainment of their future projections. Therefore; qualities such as optimism; perseverance and hope seem to permeate the children's process of recovery. Strong networks of support; particularly friendships with other children; also seem to contribute to developing and sustaining resilience

HIV/AIDS-related knowledge, attitudes and practices among South African military recruits.

OBJECTIVES: To assess the level of HIV-related knowledge, as well as high-risk behaviour and attitudes towards HIV, in a group of South African National Defence Force (SANDF) recruits. DESIGN: Cross-sectional study. SETTING: Tempe military base in Bloemfontein. SUBJECTS: Three hundred and thirty-nine recruits from one company. OUTCOME MEASURES: HIV-related knowledge, attitudes and practices based on a self-administered questionnaire. RESULTS: All of the recruits were male, and most of them (81.4%) were black. The majority of recruits (98.5%) were between 18 and 24 years old. They had a good level of knowledge regarding HIV and AIDS, with more than 80% giving a correct response in most cases. However, several important misconceptions regarding HIV/AIDS and its transmission still exist. Furthermore, several recruits still practised high-risk behaviour, such as not using condoms with casual or new partners. Most obtained their knowledge regarding HIV/AIDS from schools (34.8%), health and social services (27.1%) and the printed media (17.7%), while only 5.2% stated that they learnt about HIV/AIDS from the SANDF education programmes. CONCLUSION: Efforts towards initiating behaviour changes in military recruits should be intensified, and if necessary education programmes should be adapted to facilitate achievement of this goal.

A "Youth Multi-function Centre" in the Free State: an alternative to clinic-based HIV/AIDS prevention and care.

The youth are especially vulnerable to the HIV/AIDS epidemic in South Africa. In the Free State (second highest incidence of HIV/AIDS among the provinces), the Welkom-Goldfields area may for various reasons be singled out as a high risk area for HIV/AIDS which should receive priority attention in attempts to combat the disease. It is suggested that a Youth Multi-function Centre would place youth reproductive health care in the broader development and life skills arena--where it could be thought to rightfully belong. The objectives of the paper are to depict the rationale for a Youth Multi-function Centre, to broadly conceptualise a Youth Multi-function Centre, and to report on the process and methodology followed in an attempt to actually establish such a centre in Thabong/Welkom.

Down the needle! Should public sector nurses in South Africa have the right to strike?

It is often argued that because the public sector provides essential services, it is intolerable that the citizenry be denied its entitlement because of a domestic dispute between civil servants (such as nurses) and the state. In this contribution an attempt is made to unravel a number of ideological, legislative and ethical issues relating to the right of the public sector nurse to strike. Notwithstanding the merits of opposite contentions, it is argued that public sector nurses should, in fact, have the right to strike. If this right is to be legitimized, however, due consideration should be given to problems relating to nurses' labour organisation and preventative measures to ensure minimal harm to patients in the planning and in the course of strike action.