Association between experienced stigma, anxiety, depression and loneliness among people with drug-resistant tuberculosis in Lagos Nigeria: The moderating role of social support.

BACKGROUND: This study assessed the moderating effect of social support on the association between experienced stigma versus anxiety, depression and loneliness among people with drug-resistant tuberculosis. METHODS: A descriptive cross-sectional study was conducted among 203 adults on treatment for drug-resistant tuberculosis for at least 8 weeks. Validated scales were used to assess experienced stigma, anxiety, depression, loneliness and social support. Partial correlations and hierarchical multiple regression were used to determine the moderating effect of social support on the association between experienced stigma versus anxiety, depression and loneliness. The interaction was visualised using slope analysis. RESULTS: Anxiety, loneliness and depression were reported by 148 (72.9%), 114 (56.2%) and 128 (63.1%) of the 203 participants, respectively. Experienced stigma was positively associated with depression (B = 0.428, p < 0.001), anxiety (B = 0.374, p < 0.001) and loneliness (B = 0.285, p = 0.001). Social support was negatively associated with depression (B = -0.255, p < 0.001), anxiety (B = -0.406, p < 0.001) and loneliness (B = -0.270, p = 0.001). The impact of experienced stigma on depression was different at low (B = 0.567, SE = 0.115, p < 0.001) and high (B = 0.275, SE = 0.253, p = 0.024) groups of social support. Similarly, at low social support, the effect of experienced stigma on loneliness (B = 0.491, SE = 0.250, p < 0.001) and anxiety (B = 0.254, SE = 0.060, p = 0.044) was different compared to the effect of experienced stigma on loneliness (B = 0.275, SE = 0.253, p = 0.024) and anxiety (B = 0.127, SE = 0.094, p = 0.307) at high group of social support. CONCLUSION: In this study, social support reduced the effects of experienced stigma on anxiety, depression and loneliness suggesting that improving social support among people with drug-resistant tuberculosis is crucial in reducing the negative effects of stigma on anxiety, depression and loneliness.

Provision of HIV testing services and its impact on the HIV positivity rate in the public health sector in KwaZulu-Natal: a ten-year review.

South Africa has been rated as having the most severe HIV epidemic in the world since it has one of the largest populations of people living with HIV (PLHIV). KwaZulu-Natal (KZN) is the epicentre of the HIV epidemic. The HIV test and treat services in the public health sector are critical to managing the epidemic and responding to the increase in HIV infections. The KwaZulu-Natal Department of Health (DOH) commissioned a review of the provision of HIV testing services in the province and aimed to investigate its impact on the HIV positivity rate over a ten-year period. The study was an ecological study design using data extracted from the Department's District Health Information System (DHIS). Descriptive analysis was conducted in addition to ANOVA and multiple regression analysis. The results of this study have shown that the total number of HIV tests conducted over the ten-year period in the province has increased with the highest number of HIV tests being conducted in the 2018/2019 MTEF year. ANOVA analysis indicates that there was a statistically significant difference in the total number of HIV tests conducted and the number of HIV tests per 100 000 population across the province's 11 districts (p < 0.001). Statistically significant differences were observed in the HIV testing rate and in the HIV positivity rate over the period (p < 0.001). Results from multiple regression analysis showed that the HIV testing rate per 100 000 population was the strongest predictor of the HIV positivity rate. HIV positivity among clients correlated negatively with the number of HIV tests conducted per 100 000 population (r = -0.823; p < 0.001) and the HIV testing rate (r = -0.324; p < 0.01). This study has found that HIV testing could have an impact on reducing the positivity rate of HIV in the province and is therefore an effective strategy in curbing the HIV epidemic. The KwaZulu-Natal Department of Health should ensure that strategies for implementing and maintaining HIV testing and treating services should continue at an accelerated rate in order to achieve the first 95 of the UNAIDS 2025 SDG target.

Cost-effectiveness of staff and workload profiles in retaining patients on antiretroviral therapy in KwaZulu-Natal, South Africa.

BACKGROUND: There is paucity of information on the cost-effectiveness of delivery strategies to retain patients on antiretroviral therapy (ART) and this study tries to fill this gap. METHODS: The analysis is based on a representative sample of 2835 patients attending 32 ART sites in KwaZulu-Natal (KZN), South Africa. Extended Cox regression and Kaplan Meier were used to estimate the transition probabilities to remain on ART among patients who attended sites with different staff and workload profiles. Annual costs per patient-year of observation for these delivery profiles were estimated. Probabilistic sensitivity analysis took into account parameters' uncertainty. RESULTS: The delivery sites with a full-time doctor and a full-time senior professional nurse and an intake of less than 200 new patients per doctor per year were the most cost-effective in retaining patients on ART. If 1000 new patients were followed up by this type of site, 724 patients would still be on ART after 10 years at a discounted cost of US$8.41 million at 2006 value with an incremental cost-effectiveness ratio of US$12,271 per extra retained patient over the second not dominated site profile. CONCLUSIONS: The results could be used to estimate the human resources needed for a sustainable scaling up of ART in KZN.

Retrospective study on the critical factors for retaining patients on antiretroviral therapy in KwaZulu-Natal, South Africa.

OBJECTIVE: To analyze the critical factors favoring the retention of patients under antiretroviral therapy (ART) in KwaZulu-Natal (KZN), South Africa. DESIGN AND METHODS: This retrospective study was based on the review of a representative sample of patients who began ART between March 2004 and May 2006 in 32 public sector sites and were followed up to July 1, 2007. Extended Cox proportional hazard models were used to identify the factors which significantly influenced treatment retention during the first 2 years of treatment. Kaplan-Meyer provided the probabilities of remaining on ART if these factors were present. RESULTS: The 2835 sampled patients corresponded to about 10% of the universe of patients under ART in the 32 sites; 929 (33%) were males, and the median age of the sampled patients was 34 (interquartile range: 28-41). The analysis identified factors that significantly decreased the probability of remaining on ART. Patients' risk factors were initial CD4 <100 cells per microliter, lack of a telephone contact number, and being male. Sites' risk factors were the presence of a part time (PT) versus a full time (FT) senior professional nurse, a PT versus FT doctor, and intakes of 200 or more new patients per doctor per year. The probability of remaining on ART declined significantly for each increasing level of workload, but having a FT versus a PT doctor made a significant difference only for level of workload of 200 or more new patients per year. CONCLUSIONS: The analysis has identified the conditions influencing retention of ART patients in KZN. This has provided a method to estimate absorption capacity of the ART delivery sites, which is of added value for a sustainable expansion of the ART coverage.

The preparedness of emergency medical services against occupationally acquired communicable diseases in the prehospital environment in South Africa.

BACKGROUND: Emergency medical care is performed in an uncontrolled environment and involves invasive procedures and life support measures. The performance of these duties places emergency care practitioners (ECPs) at risk of occupationally acquired injuries and communicable diseases. Although legislative guidelines exist for the protection of healthcare workers, little is known about the protective measures available for and utilised by ECPs in the pre-hospital environment in South Africa. OBJECTIVES: To review the availability and implementation of emergency medical services (EMS)-specific infection control policies and standard operating procedures in the pre-hospital environment. METHODS: Interviews with key informants were used to collect data concerning policies on communicable diseases and infection control in the EMS, the operational aspects of these policies, and educational programmes on communicable diseases and infection control for ECPs. RESULTS: There is no national policy on communicable diseases and infection control in EMS. Only KwaZulu-Natal, Eastern Cape and Gauteng have EMS-specific standard operating procedures for communicable diseases and infection control. Formal education and in-service training is limited. CONCLUSIONS: A national communicable disease and infection control policy specific to the EMS needs to be developed together with an accredited training module on communicable diseases and infection control for EMS in the pre-hospital environment.

Changing patterns of under- and over-nutrition in South African children-future risks of non-communicable diseases.

Under- and over-nutrition in children in KwaZulu-Natal, South Africa was investigated comparing data collected from primary school children in a rural district (643 children aged 8-11 years in 1994) with secondary data from the National Schools Study (16,179 children, 4-11 years in 1994), the Vitamin A Consultative Group Study (408 children, 2-5 years in 1994) and the Income Dynamics Study (1,593 children, 2-11 years in 1998). Stunting and wasting (WHO/NCHS guidelines) and overweight and obesity (International Obesity Task Force guidelines) were retrospectively analysed from these studies and compared in the children aged 4-5 and 8-11 years. There was moderate stunting in 10-25%, wasting in 1-6%, 5-24% were overweight and 1-10% obese. Girls in the National Schools Study (p<0.005) and in the primary datasets (p=0.02) had a significantly higher prevalence of overweight than boys; girls (1.4%) were also more obese than boys (0.9%) in the Schools Study (p=0.002), and the boys significantly more stunted (p<0.005) and wasted (p<0.005). An increasing prevalence of overweight and obesity was seen in both the 4-5- and 8-11-year age-groups. The finding that moderate stunting co-exists with overweight and obesity suggests that patterns of under- and over-nutrition in South African children are changing and might indicate the early stages of a complex nutritional transition. Action is required to prevent the future risk of non-communicable diseases.

The effects of a systematically developed photo-novella on knowledge, attitudes, communication and behavioural intentions with respect to sexually transmitted infections among secondary school learners in South Africa.

A pre-post test follow-up design was used to test the effects of a systematically developed photo-novella (Laduma) on knowledge, attitudes, communication and behavioural intentions with respect to sexually transmitted infections, after a single reading by 1168 secondary school learners in South Africa. The reading resulted in an increase in knowledge on the spread of sexually transmitted infections (STIs), change in attitude to condom use and towards people with STIs and/or HIV/AIDS, as well as increased intention to practice safe sex. Laduma did not influence communication about sexually transmitted infections and reported sexual behaviour and condom use. While print media proved to be an effective strategy to reach large numbers of youth and prepare them for adequate preventive behaviours, the study also identified the need to combine print media with other planned theory-based interventions that build confidence and skills to initiate the preventive behaviour.