Poster HSR2018:Rural women’s preferences and knowledge for integrated, community-based self-collection for cervical cancer screening in Uganda: The ASPIRE Mayuge project

Please join me at the Fifth Global Symposium for Health Systems Research in Liverpool in October 2018. Here is the poster I will be presenting on the ASPIRE Mayuge Project in Uganda. To learn more about the project click here

Publication JANAC:Patient Responses on Quality of Care and Satisfaction with Staff After Integrated HIV Care in South African Primary Health Care Clinics

Our latest research on Quality of Care and Satisfaction with Staff in HIV-Integrated Clinics in Free State, South Africa

For full text of the article, please visit the journal's website and find the article here.

To see a draft of the article if you do not have access to the journal click here.

Abstract:HIV care integrated into primary health care (PHC) encourages reorganized service delivery but could increase workload. In 2012-2013, we surveyed 910 patients and caregivers at two time points after integration in four clinics in Free State, South Africa. Likert surveys measured quality of care (QoC) and satisfaction with staff (SwS). QoC scores were lower for females, those older than 56 years, those visiting clinics every 3 months, and child health participants. Regression estimates showed QoC scores higher for ages 36-45 versus 18-25 years, and lower for those attending clinics for more than 10 years versus 6-12 months. Overall, SwS scores were lower for child health attendees and higher for tuberculosis attendees compared to chronic disease care attendees. Research is needed to understand determinants of disparities in QoC and SwS, especially for child health, diabetes, and hypertension attendees, to ensure high-quality care experiences for all patients attending PHC clinics with integrated HIV care.

• May 2018
• Journal of the Association of Nurses in AIDS Care 29(5)

• DOI: 
• 10.1016/j.jana.2018.04.014

Publication JAIDS:Integrated Hiv-Care into Primary Care Clinics and the Influence on Diabetes and Hypertension Care: An Interrupted Time Series Analysis in Free State, South Africa Over Four Years

What happens to NCD care when HIV-care is integrated into Primary Health Care Clinics? Read more to find out.

To access the full text of this article, please visit the journal's website here.
If you do not have access to the journal, please read a draft version here.

Abstract:Background: Non-communicable diseases (NCDs), specifically diabetes and hypertension, are rising in high-HIV burdened countries like South Africa. How integrated HIV-care into primary health care (PHC) influences NCD care is unknown. We aimed to understand whether differences existed in NCD care (pre versus post-integration) and how changes may relate to HIV patient numbers. Setting: Public-sector PHC clinics in Free State, South Africa METHODS:: Using a quasi-experimental design, we analysed monthly administrative data on four indicators for diabetes and hypertension (clinic and population levels) during four years as HIV-integration was implemented in PHC. Data represented 131 PHC clinics (PHCCs) with a catchment population of 1.5 million. We utilised interrupted time series analysis at ±18 and ±30 months from HIV integration in each clinic to identify changes in trends post-integration compared to pre-integration. We utilised linear mixed effect models to study relationships between HIV and NCD indicators. Results: Patients receiving ART in the 131 PHC clinics studied increased from 1614 (April 2009) to 57, 958 (April 2013). Trends in new diabetes patients on treatment remained unchanged. However, population level new hypertensives on treatment decreased at ±30 months from integration by 6/100, 000 (SE=3,p<0.02) and was associated with the number of new HIV patients on treatment at the clinics. Conclusion: Our findings suggest that during the implementation of integrated HIV-care into PHCCs care for hypertensive patients could be compromised. Further research is needed to understand determinants NCD care in South Africa and other high HIV-burdened settings to ensure patient-centred PHC.

Effectiveness and Equity in integrated HIV care

Couldn't make it to the American Public Health Association (APHA) annual conference in Chicago in October-November 2015? No worries. Here's a downloadable copy of the poster I presented and a link to the abstract.

We outline many of the benefits and challenges to health system effectiveness and equity for patients receiving care in integrated clinics. In April 2010, South Africa implemented of a policy providing comprehensive HIV care to public sector primary health care clinics. Through focus group discussions with health care works and key informant interviews with a variety of health system actors, we were able to see how our participants viewed the impact on patients.

Here is a link to the abstract https://apha.confex.com/apha/143am/webprogram/Paper333097.html

What can we learn from the HIV response to shift the paradigm in health systems research?

HIV skeptics behold! 15 million people on HIV treatment when many said it wouldn't be possible. Now, it is time for a paradigm shift towards integrated, patient-centered health systems.

Read my featured article on the International Health Policies website hosted by the Institute of Tropical Medicine in Antwerp. Click here.

What happens to Primary Health Care (PHC) service delivery when you integrate HIV care?

Missed my presentation at the International AIDS society conference on Monday July 20th, 2015? Here are some highlights.

In our study of 131 public sector primary health care clinics over 4 years, we found that despite a massive and rapid increase from about 1,600 patients on HIV treatment (April 2009) to over 57, 000 patients (April 2013), service delivery was not greatly compromised. 77% of these patients were never on HIV treatment before. Integration means the provision of comprehensive HIV care (from testing to treatment to follow-up) in PHC Clinics.

For full size image click here 
(Data Visualization by Corine Bond. contact: corine.bond@gmail.com) 

However, we did identify decreases in children fully immunized at 1 year old. This decrease was not related to the number of HIV patients in the primary health care clinics and was only present in 11-13 clinics in our study. We also identified a decrease in the number of clinic visits per patient per year which may be related to receiving multiple services at one time.

Key message: HIV has challenged us to provide care for unprecedented number of people. This study showed that it can be done without compromising a primary health care based health system. We learned lesson from HIV to apply to other diseases to provide integrated patient centered care. However, further evidence is urgently needed to understand the effects of integrated care on child health. We must also support HCWs and address determinants of weak health systems to ensure high quality health care can be provided for those who need it within their communities.

Watch the 2 minute trailer of "Now we are Free", a patient account of how integrated HIV care changes communities' perception of HIV and healthcare.

Filming and Research by Angeli Rawat PhD. Music and Video editing by Jonathan Contreras-Whitney. Contact: jocowhits@gmail.com

Does the patient experience of healthcare change following the integration of HIV care into primary health care clinics?

Poster presented at the 8th International AIDS Society conference on HIV Pathogenesis, Treatment & Prevention. Vancouver, British Columbia Canada. 19-22nd of July, 2015

For those of you who will be at the IAS2015, drop by my poster on Tuesday

Presentation day: Tuesday, 21 July 2015
Presentation time: 12:30 - 14:30.
Poster number: TUPED807
Location: Exhibition, located in Hall B on the West Exhibition Level

To download the poster please click here.