Health Facilities In South Africa Research Articles

South African midwife specialists' experiences in the utilisation of their knowledge and skills.

Midwifery specialisation was introduced in 1993 as a response to escalating maternal and neonatal mortalities and shortage of physicians in rural parts of South Africa. Basic midwives enrolled into a postgraduate midwifery qualification to extend their knowledge and skills which enabled them to manage complicated obstetric conditions. The postgraduate midwifery qualification rendered them midwife specialists upon completion of the course. Yet, MS remain underutilised in clinical facilities due to limiting practice regulations and fear of medico-legal litigations, leading to forfeiture of skills. The study aimed to explore and describe midwife specialist' experiences of optimal utilisation of their knowledge and skills in public health facilities in South Africa. Public health facilities based in seven provinces in South Africa where MS were employed, formed part of the research setting. A qualitative, descriptive and explorative research design was followed using phenomenological approach. Sixteen purposefully sampled midwife specialists participated in four focus group interviews. Data were analysed using Collaizi's descriptive method. Three themes, each with categories, were derived from the data. Research results confirmed midwife specialist' limited utilisation of knowledge and skills in public facilities. This was associated with the existing practice regulations, restricting midwife specialists to basic midwifery roles. The lack of practice regulations, particularly for midwife specialists hinders optimal utilisation of their knowledge and skills in the public health facilities. This study highlighted midwife specialist' barriers in optimally embracing their expert knowledge and skills. Barriers may guide formulation of strategies to facilitate midwife specialist' knowledge and skills utilisation.

Subversion of digital Darwinism in public healthcare facilities in South Africa

Subversion of digital Darwinism in public healthcare facilities in South Africa

An introduction to gender affirming healthcare: What the family physician needs to know.

Gender affirming healthcare (GAHC) is a relatively new field in primary health care that describes a range of gender affirming practices, including hormone therapy, for transgender and gender diverse (TGD) people. In 2019, gender affirming hormones were approved by South African National Essential Medicine List Committee (NEMLC) for tertiary-level care, and in October 2021 the Southern Africa HIV Clinicians Society published a GAHC guideline for South Africa. Unfortunately, TGD people still experience discrimination and stigmatisation in healthcare facilities in South Africa, leading to poor access to care and higher health risks with poorer outcomes. Gender affirming care in the primary health care clinic can improve access to health care, with improved provision of preventative services. This article defines key transgender concepts, describes the informed consent process and outlines the initiation and monitoring of both feminising and masculinising hormone treatment for TGD people. Staff at healthcare facilities need to receive training on gender affirming practices and how to ensure a safe environment for TGD clients.

Perceptions of and Practical Experience with the National Surveillance Centre in Managing Medicines Availability Amongst Users within Public Healthcare Facilities in South Africa: Findings and Implications.

The introduction of the National Surveillance Centre (NSC) has improved the efficiency and effectiveness of managing medicines availability within the public healthcare system in South Africa. However, at present, there is limited data regarding the perceptions among users of the NSC and challenges that need addressing. A descriptive quantitative study was performed among all registered active NSC users between August and November 2022. Overall, 114/169 users responded to a custom-developed, self-administered questionnaire (67.5% response rate). Most respondents used the Stock Visibility System (SVS) National Department of Health (NDoH) (66.7% for medicines and 51.8% for personal protective equipment (PPE) or SVS COVID-19 (64.9% for COVID-19 vaccines) or RxSolution (57.0% manual report or 42.1% application programming interface (API)) for reporting medicines, PPE, and COVID-19 vaccines to the NSC and were confident in the accuracy of the reported data. Most respondents focused on both medicines availability and reporting compliance when accessing the NSC, with the integrated medicines availability dashboard and the COVID-19 vaccine dashboard being the most popular. The respondents believed the NSC allowed ease of access to data and improved data quality to better monitor medicines availability and use. Identified areas for improvement included improving internet connectivity, retraining some users, standardising the dashboards, adding more data points and reports, and expanding user adoption by increasing licence limits. Overall, this study found that the NSC in South Africa provides an effective solution for monitoring and improving medicines availability.

A Single Question on Maternal HIV Status Can Improve Identification of Children Living With HIV in South Africa.

Screening tools to improve identification of children living with HIV (CLHIV) have been validated and used in various settings. The aim of our study was to optimize a screening tool for Primary Healthcare Clinics (PHCs) in South Africa (SA). A cross-sectional study was conducted at PHCs in Johannesburg and Mopani Districts, between June 2021 and June 2022. Children 5-14 years of age with HIV negative or unknown status accompanied by their mothers, or appropriate caregivers, were enrolled. Demographic data, responses to the screening tool questions, and HIV test results were captured. Logistic regression modeling was used to optimize an existing 10-item screening tool, and sensitivity, specificity, and number needed to test (NNT) used to choose the final tool. We enrolled 14,147 children in the study, with 62 children testing HIV positive (HIV positivity of 0.4%). The 10-item tool with a single positive response had a sensitivity of 91.9% and specificity of 43.3%. An optimal combination of 5-items with two positive responses had the lowest NNT of 72, 82.3% sensitivity and 74.2% specificity. Maternal HIV status alone, HIV positive or unknown, had a 95.2% sensitivity, 65.0% specificity and NNT of 84. The 1-item tool only would have missed 5% of CLHIV (N = 3) compared with the 5-item tool that missed 18% (n = 11). A 1-item screening tool asking about maternal HIV status can improve efficiency of testing of children in primary healthcare facilities in SA and improve identification of CLHIV who are not on treatment.

Stigma towards women requesting abortion and association with health facility staff facilitation and obstruction of abortion care in South Africa.

Abortion stigma has been shown to influence provider attitudes around abortion and may decrease provider willingness to participate in abortion care, or lead some to obstruct care. However, this link remains understudied. The present study uses baseline data collected through a cluster-randomized controlled trial in 16 public sector health facilities in South Africa in 2020. A total of 279 clinical and non-clinical health facility workers were surveyed. Primary outcome measures included: 1) willingness to facilitate abortion care in eight hypothetical scenarios, 2) facilitation of abortion care in the last 30 days, and 3) obstruction of abortion care in the last 30 days. Logistic regression models were used to assess the association between level of stigma as measured through the Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS) and the primary outcomes. Overall, 50% of respondents in the sample were willing to facilitate abortion care in each of the eight scenarios, with differences in willingness based on the abortion client's age and personal situation in each scenario. Over 90% reported facilitating abortion care in the last 30 days, but 31% also reported having obstructed abortion care in the last 30 days. Stigma was significantly associated with willingness to facilitate abortion care and actual obstruction of abortion care in the last 30 days. Controlling for covariates, odds of willingness to facilitate abortion care in every scenario decreased with every one-point increase in SABAS score (reflecting more stigmatizing attitudes), and odds of obstructing abortion care increased with every one-point increase in SABAS score. Lower abortion stigma on the part of health facility workers was associated with willingness to facilitate abortion access but not actual facilitation of abortion services. Higher abortion stigma was associated with actual obstruction of an abortion service in the last 30 days. Interventions to reduce stigma towards women seeking abortion, and particularly negative stereotyping, among all health facility staff is key to ensuring equitable and non-discriminatory access to abortion. Retrospectively registered on clinicaltrials.gov (ID: NCT04290832) on February 27, 2020. The link between stigma against women seeking abortion and decisions around whether to provide, abstain, or obstruct abortion care remains understudied. This paper assesses how stigmatizing beliefs and attitudes towards women seeking abortion in South Africa affects willingness to facilitate abortion care and actual facilitation or obstruction of abortion care in practice. A total of 279 clinical and non-clinical health facility workers were surveyed between February and March 2020. Overall, half of respondents in the sample were willing to facilitate abortion care in each of the eight scenarios, with important differences in willingness by scenario. Almost all respondents reported facilitating an abortion procedure in the last 30 days, but one in three also reported having obstructed abortion care in the last 30 days. More stigmatizing attitudes corresponded to decreased willingness to provide abortion care and increased odds of obstructing abortion care. Results show that stigmatizing attitudes, beliefs, and actions toward women who seek abortion shape how clinical and non-clinical staff in South Africa feel about their participation in abortion services and whether they obstruct this care. Facility staff hold great power in determining whose abortions are facilitated and whose are obstructed, resulting in stigma and discrimination being openly perpetuated. Continuous work to reduce stigma towards women seeking abortion among all health workers is key to ensuring equitable and non-discriminatory access to abortion for all.

Yield of Facility-based Targeted Universal Testing for Tuberculosis With Xpert and Mycobacterial Culture in High-Risk Groups Attending Primary Care Facilities in South Africa.

We report the yield of targeted universal tuberculosis (TB) testing of clinic attendees in high-risk groups. Clinic attendees in primary healthcare facilities in South Africa with one of the following risk factors underwent sputum testing for TB: human immunodeficiency virus (HIV), contact with a TB patient in the past year, and having had TB in the past 2 years. A single sample was collected for Xpert-Ultra (Xpert) and culture. We report the proportion positive for Mycobacterium tuberculosis. Data were analyzed descriptively. The unadjusted clinical and demographic factors' relative risk of TB detected by culture or Xpert were calculated and concordance between Xpert and culture is described. A total of 30 513 participants had a TB test result. Median age was 39 years, and 11 553 (38%) were men. The majority (n = 21734, 71%) had HIV, 12 492 (41%) reported close contact with a TB patient, and 1573 (5%) reported prior TB. Overall, 8.3% were positive for M. tuberculosis by culture and/or Xpert compared with 6.0% with trace-positive results excluded. In asymptomatic participants, the yield was 6.7% and 10.1% in symptomatic participants (with trace-positives excluded). Only 10% of trace-positive results were culture-positive. We found that 55% of clinic attendees with a sputum result positive for M. tuberculosis did not have a positive TB symptom screen. A high proportion of clinic attendees with specific risk factors (HIV, close TB contact, history of TB) test positive for M. tuberculosis when universal testing is implemented.

Disease and design in twentieth-century South Africa: exploring the consequences of the 1918–19 Spanish Flu pandemic through contributions of émigré Dutch architects

The architectural history of healthcare in South Africa remains greatly understudied, as do the consequences of the 1918–19 Spanish Flu, which ravaged its population. Yet that pandemic had great consequences for South African society, spatial planning and the development of healthcare, of which the latter two were still in their infancy at the time. This article explores the link between disease and design in South Africa through the presentation of the histories of selected hospitals, maternity homes, orphanages and a special care school designed by émigré Dutch architects from the 1920s to the 1970s. It is the product of desktop and archival research, site visits and interviews undertaken in both South Africa and the Netherlands. It outlines the disparity of care that was provided for different groups and is a first attempt to identify healthcare ideas transposed into the subcontinent fuelled by the tragic experiences of the Spanish Flu pandemic. Due to this health crisis, communities – structured in terms of language, faith and race – attempted to develop their own facilities for the care of their own. Where communities had no means of their own, charitable organisations tried to fill the void. Over the course of the twentieth century, public healthcare was centralised, but many of the community and charitable institutions persist. By chance or choice, émigré Dutch architects made a disproportionately large contribution to the development of healthcare facilities in South Africa, not only in the number and range of facilities they designed, but also by introducing contemporary ideas into South African healthcare design.

Impacts of intimate partner violence and sexual abuse on antiretroviral adherence among adolescents living with HIV in South Africa.

We are failing to reach 95-95-95 for adolescents living with HIV (ALHIV). Sexual abuse and intimate partner violence (IPV) may impact antiretroviral therapy (ART) adherence, with high rates of 17.4 and 29.7%, respectively, across the southern sub-Saharan African region. However, evidence on their associations with adolescent ART adherence remains limited, with only three cross-sectional studies globally. A prospective cohort of ALHIV (sample N = 980, 55% female individuals, baseline mean age 13.6 years) were recruited from 53 health facilities in South Africa's Eastern Cape Province and responded to a structured questionnaire at 18-month and 36-month follow-up (2015-2016, 2017-2018). A repeated-measures random effects model assessed multivariable associations of self-reported sexual abuse and IPV with past-week ART adherence, controlling for individual, socioeconomic, and HIV-related factors. Past-week adherence was defined based on currently taking ART and not having missed any doses in the past 7 days (including weekends). We further fitted a moderation model by sex. Fifty-one percent of adolescents reported consistent ART adherence at both time points. Exposure to IPV was associated with lower odds of self-reported ART adherence (aOR 0.39, 95% CI 0.21-0.72, P = 0.003), as was sexual abuse (aOR 0.54, 95% CI 0.29-0.99, P = 0.048). The marginal predicted probability of ART adherence for adolescents with no exposure to either IPV or sexual abuse was 72% (95% CI 70-74%) compared with 38% (95% CI 20-56%) for adolescents with exposure to both IPV and sexual abuse. Moderation results showed similar associations between sexual violence and ART adherence by sex. Sexual violence prevention and postviolence care may be essential components of supporting adolescent ART adherence. Integration of HIV and violence prevention services will require accessible services and simple referral systems.

Digital Health Ecosystem Framework to Address Fragmentation of the Health System in South Africa

Globally, the healthcare industry is plagued by fragmentation, and this fragmentation of the health system has become one of the major problems facing especially low- and middle-income countries. Likewise, the current health system in South Africa is highly fragmented and segmented, with two-tiered systems characterised by a multiplicity of health information systems. This fragmentation has inhibited the efficient delivery of healthcare services and resulted in limited access to integrated health data across healthcare providers. This paper proposes a Digital Health Ecosystem framework to address fragmentation of the health system in South Africa. A qualitative approach was employed, using desktop-based research. A literature review was conducted to elucidate the need for a framework to address fragmentation of the health system in South Africa. It emerged from the literature that the coexistence of subsystems operating independently contributes to health system fragmentation in South Africa. The proposed framework aims to address the ubiquitous problem of health system fragmentation and to enhance data-sharing capabilities across healthcare facilities. A Digital Health Ecosystem offers capabilities to create a digital environment for cooperation, data sharing and information exchange between a network of healthcare organisations. The technology offers South African healthcare facilities a new way to work seamlessly together to provide multidisciplinary and collaborative healthcare services to patients. Healthcare facilities in South Africa are urged to embrace a Digital Health Ecosystem to improve the safety and quality of healthcare and increase access to and availability of clinical, patient and administrative data.

Leveraging routine data in impact evaluation: Understanding data systems in primary healthcare prior to a matched cluster-randomised evaluation of adherence guidelines in South Africa.

An essential part of providing high-quality patient care and a means of efficiently conducting research studies relies upon high-quality routinely collected medical information. To describe the registers, paper records and databases used in a sample of primary healthcare clinics in South Africa (SA) with the view to conduct an impact evaluation using routine data. Between October 2015 and December 2015, we collected information on the presence, quality and completeness of registers, clinical stationery and databases at 24 public health facilities in SA. We describe each register and type of clinical stationery we encountered, their primary uses, and the quality of completion. We also mapped the ideal flow of data through a site to better understand how its data collection works. We identified 13 registers (9 standard, 4 non-standard), 5 types of stationery and 4 databases as sources of medical information within a site. Not all clinics used all the standardised registers, and in those that did, registers were kept in various degrees of completeness: a common problem was inconsistent recording of folder numbers. The quality of patient stationery was generally high, with only the chronic patient record being considered of varied quality. The TIER.Net database had high-quality information on key variables, but national identification (ID) number was incompletely captured (42% complete). Very few evaluation sites used electronic data collection systems for conditions other than HIV/AIDS. Registers, databases and clinical stationery were not implemented or completed consistently across the 24 evaluation sites. For those considering using routinely collected data for research and evaluation purposes, we would recommend a thorough review of clinic data collection systems for both quality and completeness before considering them to be a reliable data source.

Progress towards the UNAIDS 95-95-95 targets among pregnant women in South Africa: Results from the 2017 and 2019 national Antenatal HIV Sentinel Surveys.

ObjectivesThe UNAIDS 95-95-95 global targets for epidemic control aim to ensure by 2030 that 95% of HIV-positive people know their HIV status, 95% of people diagnosed with HIV receive sustained antiretroviral therapy (ART), and 95% of people on ART have viral suppression. While data on the first and second 95 targets are routinely reported nationally, data on the third 95 target are not available for pregnant women in South Africa. The lack of data on the third 95 target limits the inclusion of low viral suppression as one of the contributing factors in MTCT root cause analyses. This study assessed progress towards the 95-95-95 targets among pregnant women between the ages of 15–49 years attending public health facilities in South Africa.MethodData were obtained from two consecutive national cross-sectional antenatal HIV sentinel surveys conducted between 1 October and 15 November in both 2017 and 2019. In each survey, data on age, knowledge of HIV status, ART initiation, and geographical location (province) were extracted from medical records. A blood specimen was collected from each woman and tested for HIV. Viral load tests were performed on HIV-positive specimens. Descriptive and multiple logistic regression analyses were performed to examine association between province and viral suppression (defined as viral load <50 copies/mL) using the combined dataset (i.e., both 2017 and 2019 data combined). All analyses considered the survey design.ResultsOf 10 065 and 11 321 HIV-positive women included in the 2017 and 2019 surveys, respectively, 96.0% (95% confidence interval (CI): 95.6–96.4%) and 97.6% (95% CI: 97.3–97.8%) knew their HIV-positive status; 86.6% (95% CI: 85.9–87.3%) and 96.0% (95% CI: 95.6–96.4%) of those who knew their HIV status were receiving ART; while 64.2% (95% CI: 63.2–65.2%) and 66.0% (95% CI: 65.1–66.8%) of those receiving ART were virally suppressed. Achievement of the third 95 target significantly varied by province ranging from 33.9–72.6% in 2017 and 43.4–77.3% in 2019. Knowledge of HIV-positive status, ART initiation, and viral suppression increased in both 15–24 and 25–49 year age groups between 2017 and 2019. In a multivariable analysis adjusting for survey year, gravidity, and education, the odds of viral suppression significantly varied by province (except KwaZulu-Natal and Western Cape, other provinces were less likely to attain viral suppression compared to Gauteng), age (adjusted odds ratio (AOR) for 15–24 years vs 25–49 years: 0.7, 95% CI: 0.6–0.8), and timing of ART initiation (AOR for ART initiation during pregnancy vs before pregnancy: 0.4, 95% CI: 0.5–0.6).ConclusionAlthough in 2019 the first and second 95 targets were achieved among pregnant women, meeting the third 95 target remains a challenge. This study highlighted the importance of promoting early ART initiation and the need to target young women in efforts to improve progress towards the third 95 target. Additionally, the provincial variation in viral suppression could be further investigated in future studies to identify and address the root causes underlying these differences.

Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014–19: a cross-sectional study

SummaryBackgroundFew population-level estimates of invasive neonatal infections have been reported from sub-Saharan Africa. We estimated the national incidence risk, aetiology, and pathogen antimicrobial susceptibility for culture-confirmed neonatal bloodstream infections and meningitis in South Africa.MethodsWe conducted a cross-sectional study of neonates (<28 days of life) admitted to neonatal or paediatric wards of 256 public sector health facilities in South Africa during 2014–19. Diagnostic pathology records from Jan 1, 2014, to Dec 31, 2019, were extracted from a national pathology data warehouse. A case was defined as a neonate with at least one positive blood or cerebrospinal fluid culture during a 14-day period. Incidence risk was calculated using annual numbers of registered livebirths. Among the causative pathogens identified, we calculated the proportion of cases attributed to each of them, as well as the rates of antibiotic susceptibility of Gram-positive and Gram-negative bacteria.FindingsAmong 43 438 records of positive cultures, there were 37 631 incident cases of neonatal infection with at least one pathogen isolated. The overall incidence risk of culture-confirmed infections was 6·0 per 1000 livebirths (95% CI 6·0–6·1). The incidence risk of late-onset sepsis (days 3–27 of life) was 4·9 per 1000 livebirths (4·9–5·0) and that of early-onset sepsis (days 0–2 of life) was 1·1 per 1000 livebirths (1·1–1·1); risk ratio 4·4 (95% CI 4·3–4·5). The cause of infection differed by syndrome, timing of infection onset, facility, and province, although Klebsiella pneumoniae (26%), Acinetobacter baumannii (13%), and Staphylococcus aureus (12%) were the dominant pathogens overall. Gram-negative bacteria had declining susceptibility to most antibiotics over the study period.InterpretationWe found a high incidence risk of late-onset sepsis with provincial variations, predominance of K pneumoniae, and declining antibiotic susceptibility among Gram-negative bacteria. This national surveillance in an upper-middle-income country provides a baseline burden of neonatal infections against which the impact of future clinical and public health interventions can be measured.FundingBill & Melinda Gates Foundation.

An investigation of the factors influencing the choice of healthcare facility in South Africa

The objective of the study was to assess the factors that motivate or demotivate households to choose among the three healthcare facilities, public healthcare, private health care and traditional healthcare facilities in South Africa as revealed by Statistics South Africa . The utilisation of healthcare facilities in South Africa is such that more households prefer public healthcare facilities more than other healthcare facilities. The multinomial logit model was used, with traditional/self-medication category as the reference or baseline category. The results indicated that gender, income and access to grants were significant in influencing the probability of a household choosing a public healthcare facility, while age, income, grants, salaries/wages/commission and pensions were significant in influencing the choice of private healthcare institutions. Therefore the study recommends that due to a large portion of households that are using public health facilities compared to private and traditional facilities, the government must invest more in public healthcare facilities in South Africa.

Discourses of Mental Wellness Among Adolescents Living with HIV in Cape Town, South Africa.

BackgroundAdolescence is a unique period of development where individuals transition from childhood to adulthood, and where they are at heightened risk for developing mental health problems and engaging in risky behaviours. In addition, adolescents living with HIV (ALHIV) must learn to cope with challenges related to the biological impact of a chronic condition, adhering to lifelong treatment, and managing HIV-related psychological and social challenges. Mental wellness as a precursor to mental wellbeing, is vital to facilitate persistent adherence and engagement in care for optimal treatment outcomes for ALHIV. However, little is known about how ALHIV understand and talk about mental wellness in the context being on HIV treatment.MethodsWe conducted a photovoice study with 12 groups, consisting of 43 ALHIV, aged 15–19 years, and receiving HIV treatment at three public primary health care facilities in the Western Cape Metropole in South Africa.ResultsThrough discourse analysis, we identified six themes that depicted mental wellness concepts that were prominent in their experiences, namely, connectedness, spirituality and mindfulness, social coherence and awareness, self-esteem, self-acceptance, and sense of coherence. In addition, the adolescents gave accounts of six mental wellness behaviours namely, self-efficacy, coping, resilience, life purpose, engagement in enjoyable life activities and physical functioning.DiscussionThese concepts and behaviours are similar to those identified in targeted interventions aimed at ALHIV. These mental wellness concepts and behaviours are critical to improving health outcomes for ALHIV and should be targeted in the delivery of youth friendly services and integrated HIV care in public healthcare facilities in South Africa and the sub-Saharan African continent.

Coverage of diabetes complications screening in rural Eastern Cape, South Africa: A cross-sectional survey.

There is a paucity of data on the coverage of diabetes mellitus (DM) complications screening in primary healthcare facilities in South Africa (SA). This study assesses the extent of screening for DM complications among individuals with type 2 DM attending primary health facilities in rural Eastern Cape (EC), SA. The study adopted a descriptive, cross-sectional design and obtained data from 372 individuals with type 2 diabetes attending six selected primary healthcare centres (PHCs) in two EC districts. Demographic and clinical data were obtained through questionnaire-based interviews and reviews of medical records. We assessed the extent of screening for estimated glomerular filtration rate (eGFR), fasting lipogram, eye examination, foot examination and glycated hemoglobin (HbA1c) in the past year. Participants mean age was 62 (standard deviation [s.d.] ± 11) years, and their mean duration of diagnosis was 9 (s.d. ± 8) years. In the past year, HbA1c result was available for 71 (19.1%) of the participants; 60 (16.1%) had eGFR results, while only 33 (8.9%) had documented lipid results. In total, 52 (14.0%) had carried out eye examinations, while only 9 (2.3%) had undergone foot examinations in the past year. About two-thirds of the participants (59.9%) had not undergone any form of complication screening in the past year, and none had undergone the complete screening panel. The coverage of screening for DM complications was low across all indicators. Studies to understand barriers to and facilitators of DM complications screening at PHCs are required. Also, interventions to improve diabetes complication screening in the region are needed and should target the primary healthcare providers.

Association between viral suppression during the third trimester of pregnancy and unintended pregnancy among women on antiretroviral therapy: Results from the 2019 antenatal HIV Sentinel Survey, South Africa.

ObjectivesAbout half of the pregnancies among women living with HIV (WLWH) receiving antiretroviral therapy (ART) in sub-Saharan African countries are reported to be unintended. Unintended pregnancy is associated with late initiation of antenatal care (ANC), and may delay provision of viral load monitoring services, antenatal adherence counselling and support, and other services that promote sustained viral suppression throughout pregnancy. This study examines the association between unsuppressed viral load during the third trimester of pregnancy and unintended pregnancy among women who initiated ART before pregnancy.MethodsThis was an analysis of data from a national antenatal survey conducted at 1 589 public health facilities in South Africa between 1 October and 15 November 2019. Consenting pregnant women aged 15–49 years attending ANC during the survey period were enrolled. Demographic and clinical data were collected through interview and medical record review. Pregnancy intention was assessed using two questions from the London Measure of Unplanned Pregnancy, and responses were categorized as “unintended,” “undecided,” and “intended.” Blood specimens were collected from all women and tested for HIV; and if positive, a viral load test was performed. A survey domain-based poisson regression model examined the association between unsuppressed viral load during the third trimester of pregnancy and unintended pregnancy among women who initiated ART before pregnancy. Viral suppression was defined as viral load <50 copies/mL.ResultsOf 10 901 WLWH with viral load data available, 63.3% (95% confidence interval (CI): 62.4%-64.1%) were virally suppressed. Among the 2 681 women (representing 24.1% of all WLWH with viral load data) who initiated ART before pregnancy and were in their third trimester at the time of enrolment, 74.4% (95% CI: 73.0%-75.8%) were virally suppressed. In the same population, the proportion virally suppressed was lower among women whose current pregnancies were unintended (72.1%, 95% CI: 70.1%-74.1%) compared to women whose pregnancies were intended (78.3%, 95% CI: 75.9%-80.5%). In multivariable analyses adjusted for age, gravity, marital status, education, location of facility and syphilis status, unintended pregnancy was associated with unsuppressed viral load during the third trimester (adjusted relative risk: 1.3, 95% CI: 1.1–1.4) among women who initiated ART before pregnancy.ConclusionThe identified association between unsuppressed viral load and unintended pregnancy among pregnant women who initiated ART before pregnancy highlights the need to strengthen routine assessment of fertility preferences and provision of contraceptive services to reproductive age WLWH receiving ART.

Fosfomycin resistance in community-acquired urinary pathogens from Western Cape, South Africa.

Oral fosfomycin is commonly used to treat uncomplicated urinary tract infections (UTI) and whilst resistance has been reported in many healthcare facilities in South Africa, the current prevalence remains unknown. This study investigated the prevalence and mechanisms of fosfomycin resistance amongst urinary pathogens in the Western Cape, South Africa. Of the 200 isolates collected during the study period (2019–2020), seven (3.5%) were fosfomycin resistant. Mutations in the glpT and uhpT transporter genes were the most common mechanism of resistance detected. These findings support the ongoing use of fosfomycin as an empiric antibiotic choice for the treatment of community-acquired UTI in this setting.

The neonatal transfer process through the lens of neonatologists at public hospitals in South Africa.

BackgroundNeonatal care is provided by various levels of healthcare facilities in South Africa. Intensive care for neonates is only provided at the higher levels, hence the need for transfers from lower-level to higher-level facilities (e.g. primary hospitals to tertiary hospitals) or across levels of facilities, particularly when life-threatening situations arise (e.g. cardiac deterioration, respiratory deterioration and desaturation).AimThe aim of the study was to explore neonatologists’ views regarding the neonatal transfer process and to describe the preparedness of advanced life support (ALS) paramedics to undertake such transfers.SettingThe setting consisted of neonatologists from three provinces i.e. KwaZulu-Natal, Gauteng and Western cape.MethodA qualitative descriptive design was utilised in this study. Semistructured interviews were conducted on the public health hospitals in three provinces (N = 9; n = 3) with neonatologists (N = 7; n = 7) who were involved in the transfers of critically ill neonates. The process of thematic analysis was used.ResultsThe themes that emerged in this study were: an awareness of local contextual realities related to neonatal transfers, challenges evident within the context of neonatal transfers, decision-making around the transfer of ill neonates, ALS paramedic preparedness for transfers and good clinical governanceConclusionThe study found that there was a need to be aware of local contextual realities confronting neonatal transfers, a need for greater preparedness for paramedics to undertake these transfers, a need for a sound referral processes and a need for coordinated transfer effort between paramedics, hospital staff and transport team members for the successful transfer of critically ill neonates.ContributionThe findings highlight the challenges confronting the neonatal transfer process in South Africa through the lens of neonatologist at public hospitals. Hence, the study reinforces the preparedness and coordination of the transfer process, along with more efficient communication between paramedics, hospital staff and the transfer team.

Poorly controlled hypertension among adults treated for hypertension in Tshwane District, South Africa.

Adequate control of hypertension (HTN) is essential to prevent complications such as cardiovascular and kidney diseases. Despite the use of established clinical protocols on the treatment of HTN in primary health facilities in South Africa, the HTN of many patients remains poorly controlled. The objectives of this study were to determine the prevalence of poorly controlled HTN as well as identify related associated risk factors in a sample of adult attendees in primary health care facilities. A cross-sectional study was conducted among adult hypertension clinic attendees at primary health care facilities in Tshwane District, South Africa. Data were collected using the WHO Stepwise instrument on chronic disease risk factor surveillance and anthropometric and blood pressure (BP) measurements. Stata Version 13 was used for data analysis. Of the 327 patients who participated in the study, 72.2% were female and 27.8% were male. Their mean age was 56 years (SD = 10.8 years). The prevalence of uncontrolled HTN was 58%, with the mean systolic BP and diastolic BP of 142.18 and 87.43, respectively. The prevalence of poorly controlled HTN increased with age. Factors associated with poorly controlled HTN were age, gender, being unemployed, source of income, smoking, alcohol use, lack of physical activity, and skipping of medication. By multi-variate analysis, both the mean systolic and diastolic blood pressures were found to be significantly associated with poorly controlled BP. The high prevalence of poorly controlled BP among patients who are on treatment suggests the need to re-consider the appropriateness of the current integrated management and treatment of HTN used in primary health care facilities in South Africa. The results suggest that the established clinical protocols and standard treatment for HTN are not beneficial for all patients and that physicians should use the treatment response of individual patients to make clinical decisions.