Health Care In South Africa Research Articles

National stakeholders\u2019 perceptions of the processes that inform the development of national clinical practice guidelines for primary healthcare in South Africa

BackgroundThere is increased international focus on improving the rigour of clinical practice guideline (CPG) development practices. However, few empirical studies on CPG development have been conducted in low- and middle-income countries. This paper explores national stakeholders’ perceptions of processes informing CPG development for primary healthcare in South Africa, focusing on both their aspirations and views of what is actually occurring.MethodsA qualitative study design was employed including individual interviews with 37 South African primary care CPG development role-players. Participants represented various disciplines, sectors and provinces. The data were analysed through thematic analysis and an interpretivist conceptual framework.ResultsStrongly reflecting current international standards, participants identified six ‘aspirational’ processes that they thought should inform South African CPG development, as follows: (1) evidence; (2) stakeholder consultation; (3) transparency; (4) management of interests; (5) communication/co-ordination between CPG development groups; and (6) fit-for-context. While perceptions of a transition towards more robust processes was common, CPG development was seen to face ongoing challenges with regards to all six aspirational processes. Many challenges were attributed to inadequate financial and human resources, which were perceived to hinder capacity to undertake the necessary methodological work, respond to stakeholders’ feedback, and document and share decision-making processes. Challenges were also linked to a complex web of politics, power and interests. The CPG development arena was described as saturated with personal and financial interests, groups competing for authority over specific territories and unequal power dynamics which favour those with the time, resources and authority to make contributions. These were all perceived to affect efforts for transparency, collaboration and inclusivity in CPG development.ConclusionWhile there is strong commitment amongst national stakeholders to advance CPG development processes, a mix of values, politics, power and capacity constraints pose significant challenges. Contrasting perspectives regarding managing interests and how best to adapt to within-country contexts requires further exploration. Dedicated resources for CPG development, standardised systems for managing conflicting interests, and the development of a political environment that fosters collaboration and more equitable inclusion within and between CPG development groups are needed. These initiatives may enhance CPG quality and acceptability, with associated positive impact on patient care.

The National Education, Health and Allied Workers' Union (NEHAWU) strikes: South Africa's healthcare battlefield.

The right to strike is a fundamental right entrenched in section 23 of the Bill of Rights. Strikes are an almost everyday occurrence in South Africa and strikes in healthcare facilities raise difficult and complex moral and ethical questions. The right to strike is conditionally limited by section 36 of the Constitution and for workers engaging in essential services it is further limited under section 65 of the Labour Relations Act. Healthcare practitioners, including emergency care personnel, and much-needed healthcare facilities have come under attack during the National Education, Health and Allied Workers' Union (NEHAWU) strikes, which have prevented patients from accessing healthcare and threatened the training of undergraduate students and registrars. While generally security and policing have been lacking at targeted facilities, many doctors stood by their patients despite threats to their safety. Healthcare facilities, vehicles and practitioners must be protected. Solutions must come from politicians and include preventive actions and enforcement of the law.

Healthcare in Crisis: A Shameful Disrespect of our Constitution

Healthcare in South Africa (SA) is in crisis. Of the complaints received by the health ombud, 40% are from Gauteng Province. Despite the dire shortage of human resources, the Gauteng Department of Health has decided not to fill vacated posts. As a result, the training of registrars and medical students suffers. Legal constraints have also created an impasse between tiers of government, allowing for near self-governance with impunity at the provincial offices. The public sector provides healthcare access to 84% of patients in SA, and this group is being denied access to healthcare in the country. The fundamental right to healthcare is affirmed in the Constitution; however, its implementation is riddled with impediments. Urgent intervention is necessary to address the crisis.

THE COST OF INDIFFERENCE IN A MEDICAL NEGLIGENCE CASE: Lushaba v MEC for Health, Gauteng (17077/2012 [2014] ZAGPJHC 407 (16 October 2014))

The much-debated diagnostic report, the National Development Plan 2030 (NDP), paints a worrying picture about the state of the health system in South Africa. The NDP simply states that, “At institutional level, healthcare management is in crisis” (Republic of South Africa 2012, National Development Plan of 2030: 52). One of the remedial measures proposed by the NDP is the introduction of the National Health Insurance in South Africa (Republic of South Africa 2012, National Development Plan of 2030: 52). It is hoped that the National Health Insurance “will ensure that everyone has access to appropriate, efficient and quality health services” (Republic of South Africa 2012, National Development Plan of 2030: 4).The Constitution of the Republic of South Africa, 1996 sets the benchmark and the ideals towards which public servants must strive as they deliver the much-needed services to the general populace (s 195(1)(a)−(i)). Among others, public servants must promote and maintain a high standard of professional ethics (s 195(1)(a)). Further, the Batho Pele Principles require it of government institutions to, inter alia communicate the level and quality of service, which the public must expect from them (Batho Pele Principles Principle 2). It is therefore not misguided to say that generally, people are aware of the standard of service they should expect from state institutions. As a matter of fact, people have gone to the courts of law to hold state institutions accountable. In this regard the medical fraternity has in the recent past witnessed an upsurge of court cases of negligence against the health department. This rise in litigation has led to a crisis of another kind. According to the Minister of Health, healthcare in South Africa is facing a crisis because some medical practitioners, particularly gynaecologists and obstetricians, have opted not to perform operations for fear of lawsuits.The concerns of the Minister notwithstanding, the daily experiences of people point to the fact that despite the lofty ideals in the Constitution and the Batho Pele Principles, the general public continues to receive sub-standard service from public institutions, especially from public hospitals. The case of Lushaba v MEC for Health, Gauteng (The original case) provides a good illustration of a nation, which is in a state of paralysis ethically. The case paints a picture of “state employees who could not be bothered to do their work” (The rule nisi case par 87). What is even more ominous is the observation by Robinson JA that shaming such public officials no longer has any effect (The rule nisi case par 90).The Lushaba case has all the hallmarks of the cost of indifference on the ethical values of a nation. Axiomatically, such a cost cannot only be measured in Rands and cents. Later in the discussion, we hope to make it clear that indifference impacts on the valuable time of the court and the plaintiff, the reputation of the various institutions involved, quality of life of the child born with cerebral palsy as a result of indifference, the dignity of both the mother and her son and, of course, the taxpayers’ money. These factors combined provide a good basis for reflection on the cost of indifference in this case. To provide some background, the facts of the Lushaba case are discussed briefly, after which the indifference of every role player in the events leading up to the two court cases are highlighted. In the process, our discussion also makes mention of the trajectory that the case followed from the court a quo all the way to the Constitutional Court (MEC for Health, Gauteng v Lushaba [2015] ZACC 16). In the Constitutional Court’s judgment, even the High Court judge came under scrutiny.

Collaborative mental health care in the bureaucratic field of post-apartheid South Africa

ABSTRACTSouth Africa's long and arduous journey from colonial and apartheid-era care for people with mental illness to more comprehensive, equitable mental health care is well-described. Deeper engagement with the structural power dynamics involved in providing collaborative mental health services are less-well described, especially in its post-apartheid era. This conceptual article positions state and non-state mental health service providers – along with their relationships and conflicts – within Bourdieu's bureaucratic field. It is suggested that key internecine struggles in South Africa's post-apartheid socio-political arena have influenced the ways in which collaborative mental health care is provided. Drawing from two recent examples of conflict within the bureaucratic field, the article illustrates the ways in which neoliberal forces play out in contemporary South Africa's mental health service delivery. Struggles between the state and private healthcare in the Life Esidimeni tragedy receive focus, as well as the shifting of responsibility onto civil society. A court case between the state and a coalition of non-profit organisations provides further evidence that neoliberal rationalities significantly influences the position and power of non-state service providers. Unless serious consideration is given to these dynamics, collaborative mental health care in South Africa will remain out of reach.

Understanding the types of fraud in claims to South African medical schemes

Medical schemes play a significant role in funding private healthcare in South Africa (SA). However, the sector is negatively affected by the high rate of fraudulent claims. To identify the types of fraudulent activities committed in SA medical scheme claims. A cross-sectional qualitative study was conducted, adopting a case study strategy. A sample of 15 employees was purposively selected from a single medical scheme administration company in SA. Semi-structured interviews were conducted to collect data from study participants. A thematic analysis of the data was done using ATLAS.ti software (ATLAS.ti Scientific Software Development, Germany). The study population comprised the 17 companies that administer medical schemes in SA. Data were collected from 15 study participants, who were selected from the medical scheme administrator chosen as a case study. The study found that medical schemes were defrauded in numerous ways. The perpetrators of this type of fraud include healthcare service providers, medical scheme members, employees, brokers and syndicates. Medical schemes are mostly defrauded by the submission of false claims by service providers and syndicates. Fraud committed by medical scheme members encompasses the sharing of medical scheme benefits with non-members (card farming) and non-disclosure of pre-existing conditions at the application stage. The study concluded that perpetrators of fraud have found several ways of defrauding SA medical schemes regarding claims. Understanding and identifying the types of fraud events facing medical schemes is the initial step towards establishing methods to mitigate this risk. Future studies should examine strategies to manage fraudulent medical scheme claims.

Understanding the types of fraud in claims to South African medical schemes

Background. Medical schemes play a significant role in funding private healthcare in South Africa (SA). However, the sector is negatively affected by the high rate of fraudulent claims. Objectives. To identify the types of fraudulent activities committed in SA medical scheme claims. Methods. A cross-sectional qualitative study was conducted, adopting a case study strategy. A sample of 15 employees was purposively selected from a single medical scheme administration company in SA. Semi-structured interviews were conducted to collect data from study participants. A thematic analysis of the data was done using ATLAS.ti software (ATLAS.ti Scientific Software Development, Germany). Results. The study population comprised the 17 companies that administer medical schemes in SA. Data were collected from 15 study participants, who were selected from the medical scheme administrator chosen as a case study. The study found that medical schemes were defrauded in numerous ways. The perpetrators of this type of fraud include healthcare service providers, medical scheme members, employees, brokers and syndicates. Medical schemes are mostly defrauded by the submission of false claims by service providers and syndicates. Fraud committed by medical scheme members encompasses the sharing of medical scheme benefits with non-members (card farming) and non-disclosure of pre-existing conditions at the application stage. Conclusions. The study concluded that perpetrators of fraud have found several ways of defrauding SA medical schemes regarding claims. Understanding and identifying the types of fraud events facing medical schemes is the initial step towards establishing methods to mitigate this risk. Future studies should examine strategies to manage fraudulent medical scheme claims.

Integrated Decentralized Training for Health Professions Education at the University of KwaZulu-Natal, South Africa: Protocol for the I-DecT Project.

BackgroundThe Integrated Decentralized Training (i-DecT) project was created to address the current need for health care in South Africa among resource poor climates in rural and periurban settings. The University of KwaZulu-Natal (UKZN) in South Africa has embarked on a program within the School of Health Sciences (SHS) to decentralize the clinical learning platform in order to address this disparity. Framed in a pragmatic stance, this proposal is geared towards informing the roll out of decentralized clinical training (DCT) within the province of KwaZulu-Natal. There currently remains uncertainty as to how the implementation of this program will unfold, especially for the diverse SHS, which includes specialities like audiology, dentistry, occupational therapy, optometry, pharmacy, physiotherapy, speech-language pathology, and sport science. Consequently, there is a need to carefully monitor and manage this DCT in order to ensure that the participating students have a positive learning experience and achieve expected academic outcomes, and that the needs of the communities are addressed adequately.ObjectiveThe study aims to explore the factors that will influence the roll-out of the DCT by developing an inclusive and context-specific model that will adhere to the standards set by the SHS for the DCT program at UKZN.MethodsKey role players, including but not limited to, the South African Ministry of Health policy makers, clinicians, policy makers at UKZN, clinical educators, academicians, and students of UKZN within the SHS will participate in this project. Once the infrastructural, staffing and pedagogical enablers and challenges are identified, together with a review of existing models of decentralized training, a context-specific model for DCTl will be proposed based on initial pilot data that will be tested within iterative cycles in an Action Learning Action Research (ALAR) process.ResultsThe study was designed to fit within the existing structures, and emerging framework and memorandum of understanding between the partners of this initiative, namely, the Ministry of Health and UKZN in order to develop health care professionals that are competent and prepared for the changing dynamics of healthcare in a developing world.ConclusionsIt is envisioned that this study, the first to include a combination of health professionals in a DCT platform at UKZN, will not only contribute to effective service delivery, but may also serve to promote an interprofessional cooperation within the SHS and tertiary institutions in similar settings.

Application of the Batho Pele Principles as a Quality Management tool in HIV-AIDS Healthcare in south Africa

HIV-AIDS continues to bear a high disease burden in many developing countries including South Africa which has the greatest disease prevalence. The only way to counteract the devastating effects of this disease is to ensure adequate point of care HIV diagnosis and referral to timely care through HIV-AIDS programmes. The South African state HIV-AIDS programme is currently the largest programme in the world as it provides HIV-AIDS services to almost 7 million South Africans. Quality management systems in healthcare is therefore a pre requisite to ensure safe and efficacious HIV-AIDS care is provided to those affected and infected by HIV-AIDS. One such quality management tool proposed is, the application of the Batho Pele principles as a quality management tool in HIV-AIDS healthcare. The Batho Pele initiative aims to enhance the quality and accessibility of government services by improving efficiency and accountability to the recipients of public goods and services. The Batho Pele (“People First”) principles are aligned to the South African constitution. All government officials must follow the “Batho Pele” principles which require public servants to be polite, open and transparent and to deliver good service to the public. Batho Pele requires that nine service delivery principles be implemented regarding consulting, service standards, courtesy, information delivery transparency and value for money. This is a an exploratory article which reviews the literature available to assess the alignment of the Batho Pele principles as a quality management tool in HIV-AIDS healthcare towards building good leadership and clinical strategic direction in South Africa.

Experiences of Nurse Graduates of an Integrated HIV Curriculum from a Selected University in South Africa

Nurses remain a crucial part in the management and care of HIV, especially in resource constrained settings where they fulfil a variety of roles and functions. Competent HIV healthcare providers, especially nurses who provide and support the first line of healthcare in South Africa, are needed to achieve optimal clinical outcomes for all people living with HIV. The integration of HIV-related competencies in an undergraduate nursing curriculum is critical to maintain continuity of HIV related knowledge, skills and competencies within undergraduate nursing programmes from the first year of training, as it builds on foundational levels of understanding to promote critical thinking and skills for continuing learning in the area of HIV care. Against this background, this article reports on the experiences of the first cohort of student nurses who were exposed to the integration of HIV nursing competencies within a four-year Bachelor of Nursing programme. A descriptive exploratory design using a focus group discussion underpinned the study and was considered appropriate to explore the graduated student nurses experiences of the integration of HIV competencies within a four-year Bachelor of Nursing programme and how the integrated HIV programme prepared them for their practice in the management of HIV nursing care. Three themes emerged from the study, namely, evidence informed nursing care, innovative problem-solving skills, and confident to practise. The results showed an overall positive experience from the participants in their ability to independently practise and fulfil a range of HIV-related nursing care. The findings have demonstrated that the first cohort of nurse graduates from an integrated HIV Bachelor of Nursing curriculum showed success in the participants’ experience of the HIV related content and their ability to transfer the knowledge, attitudes and skills to meaningfully and effectively manage HIV-related nursing care.

Electronic health information systems for public health care in South Africa: a review of current operational systems

Background and Purpose : The South African eHealth Strategy was published in 2012 and acknowledges that health information systems should be used to strengthen the public health care system in the country. While the benefit of electronic health information systems has been documented in the literature, the implementation of these systems in public health care in South Africa remains limited. Currently, patient data is still manually recorded in the patient’s file, while data required for monitoring and evaluation purposes is hand written by the nurses in registers, aggregated and only the results entered into electronic health information systems for analysis. Methods : The objective of the paper is to review existing electronic health information systems in public health care in South Africa in terms of their role and focus on health care. A qualitative approach was undertaken to identify the role of health information systems that are most prevalent in public health care in South Africa. Results : The results indicate that the most common role of health information systems include support for clinical care, e.g. radiology and pathology, as well as monitoring, evaluation and administration purposes. While some systems do capture limited clinical information, there seems to be few systems that support patient centred clinical care. Conclusions : The recommendation of the paper is that the role of health information systems should be expanded to support direct patient care and improve health outcomes for individuals.

Cost awareness among healthcare professionals at a South African hospital: A cross-sectional survey.

Financial cost is a recognised cause of lack of access to adequate healthcare in South Africa (SA). Data describing the SA healthcare professional (HCP)'s awareness of costs are scant. Their increased awareness of healthcare costs may improve efficacy and reduce wasteful expenditure. To assess SA HCP's knowledge of healthcare costs, identify factors that influence cost awareness, and to determine if surveyed HCPs received training related to cost management during their studies or at any stage during their practice. This cross-sectional survey was conducted by means of a standardised questionnaire. HCPs working at a major tertiary academic hospital were asked to answer an anonymous standardised questionnaire aimed at determining their awareness of the costs of commonly requested hospital items and tests. Cost accuracy was determined by assessing the log deviation of the estimated cost from true cost, with values >0 and <0 representing overestimates and underestimates, respectively. Cost estimations were considered correct if the absolute value of the log deviation was <0.2. Participants' attitudes towards the potential impact of the availability of cost information on their practice were assessed. The overall cost estimation of accuracy was low (mean 0.60; standard deviation 1.99) and differed widely between items. Cheaper items were more likely to be overestimated and expensive items to be underestimated. The majority of participants indicated that cost awareness education was not part of their training or practice (84.5%) and that they would like cost information to be made readily available (92.2%). Eighty-four percent of participants were of the opinion that cost information would not negatively affect patient care. The use of percentage deviation from true cost as a method of assessing cost awareness creates a bias towards overestimation, which is more relevant for cheap items, as larger overestimates are more common for these items. We propose the use of log deviation of the estimated cost from the true cost as a method of assessing cost estimation accuracy. HCPs have a limited understanding of the costs of disposables, tests and drugs commonly used in their practice and would prefer that cost information be made readily available to them. Attention should be paid to improving cost awareness among HCPs working at SA hospitals.

The Development of the Interface between Law, Medicine and Psychiatry: Medico-Legal Perspectives in History

Medicine and law were related from early times. This relation resulted as a necessity of protecting communities from the irresponsible acts of impostors. Various legal codes dealing with medical malpractice existed in Egypt, Mesopotamia, China, Islam, Greece, Rome, Persia and India. Over the course of the past 30 years, interest in the history of psychiatry has boomed. Much of this proliferation of interest has taken place under the broad influence of postmodernism and has resulted in multiple and diverse histories that no longer seek to provide a linear narrative of constant evolutionary progress. Rather, these new histories explore and disrupt taken for granted assumptions about the past and provide a starting point for discussion and debate about the some of the very foundations of mental health care in South Africa. As a matter of practical importance knowledge of how knowledge accrues and knowledge of the mistakes of the past is of prime importance in preventing similar mistakes in present and future work. An important reason for specifically understanding historical psychiatry is the fact that many of the uncertainties experienced in the present are a direct result of decisions made in the past. The key issue is that while it is tempting to experience current psychiatric and legal approaches towards the mentally disordered as natural and permanent, an understanding of the past helps mental health and legal practitioners to see things in a different perspective. Psychiatric and legal approaches towards the mentally disordered have changed over time and can undoubtedly also be changed in future. Therefore, the research conducted in this article focuses on the history and development of law and psychiatry including prehistoric times, the Arabian countries, the Nile Valley as well as Greece and Rome.

Immunisation coverage in the rural Eastern Cape - are we getting the basics of primary care right? Results from a longitudinal prospective cohort study.

Immunisations are one of the most cost-effective public health interventions available and South Africa (SA) has implemented a comprehensive immunisation schedule. However, there is disagreement about the level of immunisation coverage in the country and few studies document the immunisation coverage in rural areas. To examine the successful and timely delivery of immunisations to children during the first 2 years of life in a deeply rural part of the Eastern Cape Province of SA. From January to April 2013, a cohort of sequential births (N=470) in the area surrounding Zithulele Hospital in the OR Tambo District of the Eastern Cape was recruited and followed up at home at 3, 6, 9, 12 and 24 months post birth, up to May 2015. Immunisation coverage was determined using Road-to-Health cards. The percentages of children with all immunisations up to date at the time of interview were: 48.6% at 3 months, 73.3% at 6 months, 83.9% at 9 months, 73.3% at 12 months and 73.2% at 24 months. Incomplete immunisations were attributed to stock-outs (56%), lack of awareness of the immunisation schedule or of missed immunisations by the mother (16%) and lack of clinic attendance by the mother (19%). Of the mothers who had visited the clinic for baby immunisations, 49.8% had to make multiple visits because of stock-outs. Measles coverage (of at least one dose) was 85.2% at 1 year and 96.3% by 2 years, but 20.6% of babies had not received a second measles dose (due at 18 months) by 2 years. Immunisations were often given late, particularly the 14-week immunisations. Immunisation rates in the rural Eastern Cape are well below government targets and indicate inadequate provision of basic primary care. Stock-outs of basic childhood immunisations are common and are, according to mothers, the main reason for their children's immunisations not being up to date. There is still much work to be done to ensure that the basics of disease prevention are being delivered at rural clinics in the Eastern Cape, despite attempts to re-engineer primary healthcare in SA.

Policy, power, stigma and silence: Exploring the complexities of a primary mental health care model in a rural South African setting

The Movement for Global Mental Health's (MGMH) efforts to scale up the availability of mental health services have been moderately successful. Investigations in resource-poor countries like South Africa have pointed to the value of an integrated primary mental health care model and multidisciplinary collaboration to support mental health needs in underserved and underresourced communities. However, there remains a need to explore how these policies play out within the daily realities of communities marked by varied environmental and relational complexities. Arguably, the lived realities of mental health policy and service delivery processes are best viewed through ethnographic approaches, which remain underutilised in the field of global mental health. This paper reports on findings from a case study of mental health services for HIV-affected women in a rural South African setting, which employed a motivated ethnography in order to explore the realities of the primary mental health care model and related policies in South Africa. Findings highlighted the influence of three key symbolic (intangible) factors that impact on the efficacy of the primary mental health care model: power dynamics, which shaped relationships within multidisciplinary teams; stigma, which limited the efficacy of task-shifting strategies; and the silencing of women's narratives of distress within services. The resultant gap between policy ideals and the reality of practice is discussed. The paper concludes with recommendations for building on existing successes in the delivery of primary mental health care in South Africa.

ISQUA16-2820NARROWING THE GAP: HOSPITAL ACCREDITATION AND INEQUALITY IN SOUTH AFRICA

To identify differentials in aspects of performance (as measured by the various accreditation components) and quality, as measured by health outcomes, between the public and private sectors in South Africa. The South African health system is characterised by high levels of inequality; both in the quality of care provided and in the ability for different subsets of the population to access this care. The most notable differential is between the public and private healthcare sectors in South Africa. Private healthcare in South Africa is generally perceived to offer higher and more consistent quality of care, albeit at a price. The sector accounts for half …

905TiP - Interim statistical analysis on a phase III randomised trial investigating the addition of modulated electro-hyperthermia to chemoradiation for cervical cancer in HIV positive and negative women in South Africa

Cervical cancer is the second most common cancer in South Africa where funding and resources for treatment are limited and HIV infection rates are high. A Cochrane review (2010) on pooled data from six randomised trials showed a potential benefit to the addition of hyperthermia (HT) to radiotherapy (RT) protocols for cervical cancer. The Dutch Deep Hyperthermia trial (2010) reported a cost saving per quality adjusted life year when HT was added to RT protocols. The potential cost-saving resulting from the addition of HT to cervical cancer treatment protocols may lower the burden on healthcare facilities in South Africa and improve treatment options in HIV positive patients. Trial design: The aim is to determine the clinical effects of the addition of modulated electro-hyperthermia (mEHT) on the standard treatment protocols for locally advanced cervical cancer patients in state healthcare in South Africa. The objectives are to assess the effects of the addition of mEHT on local disease control, quality of life, acute and late toxicity and survival. Method: This is an ongoing phase III randomised clinical trial conducted at the Charlotte Maxeke Johannesburg Academic Hospital. The study aims to enrol 236 female participants with FIGO stage IIB (initial distal parametrium involvement) to IIIB cervical cancer (no bilateral hydronephrosis). Participants are being randomised into a “Hyperthermia” group (mEHT plus chemoradiation) and a “Control” group (chemoradiation alone), based on HIV status, age and stage of disease. All participants are receiving 25 fractions of 2Gy external beam radiation, 3 doses of high dose rate brachytherapy (8Gy) and up to 3 doses of cisplatin (80mg/m2). The Hyperthermia group is receiving two 55 minute local mEHT treatments per week during radiation therapy. Local disease control is being assessed by Positron Emission Tomography (PET) scans. Adverse events, quality of life and overall survival are being recorded and the data is being analysed. Ethics was obtained by the Human Research and Ethics Council (clearance number: M120477) Clinical trial identification: South African Department of Health Trial Registration number: DOH-27-0113-4012; Issued 26 June 2012 Legal entity responsible for the study: University of the Witwatersrand

Mental health, intimate partner violence and HIV

Intimate partner violence (IPV) and HIV are intersecting epidemics in South Africa (SA). Despite recognition that IPV and HIV are bidirectionally linked, less attention has been given to mental health – a key health condition that is at the nexus of both violence and HIV/AIDS. While SA healthcare professionals have made great strides in treating HIV, the corresponding conditions of IPV and mental health receive far less clinical care. Treating mental health has the potential to positively effect HIV care and treatment, but is also a powerful gateway to enhanced comprehensive health in patients. Improving skills in managing the mental health of patients will lead to better health for them and quality of life for affected families. It can also assist health systems to deal more effectively with complex cases that so rarely achieve positive health outcomes.

Tracking Master of Public Health graduates: Linking higher education and the labour market

Background . Master of Public Health (MPH) students come from a wide range of health professional backgrounds. Graduate programmes in public health should equip alumni with knowledge and skills to analyse and integrate health research findings, and have a practical approach to current public health issues. In South Africa (SA), there is a need for health professionals with an adaptable public health approach who can contribute meaningfully to addressing public health problems and transforming the health sector. The role and relevance of graduate public health training in the SA healthcare system have not yet been reported. Tracking of graduates is important to assess the effectiveness of study programmes, graduates’ worth for the healthcare labour market, and their contribution towards improving the healthcare system. Objective . To describe the professional backgrounds of MPH graduates from the University of KwaZulu-Natal, Durban, SA and the role of their learning in their current public health practice. Methods. An emailed, self-administered questionnaire survey of graduates (N=61) was conducted in 2013. Results. Forty-five (73%) of the 61 contactable public health graduates from the past 10 years returned the completed questionnaire; 28 (63%) are working in the public sector and 9 (22%) at academic institutions. Graduates reported that research skills, critical analysis, report writing, and leadership and management were acquired in the MPH programme. Most reported that they were able to integrate the knowledge and skills acquired from the MPH degree in their current workplace. Conclusion. The MPH degree equips graduates with skills that contribute to addressing some of the public health problems in SA.

O34. Update on phase III randomized clinical trial investigating the effects of the addition of electro-hyperthermia to chemoradiotherapy for cervical cancer patients in South Africa

Introduction The Electro-Hyperthermia trial an ongoing phase III randomised clinical trial being conducted at the Charlotte Maxeke Johannesburg Academic Hospital. The general aim is to determine the clinical effects of the addition of modulated electro-hyperthermia (EHT) to the standard treatment protocols for locally advanced cervical cancer patients in state healthcare in South Africa. The objectives are to assess the effects of the addition of EHT on local disease control, quality of life, acute and late toxicity and overall survival. Materials and methods The study aims to enrol 236 female participants with FIGO stage IIB distal to IIIB cervical cancer. Participants are being randomised into a “Hyperthermia” group (EHT plus chemoradiation) and a “Control” group (chemoradiation alone), randomisation stratums: HIV status; age; stage of disease. All participants are receiving 50 Gy external beam radiation, 3 doses of high dose rate brachytherapy (8 Gy) and cisplatin. The Hyperthermia group is receiving two 55 minute local EHT treatments per week during radiation therapy. Local disease control is being assessed by Positron Emission Tomography (PET) scans. Adverse events, quality of life and overall survival are being recorded and the data is being analysed. Results We report preliminary data of the first 100 participants to reach 6 months post treatment. We see a positive trend in survival and local disease control in the group receiving hyperthermia. There are no significant differences in acute adverse events or quality of life between the groups. Conclusion The preliminary results on the addition of EHT are positive with no impact on adverse events, however this must be confirmed with more patients on completion of the study.