This study assessed the impact of a community-based adherence support service on the outcomes of patients on antiretroviral therapy (ART). The evaluation was a retrospective study based on patient clinical records. This study noted that a significantly higher proportion of patients with a community-based adherence supporter (also known as a patient advocate, PA) had viral load (VL) of less than 400 copies/ml at six months of treatment (70%, p=0.001); a significantly higher proportion of patients with PAs (89%) attained a treatment pickup rate of over 95% (67%; p=0.021). Patients at health facilities with PA services maintained a suppressed VL for a longer period as opposed to patients at health facilities without PA services (p=0.001), also patients at health facilities with PA services remained in care for longer periods (p=0.001). Therefore, the study concludes that integrated community-based adherence support is crucial in ensuring that patients remain in care, regularly pickup their treatment from ART clinics and are virologically suppressed. The study also underscores the importance of access to health services and the presence of an enabling environment in the treatment of AIDS.

Background: Oral health-related quality of life (OHRQoL) is influenced by cultural and societal context. Existing OHRQoL children measurement tools have been conceptualised in high-income countries. Probing whether the factors influencing OHRQoL are context-reliant in the African setting is necessary and is the purpose of the current review.Aim: To investigate if the factors influencing OHRQoL are context-reliant.Methods: Seven databases were searched using search terms (‘oral health’; and ‘quality of life’, ‘health-related quality of life’, ‘patient-reported outcomes’, ‘well-being’; and ‘child*’, ‘adolescents’, ‘teen*’, ‘youth’; and ‘determinants’, ‘factors’, ‘predictors’; and ‘oral health quality of life tools/instruments/scales’; and ‘Africa*’). Abstracts identified were exported to a reference software manager. Three of the authors used specific selection criteria to review, firstly, 307 abstracts and, secondly, 30 full papers. Data were extracted from these papers using a pre-designed data extraction form, after which quantitative synthesis of data was performed.Results: Key factors influencing OHRQoL followed an existing conceptual framework where environmental and individual factors in the form of socio-economic status (SES), area of residence and children psyche status, and the presence of any oral condition other than dental caries were reported among child populations in Africa.Conclusion: There is preliminary evidence to suggest an association between individual factors such as children’s psyche and oral problems, excluding dental caries, and environmental determinants such as area of residence and SES in children’s OHRQoL in African children. The finding that dental caries was not a key factor in child-oral health is unexpected. There seemed to be a contextual viewpoint underpinning the current OHRQoL frameworks and OHRQoL was context-reliant.

South Africa has implemented a community-based HIV programme (CBHP) in its primary healthcare (PHC) re-engineering strategy that aims to improve public healthcare delivery. This CBHP is delivered by ward-based outreach teams (WBOTs); provision of community HIV services comprises an important component of this programme. We conducted an exploratory study to determine the facilitators and barriers to successful implementation of this CBHP in rural Mopani District, South Africa. Focus group discussions were conducted with the community health workers (CHWs) and PHC nurses; participant interviews were conducted with community members who access these health services, community leaders, and social workers. We conducted a thematic content analysis and based on the key themes reported, we identified the Consolidated Framework for Implementation Research, consisting of five domains, as the most appropriate model to interpret our findings. First, in terms of intervention characteristics, community members generally valued the HIV services provided, but the variable needs impacted on programme implementation. Outer setting challenges include inability to meet the need of patients as a result of stigma, non-disclosure of HIV status and social factors. In terms of the inner setting, CHWs were grateful for the equipment and training received but expressed the need for better support of management and the provision of additional resources. With regard to characteristics of the implementers, the CHWs expressed the desire for further training despite reporting having sufficient knowledge to conduct their HIV work. Finally, in terms of the implementation process, the importance of relationship building between CHWs and community members was emphasised. In conclusion, these data underline the positive receipt and potential of the CBHP in this rural district and identify areas to further strengthen the programme. The success and sustainability of the CBHP requires ongoing commitment of resources, training, supervision, and organisational support in order to operate effectively and efficiently.

BackgroundCommunity healthcare workers (CHWs) play an important role in promoting HIV-care retention. Notwithstanding inconsistencies in the outcomes of CHW programmes, these programmes are known to have a positive effect on retention of mother-baby pairs in HIV-care in sub-Saharan Africa.AimThe aim of this analysis was to assess the effect of mothers2mothers (m2m) Ugandan Mentor Mother (MM) programme on the retention of mother-baby pairs in HIV-care.MethodsWe conducted a secondary analysis of data obtained from the m2m Uganda MM programme in nine East Central districts. The primary data was generated through a quasi-experimental study of women attending prevention of mother to child transmission of HIV (PMTCT) clinics in Uganda between January 2011 and March 2014; where those who were enrolled at PMTCT sites with the MM intervention (n = 1161) were compared with those who received standard PMCTCT services without the MM intervention (n = 1143). Frequencies and descriptive statistics were calculated for categorical and continuous measures respectively. Risk factors for retention in care were determined by clustered generalised estimating equations and reported as adjusted odds ratios (AOR) with 95% confidence intervals (95% CI).ResultsRetention in the PMTCT cascade was significantly higher for mother-baby pairs in the intervention arm compared to those in the control arm across all measured time points (96.7% vs 65.8% at 6 weeks after birth, p<0.001; 81.5% vs 42% at 6 weeks after cessation of breastfeeding, p<0.001; and 71.2% vs 20.6% at 18 months after birth, p<0.001). Relative to the control group, women in the intervention group were less likely to be lost to follow up following treatment initiation (AOR 0.05, 95% CI: 0.02, 0.15). There was no difference in the proportion of the retained mother-baby pairs who received prescribed PMTCT interventions at different time points but a significantly higher number of mother-baby pairs in the intervention arm were retained at different time points.ConclusionHIV positive mothers and their HIV exposed children in the mothers2mothers Ugandan Mentor Mother programme had higher retention in HIV care at every step along the PMTCT cascade. We therefore recommend adoption of this peer-to-peer model in sub-Saharan Africa to complement retention in care strategies and health system interventions especially among priority and key populations.

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BackgroundIncreased demand for healthcare services in countries experiencing high HIV disease burden and often coupled with a shortage of health workers, has necessitated task shifting from professional health workers to Lay Health Workers (LHWs) in order to improve healthcare delivery. Maternal and Child Health (MCH) services particularly benefit from task-shifting to LHWs or similar cadres. However, evidence on the roles and usefulness of LHWs in MCH service delivery in Sub-Saharan Africa (SSA) is not fully known.ObjectivesTo examine evidence of the roles and impact of lay health worker programmes focusing on Women Living with HIV (WLH) and their HIV-exposed infants (HEIs).MethodsA scoping review approach based on Arksey and O’Malley’s guiding principles was used to retrieve, review and analyse existing literature. We searched for articles published between January 2008 and July 2018 in seven (7) databases, including: MEDLINE, Embase, PsycINFO, Joanna Briggs, The Cochrane Library, EBM reviews and Web of Science. The critical constructs used for the literature search were “lay health worker”, “community health worker”, “peer mentor”, “mentor mother,” “Maternal and Child health worker”, “HIV positive mothers”, “HIV exposed infants” and PMTCT.ResultsThirty-three (33) full-text articles meeting the eligibility criteria were identified and included in the final analysis. Most (n = 13, 39.4%) of the included studies were conducted in South Africa and used a cluster RCT design (n = 13, 39.4%). The most commonly performed roles of LHWs in HIV specific MCH programmes included: community engagement and sensitisation, psychosocial support, linkage to care, encouraging women to bring their infants back for HIV testing and supporting default tracing. Community awareness on Mother to Child Transmission of HIV (MTCT), proper and consistent use of condoms, clinic attendance and timely HIV testing of HEIs, as well as retention in care for infected persons, have all improved because of LHW programmes.ConclusionLHWs play significant roles in the management of WLH and their HEIs, improving MCH outcomes in the process. LHW interventions are beneficial in increasing access to PMTCT services and reducing MTCT of HIV, though their impact on improving adherence to ART remains scanty. Further research is needed to evaluate ART adherence in LHW interventions targeted at WLH. LHW programmes can be enhanced by increasing supportive supervision and remuneration of LHWs.

HIV/AIDS and water-borne diseases account for a substantial degree of morbidity and mortality in different age groups across the globe, but their ripple effects are more devastating in developing countries. Estimates of the HIV/AIDS epidemic in South Africa vary but attest to a mature and generalised epidemic. Antenatal sero-prevalence data show a rising epidemic from less than 1% prevalence among pregnant women attending antenatal clinics in 1990 to over 29.5% in 2004. Prevalence is generally higher among females than males, indicating feminisation of the epidemic. Race analyses in 2003 reveal the highest prevalence to be among African (13%) followed by Whites and Coloureds (6.2%) and least among Indians (1.6%). The epidemic which has left a wave of orphans, child-headed households and its attendant ripple effects on household structures, demography, economy and education is characterised by a 'pigeon-hole' of several opportunistic infections. In rural areas, devoid of electricity and potable water, the impact is more profound because of the role of water in cooking, drinking, consumption of anti-retrovirals and in the preparation of milk supplements for infants. People with compromised immune systems are more prone to several diseases than individuals whose immune systems are not compromised by HIV/AIDS. HIV/AIDS patients therefore have greater requirements for potable water than uninfected individuals. Improving water quality will lead to a decline in child and adult mortality as well as diarrhoeal diseases in people living with HIV/AIDS. One of the hallmarks of HIV/AIDS is diarrhoea and about 90% of HIV/AIDS patients in Africa suffer from chronic diarrhoea, an easily recognisable clinical manifestation of water-borne infections. Other linkages between HIV/AIDS and water are breast feeding; unsafe water used in infant formula preparation which increases the risk of diarrhoeal diseases and deaths in infants; anti-retroviral treatment, as safe water is needed during anti-retroviral treatment or treatment for opportunistic infections in HIV. In addition to providing safe water, supply points and latrines should be close to points of use as this will reduce the long distances that care givers and HIV/AIDS patients undertake to fetch water and appropriate water system design is required. Added to the above-mentioned are poverty alleviation aspects; poverty enhances vulnerability to HIV infection and AIDS exacerbates poverty. Secured access to sufficient safe water and sanitation is also a human rights issue, just as stigmatisation of HIV/AIDS has made the disease a human rights issue. The cross-paths between HIV/AIDS and water have long-term implications for effective water resource management and the provision of wholesome water to communities. Such implications include faltering payment for water supply because HIV and AIDS are financially dis-empowering, erosion of social capital and waning productivity. Mainstreaming of HIV/AIDS in the water sector is of utmost importance, including development of workplace pol...

This study compared the level of CD4 count, viral load and health-related quality of life (HRQOL) between treatment-naïve AIDS patients and a cohort of people living with HIV who have been on treatment for 12 months. This study is based on a secondary data analysis of the records of 642 people with HIV consisting of 311 treatment-naïve AIDS patients and 331 people with HIV who have been on treatment for 12 months. The study findings are mostly presented in tables and analysed using the t-test to compare HRQOL scores, CD4 count and viral load in the two groups. The study generally noted poor financial capacity and low activity tolerance among the participants. Significant changes were noted in all the domains of HRQOL compared between the treatment-naïve patients and the 12 months treatment cohort. In the same manner, the median CD4 cell count and viral load differed significantly between both groups. The treatment-naïve and the 12 months treatment cohorts consistently reported much lower quality of life scores in the level of dependence domain which includes the measures of mobility, activity of daily living, dependence on medication and work capacity. There were little or no associations between the biomedical markers (CD4 count and viral load) and HRQOL indicators. However, the quality of life tended to increase with increase in the CD4 cell count. The poor to no association between the biomedical markers and HRQOL indicators show that these cannot be direct proxies of each other and that the CD4 cell count and viral load alone may be inadequate eligibility criteria for social support.