Health-care utilization and associated factors in Gauteng province, South Africa

Abaerei, Admas Abera; Ncayiyana, Jabulani; Levin, Jonathan

doi:10.1080/16549716.2017.1305765

Cited by 87 publications

(107 citation statements)

References 24 publications

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“…Our findings further display the gender differential among newly-diagnosed PLHIV and ART initiation seen in similar studies [15, 20, 32]. Apart from differences explained by the underlying higher HIV prevalence in women versus men [4], gender differences in health seeking behavior for HIV care are likely influenced by targeted PMTCT programs for pregnant women.…”

Section: Discussionsupporting

confidence: 79%

“…Finally, characteristics of the patients themselves are often highly predictive of timely initiation. Across Sub-Saharan Africa, women are more likely to initiate care in a timely manner than men, adolescents and young adults have been shown to seek timely care more than older adults, and individuals with higher income levels are more likely to seek care with timeliness than those with lower income levels [13–15, 17–20]. Studies similar to ours regarding timing of ART initiation in Sub-Saharan African (SSA) countries identified factors such as gender, age, location of residence, location of care facility, CD4 count, WHO stage, and TB co-infection as associated with timing of ART initiation.…”

Section: Introductionmentioning

confidence: 99%

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Timing and Predictors of Initiation on Antiretroviral Therapy Among Newly-Diagnosed HIV-Infected Persons in South Africa

Larsen

Cheyip

Tesfay³

et al. 2018

AIDS Behav

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Despite a decade of advancing HIV/AIDS treatment policy in South Africa, 20% of people living with HIV (PLHIV) eligible for antiretroviral treatment (ART) remain untreated. To inform universal test and treat (UTT) implementation in South Africa, this analysis describes the rate, timeliness and determinants of ART initiation among newly diagnosed PLHIV. This analysis used routine data from 35 purposively selected primary clinics in three high HIV-burden districts of South Africa from June 1, 2014 to March 31, 2015. Kaplan-Meier survival curves estimated the rate of ART initiation. We identified predictors of ART initiation rate and timely initiation (within 14 days of eligibility determination) using Cox proportional hazards and multivariable logistic regression models in Stata 14.1. Based on national guidelines, 6826 patients were eligible for ART initiation. Under half of men and non-pregnant women were initiated on ART within 14 days (men: 39.7.0%, 95% CI 37.7-41.9; women: 39.9%, 95% CI 38.1-41.7). Pregnant women initiated at a faster rate (within 14 days: 87.6%, 86.1-89.0). ART initiation and timeliness varied significantly by district, facility location, and age, with little to no variation by World Health Organization stage, or CD4 count. Men and non-pregnant women newly diagnosed with HIV who are eligible for ART in South Africa show suboptimal timeliness of ART initiation. If treatment initiation performance is not improved, UTT implementation will be challenging among men and non-pregnant women. UTT programming should be tailored to district and location categories to address contextual differences influencing treatment initiation.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Timing and Predictors of Initiation on Antiretroviral Therapy Among Newly-Diagnosed HIV-Infected Persons in South Africa

Larsen

Cheyip

Tesfay³

et al. 2018

AIDS Behav

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“…In the current study, the public health system was providing poor quality of care and yielding poor health outcomes due mainly to weak leadership and fragmentation of services at the implementation level. Leadership deficits and fragmentation of public healthcare services has also been observed in other South African studies [46][47][48] and research in Gauteng [49] showed that approximately 75% of randomly-selected participants indicated that they were no longer utilising public healthcare services due to the perceived diminished quality of these services. Thereupon, the 2014 Statistics South Africa general household survey indicated though that most (69%) households have a preference for public clinics and hospitals facilities first followed by a private doctor (29%) whenever a member falls ill [50], p. 28.…”

Section: Service Deliverysupporting

confidence: 58%

Public health system challenges in the Free State, South Africa: a situation appraisal to inform health system strengthening

Malakoane

Heunis

Chikobvu

et al. 2020

BMC Health Serv Res

114

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Background: Since the advent of democracy, the South African government has been putting charters, policies, strategies and plans in place in an effort to strengthen public health system performance and enhance service delivery. However, public health programme performance and outcomes remained poor while the burden of disease increased. This was also the case in the Free State Province, where major public health system challenges occurred around 2012. Assessment was necessary in order to inform health system strengthening. Methods: The study entailed a multi-method situation appraisal utilising information collated in 44 reports generated in 2013 through presentations by unit managers, subdistrict assessments by district clinical specialist teams, and group discussions with district managers, clinic supervisors, primary health care managers and chief executive and clinical officers of hospitals. These data were validated through community and provincial health indabas including non-governmental organisations, councils and academics, as well as unannounced facility visits involving discussions with a wide range of functionaries and patients. The reports were reviewed using the World Health Organization health system building blocks as a priori themes with subsequent identification of emerging subthemes. Data from the different methods employed were triangulated in a causal loop diagram showing the complex interactions between the components of an (in) effective health system. Results: The major subthemes or challenges that emerged under each a priori theme included: firstly, under the 'service delivery' a priori theme, 'fragmentation of health services' (42 reports); secondly, under the 'health workforce' a priori theme, 'staff shortages' (39 reports); thirdly, under the 'health financing' a priori theme, 'financial/cash-flow problems' (39 reports); fourthly, under the 'leadership and governance' a priori theme, 'risk to patient care' (38 reports); fifthly, under the 'medical products/technologies' a priori theme, 'dysfunctional communication technology' (27 reports); and, sixthly, under the 'information' a priori theme, 'poor information management' (26 reports). Conclusion: The major overall public health system challenges reported by stakeholders involved fragmentation of services, staff shortages and financial/cash-flow problems. In order to effect health systems strengthening there was particularly a need to improve integration and address human and financial deficiencies in this setting.

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“…While children with female caregivers are further covered by HTS under the current index testing algorithm, children under the direct care of these fathers will be missed. The problem is compounded by a lower predilection for health-seeking, including HIV testing, among men than among women [45,46]. This highlights a need for a critical analysis of whether caregiver sex is associated with HIV infection in children, especially OVC.…”

Section: Gaps In Testing Coverage and Efficacy For Orphans And Vulnermentioning

confidence: 99%

Understanding the association between caregiver sex and HIV infection among orphans and vulnerable children in Tanzania: learning from the USAID Kizazi Kipya project

Exavery¹,

Charles²,

Kuhlik³

et al. 2020

BMC Health Serv Res

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Background: Tanzania has met only 50.1% of the 90% target for diagnosing HIV in children. The country's pediatric case finding strategy uses global best practices of index testing, provider-initiated counselling and testing, and targeted community testing of at-risk populations to find about 50,000 children living with HIV (CLHIV) who are undiagnosed. However, context-specific strategies are necessary to find the hidden children to meet the full 90% target. This study assesses whether sex of the caregiver is associated with HIV status of orphans and vulnerable children (OVC) as a valuable strategy for enhanced pediatric case findings. Methods: Data originate from the community-based, United States Agency for International Development (USAID)funded Kizazi Kipya Project, which works towards increasing OVC's and their caregivers' uptake of HIV/AIDS and other health and social services in Tanzania. Included in this study are 39,578 OVC ages 0-19 years who the project enrolled during January through March 2017 in 18 regions of Tanzania and who voluntarily reported their HIV status. Data analysis involved multi-level logistic regression, with OVC HIV status as the outcome of interest and caregiver's sex as the main independent variable. Results: Three-quarters (74.3%) of the OVC included in the study had female caregivers, and their overall HIV prevalence was 7.1%. The prevalence was significantly higher (p < 0.001) among OVC with male caregivers (7.8%) than among OVC with female caregivers (6.8%), and indeed, multivariate analysis showed that OVC with male caregivers were significantly 40% more likely to be HIV-positive than those with female caregivers (OR = 1.40, 95% CI 1.08-1.83). This effect was the strongest among 0-4 year-olds (OR = 4.02, 95% CI 1.61-10.03), declined to 1.72 among 5-9 year-olds (OR = 1.72, 95% CI 1.02-2.93), and lost significance for children over age 9 years. Other significant factors included OVC age and nutritional status; caregiver HIV status and marital status; household health insurance status, and family size; and rural versus urban residence.

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Health-care utilization and associated factors in Gauteng province, South Africa

Cited by 87 publications

References 24 publications

Timing and Predictors of Initiation on Antiretroviral Therapy Among Newly-Diagnosed HIV-Infected Persons in South Africa

Timing and Predictors of Initiation on Antiretroviral Therapy Among Newly-Diagnosed HIV-Infected Persons in South Africa

Public health system challenges in the Free State, South Africa: a situation appraisal to inform health system strengthening

Understanding the association between caregiver sex and HIV infection among orphans and vulnerable children in Tanzania: learning from the USAID Kizazi Kipya project

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