ETD Collection

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Author: search.filters.author.Maakamedi, Tetelo

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    Factors associated with the feasibility and acceptability of universal TB screening in primary healthcare clinics in Johannesburg
    (2021) Maakamedi, Tetelo
    Background: TB is an airborne disease that is of great public health importance as every living individual is at risk of infection. Despite TB being a preventable and curable disease, health providers and patients attending healthcare facilities remain at an increased risk of exposure to the disease. This is as a result of the poor implementation of the TB infection prevention and control measures, despite these having been recommended by the National Department of Health and WHO. Particularly, screening for TB symptoms in everyone entering health facilities as soon as they arrive has been identified as one of the first lines of defence against the spread of the disease. The primary aim of screening all who visit health facilities as soon as they arrive is to assist health providers with early identification, diagnosis and treatment of TB suspects, however, studies show that this is not routinely practised. Moreover, many patients attending health facilities are often missed as TB cases despite reporting TB symptoms. Two probable explanations for the poor adherence to the guidelines are that the guidelines 1) are not perceived as feasible and 2) they are not acceptable to health providers. However, this has not been investigated as many feasibility and acceptability studies are usually conducted prior to implementation. Therefore, this study contributes to the Implementation Science literature by investigating the perceived feasibility and acceptability of the guidelines to screen all patients for TB symptoms as soon as they arrive at health facilities. Methods: Data were collected in 14 primary healthcare facilities in the City of Johannesburg district. Within these facilities, 69 health providers who have ever been involved in screening patients for TB symptoms were approached and they consented to participate in the study. A survey was developed and administered via the REDCap application to collect health providers’ characteristics, organisational facilitators and guidelines characteristics. Two outcome variables, feasibility and acceptability scores, were measured using the Feasibility of Intervention Measure (FIM) and the Acceptability of Intervention Measure (AIM) scales which are measured on a four-item, five-point Likert scale and they have been validated and deemed reliable. Composite scores of feasibility and acceptability were estimated and the scores ranged from 4, the lowest score possible, to 20, the highest score possible. This meant that the data were censored, and for this reason, Tobit regression models were fitted to examine factors 2 influencing health provider’s perceived feasibility and acceptability of the guidelines to screen for TB in everyone entering the health facility. This analysis was conducted in STATA 15 and effects were considered statistically significant at p<0.05. Findings: A total of 69 health providers who have ever screened patients for TB symptoms consented to participate in this study, of whom the majority (83%) were females; the median age was 40 years (IQR 34 - 47) and most (62%) were professional nurses. The majority (62%) of the health providers indicated that they were aware of both the IPC guidelines and the TB management guidelines, with 71% having been trained in at least one of the guidelines, however, less than a quarter (20%) of the participants reported to screening patients immediately after arriving at the facility. Overall, the guidelines to screen patients for TB symptoms were perceived as being feasible and acceptable with both scales having a median score of 16 or 80%. Having a postgraduate degree, having positive attitudes towards the guidelines, having ever been trained on at least one of the guidelines and the clinic having at least one of the guidelines available were significant predictors of an increase in acceptability, while having positive attitudes towards the guidelines was the only significant predictor of an increase in perceived feasibility. On the other hand, an increase in age, being female and receiving little or no help from management were significant predictors of a decrease in acceptability of the guidelines, while receiving little to no help was the only significant predictor of a decrease in perceived feasibility of the guidelines. Conclusion: Screening for TB in every patient who enters the health facility is one of the important strategies to control and eliminate TB. While health providers in this study perceived the guidelines to screen for TB symptoms in all who enter the facility as feasible and acceptable, this still did not translate into routine practice with fidelity as most health providers report to only screening patients at least an hour after arrival. This, therefore, reveals that while feasibility and acceptability may not be significant barriers towards implementing these guidelines, receiving little to no help when one is overwhelmed may indicate the conditions that most health providers are working under, that is high patient loads and short-staffed facilities. Therefore, there is a need to restructure where patients are screened for TB symptoms, provide training to those who screen these patients and also develop strategies that will leverage on the fact that health providers perceived these guidelines as feasible and acceptable to ensure that they routinely practise screening patients for TB immediately after arrival
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    Male circumcision and consistent condom use in South Africa
    (2017) Maakamedi, Tetelo
    Background: Evidence shows that circumcised men are less likely to be infected with HIV compared to their uncircumcised counterparts. However, critics have argued that adopting male VMMC as part of the comprehensive HIV prevention strategy might lead circumcised men to believe that they are completely protected against HIV. Consequently, this could cause them to neglect other HIV protective measures, such as consistent condom use. This study investigated the association between male circumcision and consistent condom use among sexually active men in South Africa. Methodology: The analyses were done using nationally representative cross-sectional secondary data drawn from the 2012 Third National HIV Communication Survey. The study sampled a total of 1899 single black men who were sexually active and were aged between 16-55 years. The management and analysis of the data were carried out using STATA version 14. Descriptive statistics were computed to describe the levels of male circumcision and consistent condom use in South Africa, and crosstabulations and a Pearson Chi-square test were used to assess associations between patterns of male circumcision and consistent condom use by selected variables. Bivariate and multivariate binomial logistic regressions were used to examine the socio-demographic determinants of male circumcision, as well as the association between male circumcision and consistent condom use. Results: The main findings showed that circumcised men were more likely (OR=1.18; C.I, 1.171 - 1.182) to consistently use condoms, compared to uncircumcised men. Furthermore, place of residence, education, occupation status and socioeconomic status were positively associated with consistent condom use. On the other hand, men who believed that they would get HIV, and those who were older than 24 years were less likely to consistently use condoms. While circumcision rates were lower in all the provinces compared to the Eastern Cape; Kwa-Zulu Natal and North West had the lowest odds of circumcision of all the provinces. However, both these provinces had the highest odds of consistent condom use compared to all the other provinces. Conclusion: This study found a positive association between male circumcision and consistent condom use. The findings revealed that, contrary to concerns that circumcised men may have a false sense of protection and therefore use condoms less consistently, circumcised men were more likely to consistently use condoms compared to uncircumcised men. There is, therefore, no evidence of risk compensation associated with circumcision. As a result, male circumcision should continue to be rolledout nationally, as part of an effective and comprehensive HIV prevention strategy. On the other hand, it is also evident that HIV prevention education targeting men is crucial, as men who believe that they will get infected with HIV and those older than 24 years need to be encouraged to practice safe sexual and HIV protective behaviours such as consistent condom use.