ETD Collection

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    Perceptions of nurses working in primary health care facilities on the implementation of the national mental health policy framework and strategic plan 2013-2020 in OR Tambo district in the Eastern Cape province
    (2018-10-09) Phomane, Mafoko
    Introduction The South African National Mental Health Policy Framework (MHPF) is widely regarded as South Africa's first official mental health policy and is an important tool for the implementation of the Mental Health Care Act of 2002. Primary healthcare nurses have been responsible for the promotion of mental health including detecting and screening of mental health disorders as well as treating people with mental health conditions. Mental health policies are important because they coordinate a common vision and plan for all programs and services related to the provision of mental health services. Without these types of organized guided programs, mental health services are inefficient and fragmented(1). The aim of the study is to explore the perceptions of Primary Health Care nurses on the implementation of the National Mental Health Policy Framework and Strategic Plan 2013-2020 in a rural setting, in Qaukeni Sub- District in OR Tambo District between 2014-2016. This research is important because it highlights the need to prioritize mental health service provision at primary health care level, as the comorbid nature of mental health disorders impacts on other health outcomes. Methods In order to explore the perceptions of nurses, a cross-sectional qualitative study was done. The research sample was Professional Nurses working in Primary Health Care Clinics in OR Tambo’s Ingquza Hill Sub District in the Eastern Cape. Thirteen in-depth one on one interviews were conducted with participants and their responses were recorded and transcribed. Thematic analysis was then used to analyze findings. Permission to conduct the study was sought from relevant authorities; ethics of informed consent, confidentiality and voluntary participation were utilized. Results The findings from this study suggest that mental health services at Primary Health Care Level are being offered in Ingquza Hill Sub District, however mental health services are not offered as per what has been outlined in the National Mental Health Policy Framework and Strategic Plan 2013-2020. Nurses perceptions highlighted that there are varying factors that act as facilitators as well as barriers to the implementation of the Mental Health Policy. The policy needs to be widely disseminated to those nurses that serve as program implementers. The following themes emerged during data analysis; access to mental health policies and treatment guidelines, management of mental illnesses/common mental disorders, training and education in mental health, supervision of those providing mental health services, limited scope of mental health services at Primary Health Care level, stakeholder and community awareness on mental health, knowledge and management of communicable diseases versus mental illnesses (Table 1). The results indicate that the lack of mental health policy implementation may have implications for access to those who are in need of mental health care services at Primary Health Care level. Conclusion The findings of the study suggest that although mental health services are being provided by Professional Nurses at this level of care, more interventions such as mental health training and provision of mental health policies and guidelines need to be put in place by the District to improve the current level of mental health service provision at Primary Health Care facilities. The inconsistent varying methods of screening mental illnesses in patients who present at primary health care clinics indicate that the provision of mental health services in the clinics visit is not uniform and therefore not in line with policies and guidelines, this has implications related to access to care for rural mental health care users. Nurses play an important role in facilitating the provision of mental health services; they however need supportive supervision from those that have mental health specialist expertise. By exploring the perceptions of nurses working at primary health care facilities on the implementation of the National Mental Health Policy Framework and Strategic Plan 2013-2020 many current barriers faced by nurses have been highlighted by this research.
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    Good to great: strategies to improve the detection of TB amongst household contacts in South Africa
    (2018) Velen, Kavindhran
    Background: In South Africa, TB household contact tracing provides an opportunity for increased TB and HIV case finding. We aimed to determine the effect of two new potential interventions for TB contact tracing programmes: Point of Care CD4 (PoC CD4) on HIV linkage to care and household Isoniazid Preventive Therapy (IPT) provision on uptake and retention of IPT. Methods: A pragmatic, three-arm, cluster-randomized trial was undertaken. TB Household contacts were randomised to 3 arms: 1) Standard of Care TB and HIV testing (SOC); 2) SOC with POC CD4 for those testing HIV positive; 3) SOC with POC CD4 and IPT for eligible household members. Linkage to care within 90 days was assessed either through patient visits (at 10 weeks and 6 months) or via telephonic contact. Results: 2,243 index TB patients and 3,012 contacts (64,3% female, median age 30 years) were enrolled. On self-report, 26(1.2%) were currently receiving TB treatment and 1816 (60.3%) reported a prior HIV test. HIV testing uptake was 34.7% in the SoC arm, 40.2% in the PoC CD4 arm (RR1.16, CI 0.99–1.36, p-value = 0.060) and 39.9% in the PoC CD4 + HH-IPT arm (RR = 1.15, CI 0.99–1.35, p-value = 0.075). Linkage to care within 3 months was 30.8% in the SoC arm and 42.1% in the POC CD4 arms (RR 1.37; CI: 0.68–2.76, p-value = 0.382). 20/21 contacts (95.2%) initiated IPT in the PoC CD4 + HH-IPT arm, compared to 3/20 (15.0%) in the PoC CD4 arm (p = 0.004; p-value from Fisher’s exact test<0.001). Among3,008 contacts screened for tuberculosis, 15 (3.4%) had bacteriologically confirmed TB with an overall yield of TB of 0.5% (95% CI: 0.3%, 0.8%). Conclusions: Household PoC CD4 testing and IPT initiation is feasible. There was only weak evidence that PoCCD4 led to a small increase in HCT uptake and no evidence for an increase in linkage-to-care. IPT initiation and completion was increased by the household intervention. Although feasible, these interventions had low impact due to the low uptake of HIV testing in households.