3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Improving STI/HIV passive partner notification using quality improvement methods in Malawi(2018) Matoga, Mitch MirichiIntroduction Human Immunodeficiency Virus (HIV) and other curable Sexually Transmitted Infections (STIs) constitute a large public health burden world-wide. The control of HIV and STIs is incomplete if sexual partners of individuals with HIV and STIs are not identified and treated. The proportion of sexual partners that present to health facilities for screening and treatment is low in the sub-Saharan African (SSA) region. A recent study in Malawi reported a sexual partner referral proportion of 24% through passive partner notification. Several other approaches to partner notification (PN) have been shown to be feasible, acceptable and cost-effective for SSA. However, passive PN is widely used as the standard of care (SOC) and is the most preferred approach for resource-limited settings including Malawi. The low proportion of sexual partner referral points to the need to improve the efficiency and effectiveness of the SOC method of PN in order to realize a better yield of sexual partners in Malawi and SSA. Methods A pre- and post-intervention quasi-experimental study was conducted at Bwaila STI Unit (BSU) in Lilongwe Malawi from January to June 2017. At baseline, we estimated the proportion of sexual partner referral and identified health system-related factors that influenced PN at BSU through interviews with health workers and clinic observations. Based on the baseline findings, a three-prong intervention was designed through expert consultation and implemented with a quality improvement (QI) team using the model for improvement (MFI). The intervention included: early start time of the clinic; shortening of the group health talk and expedited clinic flow for sexual partners. Each intervention was tested twice through 1-week long test cycles and then combined into one package and tested twice. Process data were collected and monitored using run charts. We used run charts to assess for non-random signals of change in the PN process and assessed for a 10% increase in the sexual partner referral proportion between the pre- and post-intervention periods at 95% power and at α=0.05. Results At baseline, the proportion of sexual partner referral was 15.6%. Experts included BSU staff, research staff and Ministry of Health officials who were involved in the selection of interventions based on findings from the interviews and clinic observations. The QI team consisted of the investigator, a nurse-in-charge, a counselor, a clinic receptionist and a clinic aide who championed implementation of the intervention. In the post intervention period, we assessed 267 patient records. The median age was 29 years and 56% were female. Out of the three interventions, the team managed to shorten the duration of the group health talks from 56 minutes to less than 40 minutes and expedited the clinic flow for partners by reducing the duration of clinic stay by 45 minutes. However, the target clinic start time of 08:00 hours was not achieved. The post-intervention proportion of sexual partner referral was 21.4% representing a statistically significant increase of 37% (P=0.04). There was an upward trend in data points on the run chart which was indicative of a non-random signal of improvement in the proportion of sexual partners. Discussion Our results demonstrate that passive PN can be successfully improved through use of the model for improvement in Malawi and suggest that our intervention was highly effective at increasing the proportion of sexual partner referral. However, despite this increase, the proportion of sexual partner referral remains suboptimal. More effort is required to increase the proportion of sexual partner referral in Malawi.Item Perceptions and experiences of female partners of clients of voluntary medical male circumcision in Harare, Zimbabwe(2017) Mazambara, FineIntroduction Zimbabwe is lagging behind on its target to scale up Voluntary Medical Male Circumcision (VMMC). The engagement of female partners in VMMC demand creation is important as they can play an important role in their male partners’ decision to uptake VMMC. Exploring women’s perceptions and experiences will help to better understand factors behind low uptake of VMMC in Zimbabwe as efforts are being made to scale up VMMC for HIV prevention. The aim of the study was to explore female partners’ underlying perceptions and experiences of having their partners undergo medical male circumcision in order to inform the development of promotional messages on the basis of women’s experiences with VMMC. Methods The study was conducted in Mbare, an urban high density suburb in the southern district of Harare utilising qualitative methodology. Individual in-depth interviews were conducted using an in-depth interview guide. Through purposive sampling a total of twenty female partners of medically circumcised men attending antenatal clinic between February and May 2016 were recruited. Interviews were audio recorded and transcripts were analysed using content analysis. Results The results show that women were knowledgeable about VMMC. The perception towards medical male circumcision was linked to the perceived benefits of VMMC. The main role that women played was encouraging their male partners. The perception of women towards VMMC was generally good. The perceived benefits of having a circumcised partner were Fine Mazambara 872453 iv reduced risk of HIV and STIs, improved sexual experience, improved hygiene, improved sexual communication, no need to use condoms and improvement of the relationship. The risk perception towards HIV and STIs was decreased after the male partner’s VMMC and fear of risk compensation was reported. Women had misconceptions about adverse events of circumcision and the age at which men can be circumcised. Mass media was the main source of VMMC information for women. VMMC was understood to offer direct protection from HIV for women and circumcised men were understood to being conferred full protection from HIV and STIs. Conclusions Women have knowledge on VMMC although their knowledge on adverse events associated with circumcision, age at which men can be circumcised, indirect protection for women, and partial protection for men can be improved. The perceptions of women towards VMMC were influenced by the perceived benefits of having a circumcised partner. The main perceived benefits of having a VMMC client as a male partner is reduced risk of HIV and STIs and improved sexual experience. Targeted health messages directed at women should therefore aim at increasing women’s knowledge of VMMC, include improved sexual experience and take gender issues into consideration.Item Provider perceptions of the quality of post-rape care in Ekurhuleni district(2016) Skosana, Brenda SulileBackground Rape and HIV are major public health issues in South Africa. Rape has negative short and long term health impacts, both physically and psychologically. Survivors are at high risk of sexual transmitted infections, including HIV. Health care services have two important roles in caring of survivors: attending to their physical and psychological health needs, and collecting evidence for court purposes. The national government has put measures in place to improve the quality of care for rape survivors; this includes a clinical guideline on management of sexual assault survivors. The guideline outlines a process of HIV testing and the provision of Post Exposure Prophylaxis (PEP) to prevent the transmission of HIV for survivors who report within 72 hours. South Africa has also implemented One Stop Centres, called Thuthuzela Care Centres (TCC), that enable survivors to access all medical, legal and social services. However, the PEP completion rate remains poor and health care providers often lack the training and confidence to manage rape survivors. As a result the needs of survivors remain unmet. The aim of the study was to explore the knowledge, attitudes and experiences of Clinical Forensic Medical Services health care providers from three facilities in Ekurhuleni district, and to assess the quality of post rape care and related post rape exposure prophylaxis (PEP) services provided to rape survivors, in accordance with the National Department of Health Rape and Sexual Assault Policy and Clinical Management Guidelines. The research was conducted in 2015. Methods and materials A qualitative case study approach was used in three clinical forensic medical services in Ekurhuleni District in Gauteng. A total of 17 participants were interviewed, including different categories of staff doctors, professional nurses, enrolled nurses, auxillary nurses and lay counsellors. Participants were interviewed by the researcher using a semi-structured interview guide. All interviews were audio recorded and transcribed verbatim. A thematic content analysis was carried out. Themes and subthemes were developed from the objectives and from the transcripts. Quarterly registers and statistics generated from the centres were reviewed and compared. Results Most participants were female (82.3%). All professional nurses and doctors had been trained on the management of rape. Participants viewed the training on sexual assault management as informative and recommended it for all clinicians who examine rape survivors. All participants who were interviewed demonstrated professionalism and confidence in managing rape survivors. However, most participants were uncertain about policy and clinical management guidelines and when asked, described patient flow rather than policy. Each centre had its own patient flow and record system. The provision of PEP differed among interviewees: although most participants gave the full 28 days course, some participants did not give PEP unless the survivor had agreed to HIV testing. Participants raised issues relating to the impact of caring for rape survivors on health care providers, and identified lack of psychosocial therapy for survivors, limited psychotherapy for health care providers, and lack of support from other departments as challenges that they experienced when caring of rape survivors. Conclusion Although Gauteng has developed dedicated centres and allocated dedicated staff who have attended training, the management and record system of sexual assault/rape survivors is not standardized. Most dedicated health care providers of Clinical Forensic Medical Service (CFMS) demonstrated confidence in managing sexual assault survivors, but they were uncertain about the sexual assault policies. However, there are still challenges in providing quality care to rape survivors due to lack of resources and lack of support from non CFMS staff who work in the hospital in association with CFMS health care providers. This results in other needs of rape survivors continuing to be unmet.Item Risk factors for sexually transmitted infections among mine workers in Orkney, North West Province, South Africa(2015-03-27) Magadla, BulelwaTitle: Risk factors for sexually transmitted infections among mine workers in Orkney, North West Province, South Africa. Background: The role of mobile populations in the spread of HIV has been documented in several countries of the world. In South Africa, the relationship between mine migration and HIV has been studied in detail in the mining town of Carletonville and in Welkom. The link between HIV acquisition and transmission has been well documented. Prevention and early treatment of sexually transmitted infections have been identified as public health priorities as reflected in HIV/AIDS, TB and STI strategic plan of South Africa (2012 – 2016). In this study we sought to measure the prevalence of STIs among mine workers at baseline before a planned STI treatment intervention. Objectives: To: 1) Measure the prevalence of STIs amongst the mine workers. 2) Describe the types of STI in the population. 3) Identify risk factors associated with genital ulcers diseases. Results: The highest percentage of STI positivity 188 (10.6%) was observed in the youngest male group (<30) in the study population and decreasing by age (50-64) at 1.8%. We found that of the 1685 participants, 78 (4.6%) had any STI, with 46 (2.9%) having chlamydia, 20 (1.3%) having gonorrhea and 7 (0.4%) having genital ulcer STI. Age was found to be a significant predictor of Chlamydia status. Fitting a multiple logistic regression model showed that the age group of a participant and whom the participant lived with were the two major independent factors that were associated with the risk of a person having an STI. Conclusion: There is a high demand for STI prevention programmes to focus on the younger age group. A surprising finding that in fact risk of STIs was higher among men living with their partners than among those in the single-sex hostels, where we expected to find the highest risk. Targeted door to door prevention education campaigns may go a long way in modifying the behaviour of having multiple sexual partners.Item Narratives around sexual behaviour and decisions regarding treatment-seeking of adolescent females who contracted a sexually transmitted infection: Birth to Twenty cohort(2012) Quan, Vanessa CeciliaAdolescent sexual behaviour related to low condom-use and early sexual debut has been a concern in the transmission of sexually transmitted infections (STIs) and HIV. Treatment-seeking behaviour is a problem in adolescents due to embarrassment and unfriendly health care services. The Birth to Twenty study group (Bt20) is a cohort of singletons born in 1990 with approximately 10% having tested positive for STIs at an early age. Their sexually activity and unprotected sex practices have increased their risk for HIV infection. The objectives of this study were to explore the perceptions, sexual behaviour and treatment-seeking behaviour of a sample of girls who had a previous STI, through their narratives. One-on-one narrative interviews were done on 19 girls with the aid of an interview schedule. A life history of their sexual encounters was documented. The interviews were taped and transcribed. Thematic analysis was performed. The majority of the girls had no knowledge of STIs before they were counselled by the Bt20 nurses yet 50% of the girls used condoms in their first sexual experiences. Once counselled, almost all the girls went on to seek treatment for their STI. A third of the girls reported poor service at the clinic and would prefer to be treated either privately or at Bt20 if possible. Information regarding the role of STIs in the transmission of HIV seems to be unclear. Improving the life orientation programme at schools with a focus on STIs and pregnancy would positively impact on HIV transmission. One-on-one counselling is effective but may not be feasible in under-resourced communities and the continued education of nurses in clinics, whilst increasing the number of adolescent friendly clinics, must be prioritised.Item Sexually transmitted infection (STI) and HIV / AIDS related knowledge, attitudes, perceptions and behaviour among San learners in a combined school in Platfontein, Northern Cape(2014-02-05) Fredericks, Mercedes BerylPrevention of Human immunodeficiency virus (HIV) in South Africa includes early detection and treatment of sexually transmitted infections (STIs), as well as health promotion activities. The latter include health education programmes and the promotion of screening activities such as voluntary counselling and testing (VCT). The South African government recognises the need for creating equity for access to health care services. The 1997 White Paper for the Transformation of the Health System, stipulates one of the aims of health Policy in the new South Africa as ‘promoting equity by developing a single, unified health system’. This commitment is inclusive of the Platfontein community which comprises the two largest San-groups in South Africa: the !Xun and the Khwe who were settled on the Platfontein farm at the end of 2004. There are 3500 !Xun and 1100 Khwe currently living in the Platfontein community. A health facility, compliant with the principles of Primary Health Care (PHC), was built on the farm to render services to the Khwe and !Xun communities who were not recognised as a distinct cultural group during the Apartheid era in South Africa. For the young people in the community it was the first time they could access the formal schooling and health system in South Africa. The objective of this study was to assess the perceptions, attitudes, behaviour and knowledge levels among the school-going youth of the Platfontein community, about STIs, HIV/AIDS and the health care services that are available to them.Item Patient preferences for partner notification of sexually transmitted infections(2013-03-19) Nevhutalu, Marubini PatriciaSexually transmitted infections (STI’s) are a major public health problem. If STI’s are not treated they can cause infertility, long term disability and death. Partner notification and partner treatment have been identified as important aspects of management to curb the chain of transmission, reinfection and complications of STI’s. The high prevalence of STI’s and low partner treatment rate is cause for concern. The ability to communicate with sexual partners about going to the clinic for treatment is the cornerstone in breaking the chain of reinfection and preventing complications. The aim of the study was: • To determine the percentage of patients presenting as a result of partner notification. • To describe the demography of patients attending the STI clinic. • To determine the preferred methods of partner notification from the perspective of being a patient and from the perspective of being a sexual contact/partner. The study is a replication of the study entitled ‘Patient Preferences for Partner Notification of Sexually Transmitted Infections by (Apoola, Radcliffe, Das, et al.,2006:327). ’ The study is a quantitative, descriptive, survey design, and a replicated self-administered questionnaire of the study was used. The sample of 162 patients was taken from a population of about 800 STI clinic attendees over a period of one month at a local public sector clinic in Johannesburg. Data was captured using an excel spread sheet and then were exported to the Stata Release 11 program for analysis. Data was summarized using frequencies, means, and percentages. Reliability, validity and ethical issues were taken into consideration. From the results of the study it became apparent that the majority of STI patients 156(96%) attending the STI clinic under study preferred to inform their partners themselves that the partner may be at risk of an STI and should receive treatment. Furthermore, the participants in this particular study would also prefer to be informed by their partner if they were potentially at risk of contracting a sexually transmitted infection. With respect to the demographics of the clinic attendees, the majority of the patients attended the clinic because they presented with signs and symptoms of what they believed to be a sexually transmitted infection (92%), and only 8% of the participants attended the clinic because they were informed by a partner that they have been potentially exposed to an STI. It was identified that 92% of participants did have cellular telephones, and this is potentially a good means of partner notification given that the majority of the research sample had access to cellular telephones. In conclusion the participants in this particular study would prefer to notify their partner themselves of the potential exposure to a STI as opposed to other means of partner notification.