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Within the context of the novel coronavirus pandemic and new challenges to a resource-constrained public healthcare system, many healthcare workers in South Africa have faced numerous stressors that have compromised their mental health. While the current literature on COVID-19 in South Africa highlights the widespread psychosocial stress experienced by healthcare workers during the pandemic, little is known about the coping strategies utilized to continue service delivery and maintain ones mental health and well-being during this ongoing public health emergency. In this study, we sought to explore the coping strategies used by healthcare workers employed in the public psychiatric care system in southern Gauteng, South Africa during the coronavirus disease (COVID-19) pandemic. Psychiatric healthcare workers (n = 55) employed in three tertiary public hospitals and two specialized psychiatric facilities participated in in-depth interviews between July 2020 and March 2021. We found that coping strategies spanned multi-level and multi-systemic efforts. Intrapersonal, interpersonal, material, and structural coping were mapped across individual, family, and hospital systems. The most commonly utilized coping strategies included positive mindsets and reappraisal, social support systems, and COVID-19 specific protections. Findings also highlighted the contextual and interconnected nature of coping. Healthcare workers applied multiple coping strategies to combat the negative mental health effects of the COVID-19 pandemic. Better understanding these strategies, contexts in which they are employed, and how they interact can be used to develop evidence-based interventions to support healthcare workers experiencing healthcare-related stressors during the COVID-19 pandemic.

: Introduction: South African youth and adolescents face a high burden of (Sexually Transmitted Infections) STIs, HIV and unintended pregnancies, but uptake of services remains low. To address this, tailored and scalable interventions are urgently needed. We developed a framework to fill the gap and translate the impact of facility‐level attributes into a cost‐effectiveness analysis for increasing HIV/contraceptive service uptake in adolescents using a discrete choice experiment (DCE). Methods: We used a DCE (n = 805) conducted in Gauteng, South Africa, which found that staff attitude, confidentiality, Wi‐Fi, subsidized food, afternoon hours and youth‐only services were preferred attributes of health services. Based on this, we simulated the uptake of services adapted for these preferences. We divided preferences into modifiable attributes that could readily be adapted (e.g. Wi‐Fi), and challenging to modify (more nuanced attributes that are more challenging to cost and evaluate): staff attitude and estimated the incremental change in the uptake of services using adapted services. Costs for modifiable preferences were estimated using data from two clinics in South Africa (2019 US$). We determined the incremental cost‐effectiveness ratio (ICER) for additional adolescents using services of 15 intervention combinations, and report the results of interventions on the cost‐effectiveness frontier. Results: Greatest projected impact on uptake was from friendly and confidential services, both of which were considered challenging to modify (18.5% 95% CI: 13.0%−24.0%; 8.4% 95% CI: 3.0%−14.0%, respectively). Modifiable factors on their own resulted in only small increases in expected uptake. (Food: 2.3% 95% CI: 4.0%−9.00%; Wi‐Fi: 3.0% 95% CI: −4.0% to 10.0%; Youth‐only services: 0.3% 95% CI: −6.0% to 7.0%; Afternoon services: 0.8% 95% CI: −6.0% to 7.0%). The order of interventions on the cost‐effectiveness frontier are Wi‐Fi and youth‐only services (ICER US$7.01−US$9.78 per additional adolescent utilizing HIV and contraceptive services), Wi‐Fi, youth‐only services and food (ICER US$9.32−US$10.45), followed by Wi‐Fi, youth‐only services and extended afternoon hours (ICER US$14.46–US$43.63). Conclusions: Combining DCE results and costing analyses within a modelling framework provides an innovative way to inform decisions on effective resource utilization. Modifiable preferences, such as Wi‐Fi provision, youth‐only services and subsidized food, have the potential to cost‐effectively increase the proportion of adolescents accessing HIV and contraceptive services., INTRODUCTION Existing models of care have failed to adequately address the gap in sexual health needs, access to―and uptake of―HIV and contraceptive services among adolescents in South Africa [1]. The [...]

Background: The HIV epidemic in sub-Saharan Africa has a disproportionate gender impact, with women bearing the brunt of the epidemic. South Africa carries the largest share of the global HIV burden, with similar trends seen for women due to unequal socio-cultural and economic status. Objectives: This study aims to understand 30–49 year-old women's barriers and facilitators to accessing HIV services in order to maximize health in resource limited settings and reach women missing from HIV care. Design: Employing a convenience sampling strategy, we recruited, informed, and consented participants at clinics and public areas. Interviews were conducted in respondent's preferred languages, transcribed verbatim, translated into English if needed, and thematically analyzed using grounded theory. Methods: We conducted 81 interviews with women aged 30–49 either missing from care (n = 21), having unknown HIV status (n = 30) or linked to care (n = 30) within two sites: City of Johannesburg district, Gauteng Province and Mopani district, Limpopo Province. Results: Participants missing from care reported negative staff attitudes, queues, family rejection, medication side effects, and painful blood tests as key deterrents. Participants with an unknown status were deterred by fear of being diagnosed as HIV positive and family rejection, which was similar to women missing from care who often dropped out from care due to actual family rejection. Participants linked to care reported that long queues and staff shortages were challenges but stayed in care due to a will to live for themselves and their children, in addition to counselling and feeling emotionally supported. Interestingly, participants missing from care often accessed medication from friends but, similarly to those with unknown status, noted that they would access care if attended to by supportive nurses and by having non-clinical HIV services. Conclusions: The accounts of women in this research highlight significant improvements needed to address inequities in the fight against HIV in South Africa. Additionally, the healthcare service access preferences of women aged 30–49 need to be further explored quantitatively in order to design policy relevant interventions. Plain language summary: Understanding HIV service preferences of South African women 30–49 years old missing from or linked to care: An exploratory study of Gauteng and Limpopo provinces The HIV epidemic in sub-Saharan Africa harms women more than men. South Africa carries the largest share of the global HIV burden, with similar trends seen for women. This study aims to understand 30–49 year-old women's ability to access HIV services in order to reach women missing from HIV care. We conducted 81 interviews with women aged 30–49 either missing from care (n = 21), having unknown status (n = 30) or linked to care (n = 30) within two sites: City of Johannesburg district, Gauteng Province and Mopani district, Limpopo Province. We recruited, informed, and consented participants at clinics and public areas. Interviews were conducted in respondent's preferred languages, transcribed, and translated into English for analysis. Participants missing from care reported negative staff attitudes, queues, family rejection, medication side effects and painful blood tests as key deterrents. Participants with an unknown status were deterred by fear of being diagnosed as HIV positive and family rejection, which was similar to women missing from care who often dropped out from care due to family rejection. Participants linked to care reported that long queues and staff shortages were challenges but stayed in care due to a will to live for themselves and their children, in addition to counselling and feeling emotionally supported. Interestingly, participants missing from care often accessed medication from friends but, similarly to those with unknown status, noted that they would access care if attended to by supportive nurses and by having non-clinical HIV services. The healthcare service access preferences of women aged 30–49 needs to be further explored in order to improve interventions. [ABSTRACT FROM AUTHOR]

Introduction: Pulmonary tuberculosis (PTB) remains a life-threatening disease in Tanzania, with negative physical, financial, economic and psychosocial consequences to individuals and the society. It mainly lowers the quality of life of patients, survivors and their families, especially those in the poorest and socially deprived categories. Objectives: To report and discuss a qualitative study that assessed the nature of social support desired and received by PTB patients and survivors. Participants were given a chance to share their experiences and their perceptions on whether the social support they desired had an impact on their treatmentseeking behaviour and treatment adherence. Methods: Face-to-face interviews were conducted with the three aforementioned groups, purposively selected at a TB clinic between October 2020 and March 2021. The questions covered topics related to the types of social support desired and the sources of support during and after treatment, if any. Interviews were concluded until no new information was obtained. Data analysis was facilitated using NVivo 12 software. Results: Participants pointed out a need for psychosocial, financial, and material support during and after treatment. However, they sometimes miss support from family/household members or the rest of the community. Because of this experience, they lived with difficulties, facing hardships when required to pay out of pocket for transport during the care-seeking. Survivors testified experience of a denial of support by even their close relatives who regarded them as no longer needing it after recovering. Patients and survivors also reported experience of social isolation as they were believed able to transmit PTB infections. Limited psychological support at the contacted TB clinics was another experience reported. TB clinic staff's experiences confirmed almost all the experiences shared by their clients. With limited support, resilience and self-care were identified as key mechanisms for coping. Conclusion: Complete recovery from PTB is possible, but reverting to a normal life is difficult without social support. Policies and programs need to increase opportunities for social support for TB patients and survivors. Doing so is likely to improve TB-related treatment, care-seeking practices, and adherence. [ABSTRACT FROM AUTHOR]

Introduction: South Africa is moving into a new era of HIV treatment with 'treat all' policies where people may be on treatment for most of their lives. We need to understand treatment outcomes and facilitators of long-term antiretroviral treatment (ART) adherence and retention-in-care in the South African context. In one of the first studies to investigate long-term treatment outcomes in South Africa, we aimed to describe ten-year patient outcomes at a large public-sector HIV clinic in Johannesburg and explore patient experiences of the treatment programme over this time in order to ascertain factors that may aid or hinder long-term adherence and retention. Methods: We conducted a cohort analysis (n = 6644) and in-depth interviews (n = 24) among HIV-positive adults initiating first-line ART between April 2004 and March 2007. Using clinical records, we ascertained twelve-month and ten-year all-cause mortality and loss to follow-up (LTF). Cox proportional hazards regression was used to identify baseline predictors of attrition (mortality and LTF (>3 months late for the last scheduled visit)) at twelve months and ten years. Twenty-four patients were purposively selected and interviewed to explore treatment programme experiences over ten years on ART. Results: Excluding transfers, 79.5% (95% confidence intervals (CI): 78.5 to 80.5) of the cohort were alive, in care at twelve months dropping to 35.1% (95% CI: 33.7 to 36.4) at ten years. Over 44% of deaths occurred within 12 months. Tenyear all-cause mortality increased, while LTF decreased slightly, with age. Year and age at ART initiation, sex, nationality, baseline CD4 count, anaemia, body mass index and initiating regimen were predictors of ten-year attrition. Among patients interviewed, the pretreatment clinic environment, feelings of gratitude and good fortune, support networks, and self-efficacy were facilitators of care; side effects, travel and worsening clinical conditions were barriers. Participants were generally optimistic about their futures and were committed to continued care. Conclusions: This study demonstrates the complexities of long-term chronic HIV treatment with declining all-cause mortality and increasing LTF over ten years. Barriers to long-term retention still present a significant challenge. As more people become eligible for ART in South Africa under 'treatment for all,' new healthcare delivery challenges will arise; interventions are needed to ensure long-term programme successes continue. Keywords: South Africa; HIV/AIDS; long-term ART treatment outcomes; loss to follow-up; attrition; adherence, 1 | INTRODUCTION The 2015 World Health Organization (WHO) recommendation to offer treatment to all HIV-positive persons regardless of CD4 count [1] has compressed the HIV care cascade, removing several [...]

: Introduction: In 2014, the South African government adopted a differentiated service delivery (DSD) model in its “National Adherence Guidelines for Chronic Diseases (HIV, TB and NCDs)” (AGL) to strengthen the HIV care cascade. We describe the barriers and facilitators of the AGL implementation as experienced by various stakeholders in eight intervention and control sites across four districts. Methods: Embedded within a cluster‐randomized evaluation of the AGL, we conducted 48 in‐depth interviews (IDIs) with healthcare providers, 16 IDIs with Department of Health and implementing partners and 24 focus group discussions (FGDs) with three HIV patient groups: new, stable and those not stable on treatment or not adhering to care. IDIs were conducted from August 2016 to August 2017; FGDs were conducted in January to February 2017. Content analysis was guided by the Consolidated Framework for Implementation Research. Findings were triangulated among respondent types to elicit barriers and facilitators to implementation. Results: New HIV patients found counselling helpful but intervention respondents reported sub‐optimal counselling and privacy concerns as barriers to initiation. Providers felt insufficiently trained for this intervention and were confused by the simultaneous rollout of the Universal Test and Treat strategy. For stable patients, repeat prescription collection strategies (RPCS) were generally well received. Patients and providers concurred that RPCS reduced congestion and waiting times at clinics. There was confusion though, among providers and implementers, around implementation of RPCS interventions. For patients not stable on treatment, enhanced counselling and tracing patients lost‐to‐follow‐up were perceived as beneficial to adherence behaviours but faced logistical challenges. All providers faced difficulties accessing data and identifying patients in need of tracing. Congestion at clinics and staff attitude were perceived as barriers preventing patients returning to care. Conclusions: Implementation of DSD models at scale is complex but this evaluation identified several positive aspects of AGL implementation. The positive perception of RPCS interventions and challenges managing patients not stable on treatment aligned with results from the larger evaluation. While some implementation challenges may resolve with experience, ensuring providers and implementers have the necessary training, tools and resources to operationalize AGL effectively is critical to the overall success of South Africa’s HIV control strategy., Introduction South Africa has the largest HIV treatment programme in the world, with 4.7 million public sector patients on treatment and a target of 6.1 million patients by end December [...]

South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa's Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local adaptation of CHW models and to identify potential barriers and facilitators to implementation of the revised framework to help guide and inform future planning. We conducted a qualitative study among a sample of Department of Health Managers at the National, Provincial and District level, healthcare providers, implementing partners [including non-governmental organizations (NGOs) who worked with CHWs] and CHWs themselves. Data were collected between April 2018 and December 2018. We conducted 65 in-depth interviews (IDIs) with healthcare providers, managers and experts familiar with CHW work and nine focus group discussions (FGDs) with 101 CHWs. We present (i) current models of CHW policy implementation across South Africa, (ii) facilitators, (iii) barriers to CHW programme implementation and (iv) respondents' recommendations on how the CHW programme can be improved. We chronicled the differences in NGO involvement, the common facilitators of purpose and passion in the CHWs' work and the multitude of barriers and resource limitations CHWs must work under. We found that models of implementation vary greatly and that adaptability is an important aspect of successful implementation under resource constraints. Our findings largely aligned to existing research but included an evaluation of districts/provinces that had not previously been explored together. CHWs continue to promote health and link their communities to healthcare facilities, in spite of lack of permanent employment, limited resources, such as uniforms, and low wages. [ABSTRACT FROM AUTHOR]

The essential oil composition, antimicrobial, anti-inflammatory and cytotoxic activities of 17 indigenous Agathosma species (18 samples) were investigated in order to validate their use in traditional healing. The results were related to the chemical composition of the essential oils as determined by GC and GC/MS. The antimicrobial activity was evaluated using the minimum inhibitory concentration (MIC) method on four pathogens: Staphylococcus aureus (ATCC 12600), Bacillus cereus (ATCC 11778), Klebsiella pneumoniae (NCTC 9633) and Candida albicans (ATCC 10231). The anti-inflammatory activity was evaluated using the 5-lipoxygenase assay while the cytotoxic activity was determined using the MTT (3-[4,5-dimethyl-2-thiazol-yl]-2,5-diphenyl-2H-tetrazolium bromide) cellular viability assay. The antimicrobial assay revealed that the most active oil against C. albicans was A. collina (MIC value of 3 mg/mL) whilst the most active oils against B. cereus were A. crenulata and A. pungens (MIC values of 3 mg/mL). Nine of the species had MIC values of 4 mg/mL against the Gram-positive pathogen S. aureus. The oils showed less activity against the Gram-negative pathogen K. pneumoniae. All the oils exhibited good in vitro anti-inflammatory activity with A. collina being the most potent (IC50 value of 25.98 ± 1.83 µg/mL). The results show that the oils were strong inhibitors of the enzyme 5-lipoxygenase. The oils proved to be toxic in the MTT assay displaying IC50 values of < 0.0001 µg/mL, which were relatively toxic when compared to a plant-derived compound such as quinine (IC50 value of 0.08 ± 0.03 µg/mL). The results revealed some relationships between the major components, some bioactivities and toxicities. The oils were found to differ qualitatively and quantitatively in compositions and their analysis resulted in the identification of a total of 322 compounds in 18 of the samples. [ABSTRACT FROM AUTHOR]

Background:  As part of the Reengineering Primary Health Care initiative, the South African National Department of Health (NDoH) has committed to expanding access to home-based care provided by community health workers. The NDOH also prioritised Community Health Workers (CHWs) in their agenda to improve child development outcomes in South Africa. However, there is limited research on CHWs' experiences and knowledge of early childhood development., Aim:  To explore CHWs' motivation for work, their background, training and scope of work around Early Child Development (ECD)., Setting:  The study was conducted in Mopani District, Limpopo province, South Africa, in 2017., Methods:  Five focus group discussions (FGDs) were conducted with 41 CHWs participating within a large cluster-randomised study. Data were analysed thematically using an inductive approach., Results:  Community health workers' motivation to work was influenced by personal experiences, community needs and community service. In terms of knowledge, CHWs indicated that a nutritious diet with extended breastfeeding, immunisations and preschool education is imperative for a child to thrive. The Road to Health Booklet, weighing scales and the mid-upper arm circumference tape were used as screening tools for ECD. Community health workers perceived their knowledge around ECD to be insufficient., Conclusion:  Community health workers play a crucial role in healthcare; therefore, capacity development on ECD and the provision of ECD screening tools to optimise their under-five child visits are necessary.Contribution: This study will potentially contribute to the improvement of the CHW programme in ensuring that children under 5 years of age are holistically cared for to ensure that they thrive.

For the last decade, South Africa has made substantial progress to control the dual HIV and TB epidemics. However, disruptions in TB and HIV treatment during the COVID-19 pandemic threatened to reverse this. This study aimed to identify adaptations in HIV and TB service delivery models in response to COVID-19 and government restrictions. This information informed the development of an online survey, which was utilized as part of a consultation exercise to further capture adaptations made to HIV/TB service delivery within the South African context. The literature review involved screening 380 titles and abstracts, identifying 30 HIV and TB studies across 19 countries, and categorizing 90 individual interventions into ten thematic areas. Common themes included interventions addressing screening, testing, diagnosis, medication collection and delivery support, and virtual models. Digital health interventions and adaptations to medication collection/delivery were reported in 38% of studies. Analysis of survey responses from 33 stakeholders in South Africa revealed that 47% of interventions targeted HIV, 11% TB, and 23% HIV/TB integrated service delivery. Most interventions (81%) were integrated into the national HIV or TB program, with implementation occurring at various levels: 39% at facility level, 35% at sub-district or district level, and 18% at provincial level. Programmatic data was available for 86% of interventions, with 50% being funded. This study demonstrated that services can be delivered in locations other than in health facilities (e.g., community-based or home-based) and that integrated services can also free up additional resources. Although studies varied, COVID-19 accelerated the adoption of differentiated service delivery (DSD) models for TB care, including multi-month dispensing (MMD) for TB preventative therapy (TPT) and TB treatment, home-based or mobile outreach screening and testing, and community pickup points (PuP) for TB medications. These initiatives had previously lagged behind HIV-focused DSD models, and it is crucial to sustain these services beyond the pandemic. To achieve universal health coverage, it will also be important to capitalize on these experiences and learn from HIV-focused DSD models so programs can deliver integrated person-centered chronic care services for TB, HIV, and non-communicable diseases., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Galvin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)