Publication: Evaluation of the National Adherence Guidelines for Chronic Diseases in South Africa: Healthcare Provider Perspectives on Different Care Models, 2017
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2017-06
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2017-11-15
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This report presents the result of the qualitative evaluation to understand the implementation of five adherence interventions from the provider perspective in four South African provinces. The research is part of the evaluation of the new Adherence Guidelines for HIV, TB and other chronic diseases. The study sought to answer four key questions: 1. What are the barriers to and facilitators of implementing the minimum package interventions from the perspective of the providers? 2. What are the strengths and weaknesses of each intervention for HIV positive patients from the perspective of providers? 3. How could implementation of adherence interventions and the minimum package of interventions be improved? 4. What additional strategies do providers feel would be helpful in improving treatment adherence? The report presents the thematic analysis of the qualitative interview transcripts under each of the four questions. Emerging themes are illustrated with quotes from respondents at intervention and control clinics. The results show that providers were generally positive about all the interventions, though they had mixed comments about the Direct Medicine Delivery and Tracing and Retention-in-Care models, largely because they were not always well implemented or providers felt they did not have the resources to implement them at scale. Additionally, providers' views were mixed on their perceived effectiveness of Adherence Clubs.
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“World Bank. 2017. Evaluation of the National Adherence Guidelines for Chronic Diseases in South Africa: Healthcare Provider Perspectives on Different Care Models, 2017. © World Bank. http://hdl.handle.net/10986/28873 License: CC BY 3.0 IGO.”
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Publication Evaluation of the National Adherence Guidelines for Chronic Diseases in South Africa(World Bank, Washington, DC, 2017-06)This report presents the result of the qualitative evaluation to understand the implementation of five adherence interventions from the patient perspective in four South African provinces. The research is part of the evaluation of the new Adherence Guidelines for HIV, TB and other chronic diseases. The study sought to answer four key questions: questions: 1. How does patient satisfaction with care at the intervention sites compare to the control sites among HIV positive patients? 2. What are the barriers to and facilitators of ART initiation and adherence among HIV-positive patients eligible for each intervention? 3. What are the strengths and weaknesses of each intervention for HIV positive patients from the patient perspective? 4. What additional strategies do patients feel would be helpful in improving treatment adherence? The report presents the triangulated qualitative and quantitative data from patient surveys and focus group discussions under each of the four questions. The results show that from the patient perspective, each intervention has promise and supported either ART initiation or adherence, however each could be improved. Detailed illustrative quotes are provided for each intervention according to the main themes identified. Specifically, patients had very positive feelings about Adherence Clubs and Decentralized Medication Delivery in focus group discussions.Publication Evaluation of the National Adherence Guidelines for Chronic Diseases in South Africa Using Routinely Collected Data(World Bank, Washington, DC, 2016-10-31)This report describes enrollment into the cohorts for protocol 1 for the Evaluation of the National Adherence Guidelines for Chronic Diseases in South Africa Using Routinely Collected Data. The study is evaluating short-term and long-term effects of five interventions being implemented by the National Department of Health (NDoH) in South Africa to improve adherence to HIV care and chronic disease care in general: Fast track initiation counselling, decentralized medicine delivery, adherence clubs, early patient tracing and enhanced adherence counselling. The study uses a randomized evaluation design to compare sites where the intervention was rolled out with control sites providing standard of care. Enrollment began in June 2016 and was uneven in time and by province, as expected in a process using routine data and relying on programmatic implementation. Enrollment of HIV clients into cohorts will enable the NDoH to understand the short-term and long-term impacts of interventions to improve HIV treatment initiation, adherence and retention in care.Publication Evaluation of the National Adherence Guidelines for Chronic Diseases in South Africa(World Bank, Washington, DC, 2017-10)This report describes the short-term outcomes of an evaluation study for five different HIV cohorts using routinely collected data. The evaluation study is a collaboration between the National Department of Health of South Africa, the National Health Laboratory Service (NHLS) and the World Bank. Boston University/Health Economics and Epidemiology Research Office (HE2RO) is the academic partner in the evaluation. The overall aims of the evaluation are to assess the impact of South Africa`s Adherence Guideline interventions on HIV patients’ treatment outcomes; estimate the costs of the interventions; and describe the cascade of care for TB, hypertension, and diabetes at the same clinics. The short-term endpoints reported on herein concern ART initiation among FTIC eligible patients, ARV medication pick-up among AC and DMD eligible patients, retention in care among TRIC eligible patients, and viral load suppression among EAC eligible patients. The final outcomes of this evaluation will be reported on separately, once patients have been follow-up for one year and routine data on viral load suppression and retention in care become availablePublication Evaluation of the National Adherence Guidelines for Chronic Diseases in South Africa Using Routinely Collected Data(World Bank, Washington, DC, 2017-01-31)This report describes enrollment into the cohorts for protocol 1 for the Evaluation of the National Adherence Guidelines for Chronic Diseases in South Africa Using Routinely Collected Data. The study is evaluating short-term and long-term effects of five interventions being implemented by the National Department of Health (NDoH) in South Africa to improve adherence to HIV care and chronic disease care in general: Fast track initiation counselling, decentralized medicine delivery, adherence clubs, early patient tracing and enhanced adherence counselling. The study uses a randomized evaluation design to compare sites where the intervention was rolled out with control sites providing standard of care. Enrollment began in June 2016 and was uneven in time and by province, as expected in a process using routine data and relying on programmatic implementation. Enrollment of HIV clients into cohorts will enable the NDoH to understand the short-term and long-term impacts of interventions to improve HIV treatment initiation, adherence and retention in care.Publication Evaluation of the Adherence Guidelines for Chronic Diseases in South Africa Using Routinely Collected Data(World Bank, Washington, DC, 2018-07)This report describes the findings of a study on the continua of care for tuberculosis, hypertension and diabetes in South Africa forming part of an evaluation of the National Adherence Guidelines for Chronic Diseases. Conducted by the National Department of Health in collaboration with the National Health Laboratory Service, the World Bank, and Boston University/Health Economics and Epidemiology Research Office, the study used routine data from 24 health facilities in Gauteng, KwaZulu-Natal, Limpopo, North West provinces. Observational cohorts of patients were created using clinic records and applying eligibility criteria. In the screening cohort of 3600 patients, 46 percent of eligible patients had a TB screen (83 percent of HIV patients) with 8 percent having positive screens. For hypertension, 72 of eligible patients were screened and 19 percent positive. For diabetes, 56 percent of eligible patients had evidence of screening in the past three years and 4 percent were positive. In the diagnosed cohort of 1,096 patients, treatment initiation was 98 percent for TB, 92 percent for hypertension and 82 percent for diabetes. Treatment success was 71 percent for TB, 22 percent for hypertension 18 percent for diabetes. The results demonstrated that considerable efforts are made to find cases and retain them in care, but that there is room for further improvement to maximize patient outcomes in chronic care.
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