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Identifying contextual determinants of problems in tuberculosis care provision in South Africa: a theory-generating case study

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Infectious Diseases of Poverty 2021年第3期10卷 82-94页

作者： Jamie Murdoch Robyn Curran Andre Jvan Rensburg Ajibola Awotiwon Audry Dube Max Bachmann inge petersen Lara Fairall School of Health Sciences University of East AngliaNorwich NR47TJUK. University of Cape Town Lung Institute Knowledge Translation UnitUniversity of Cape TownMowbray 7700South Africa Centre for Rural Health University of KwaZulu NatalDurbanSouth Africa Norwich Medical School University of East AngliaNorwich NR47TJUK. King's Global Health Institute King's College LondonLondon SE19NHUK. Knowledge Translation Unit Department of MedicineUniversity of Cape Town Lung InstituteUniversity of Cape TownMowbray 7700South Africa.

Background:Despite progress towards End TB Strategy targets for reducing tuberculosis(TB)incidence and deaths by 2035,South Africa remains among the top ten high-burden tuberculosis countries globally.A large challenge lies in how policies to improve detection,diagnosis and treatment completion interact with social and structural drivers *** understanding and theoretical development of the contextual determinants of problems inTB care is required for developing effective *** article reports findings from the pre-implementation phase of a study ofTB care in South Africa,contributing to HeAlth System StrEngThening in Sub-Saharan Africa(ASSET)-a five-year research programme developing and evaluating health system strengthening interventions in sub-Saharan *** study aimed to develop hypothetical propositions regarding contextual determinants of problems inTB care to inform intervention development to reduce TB deaths and incidence whilst ensuring the delivery of quality integrated,person-centred ***:Theory-building case study design using the Context and Implementation of Complex Interventions(CICI)framework to identify contextual determinants of problems in TB *** February and November 2019,we used mixed methods in six public-sector primary healthcare facilities and one public-sector hospital serving impoverished urban and rural communities in the Amajuba District of KwaZulu-Natal Province,South *** data included stakeholder interviews,observations and documentary *** data included routine data on sputum testing andTB *** were inductively analysed and mapped onto the seven CICI contextual ***:Delayed diagnosis was caused by interactions between fragmented healthcare provision;limited resources;verticalised care;poorTB screening,sputum collection and *** nurse responsible forTB care,with limited integration ofTB with other conditions,and policy focused o

关键词： Tuberculosis Health systems strengthening Primary healthcare Person-centred care Context

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Closing the treatment gap for depression co-morbid with HIV in South Africa: Voices of afflicted women

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Health 2013年第3期5卷 557-566页

作者： inge petersen Jill Hanass Hancock Arvin Bhana Kaymarlin Govender Members of Programme for Improving Mental Health Care (PRIME) Human and Social Development Human Sciences Research Council Durban South Africa University of KwaZulu-Natal Durban South Africa Research Programme Consortium Department for International Development (DFID) London UK

This Background: In South Africa the rising comorbidity of mental disorders with other non-communicable and communicable diseases, particularly in people living with HIV/AIDS (PLWHA), has helped raise the public health priority of mental ill-health. Depression, in particular, compromises anti-retroviral treatment (ART) adherence and virological suppression, thus threatening the effectiveness of South Africa’s ART programme. Given that evidence-based treatment for depression comprises medication and/ or Western-derived psychotherapies, responding to the current interest in expanding mental health services for PLWHA demands an understanding of how best to provide culturally competent care within existing resource constraints. Aim: To explore the context and local understandings of depression in women living with HIV to inform the development of contextually appropriate mental health services that could be delivered within existing resource constraints inSouth Africa. Method: Semi-structured qualitative interviews were held with 35 women living with HIV in South Africa who met the diagnostic criteria for a major depressive disorder. Results: Being HIV-positive per se was not reported to be a major cause of depression. Instead, a number of social factors were reported. These included stigma and discrimination, poverty, and stressful life events. Symptoms of depression, especially social withdrawal, negative ruminating thoughts and excessive worry suggestive of comorbid anxiety, functioned to exacerbate and trap women in a negative depressive cycle. Social support emerged as a dominant coping strategy. Group-based interventions, which afford greater opportunities for improved social support, were mooted as the most appropriate intervention by the majority of participants. Individual counselling provided through a home visitation programme was suggested for those who were too ill or too poor to attend clinics. Task sharing was also endorsed. Conclusion: The need for multi

关键词： Depression Mental Health HIV AIDS South Africa

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Comorbidities between tuberculosis and common mental disorders:a scoping review of epidemiological patterns and person-centred care interventions from low-to-middle income and BRICS countries

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Infectious Diseases of Poverty 2020年第1期9卷 95-95页

作者： AndréJanse Van Rensburg Audry Dube Robyn Curran Fentie Ambaw Jamie Murdoch Max Bachmann inge petersen Lara Fairall Centre for Rural Health School of Nursing and Public HealthUniversity of KwaZulu-Natal Howard CollegeBereaDurbanSouth Africa 不详

Background:There is increasing evidence that the substantial global burden of disease for tuberculosis unfolds in concert with dimensions of common mental ***-centred care holds much promise to ameliorate these comorbidities in low-to-middle income countries(LMICs)and emerging *** this end,this paper aims to review 1)the nature and extent of tuberculosis and common mental disorder comorbidity and 2)person-centred tuberculosis care in low-to-middle income countries and emerging *** text:A scoping review of 100 articles was conducted of English-language studies published from 2000 to 2019 in peer-reviewed and grey literature,using established guidelines,for each of the study *** broad tuberculosis/mental disorder comorbidities were described in the literature,namely alcohol use and tuberculosis,depression and tuberculosis,anxiety and tuberculosis,and general mental health and *** of comorbidity varied widely across countries for depression,anxiety,alcohol use and general mental *** use and tuberculosis were significantly related,especially in the context of *** initial tuberculosis diagnostic episode had substantial sociopsychological effects on service *** men tended to report higher rates of alcohol use and treatment default,women in general had worse mental health *** age and a history of mental illness were also associated with pronounced tuberculosis and mental disorder ***-centred tuberculosis care interventions were almost absent,with only one study from Nepal ***:There is an emerging body of evidence describing the nature and extent of tuberculosis and mental disorders comorbidity in low-to-middle income *** the potential of person-centred interventions,evidence is *** review highlights a pronounced need to address psychosocial comorbidities with tuberculosis in LMICs,where models of person-centred tube

关键词： Tuberculosis Mental disorder Comorbidity Person-centred care Low-to-middle income countries BRICS

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