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Marcus R, C P, Gill K, Smith P, Rouhani S, Mendelsohn A, Mendel E, Lince-Deroche N, Naidoo K, Ahmed N, Stirrup O, Roseleur J, Leuner R, Meyer-Rath G, Bekker LG. Acceptability, feasibility and cost of point of care testing for sexually transmitted infections among South African adolescents where syndromic management is standard of care. BMC Health Serv Res 2023; 23:1078. [PMID: 37817160 PMCID: PMC10566254 DOI: 10.1186/s12913-023-10068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Young people (YP) in southern Africa are at substantial risk of HIV and sexually transmitted infections (STIs). Despite the epidemiological and biological link between STIs and HIV transmission and acquisition, infections such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) remain widely undiagnosed. Syndromic STI management is the standard of care in low- and middle-income countries (LMICs) despite a high prevalence of asymptomatic infections. We conducted an observational study to explore the acceptability, feasibility, and cost of a STI test-and-treat service for YP in Cape Town. METHODS YP attending a mobile clinic (MC) and a youth centre clinic (YC) were offered STI screening. Urine testing for CT and NG using a 90-min molecular point-of-care (POC) test on the GeneXpert platform was conducted and treatment provided. Data were collated on demographics, sexual behaviour, presence of symptoms, uptake of same-day treatment, prevalence of CT/NG, and service acceptability. RESULTS Three hundred sixty six participants were enrolled (median age 20, 83% female).57% (209/366) of participants tested positive for either CT (126/366, 34%) or NG (57/366, 16%) or co-infection (26/366, 7%). Clinical symptoms were a poor predictor of GeneXpert diagnosed CT or NG, with a sensitivity of 46.8% and 54.0% for CT and NG respectively. Although half of participants initially chose to receive same day results and treatment, only a third waited for results on the day. The majority of participants (91%) rated the service highly via a post-visit acceptability questionnaire. CONCLUSION Curable STIs are highly prevalent in this population. STI screening using POC testing was feasible and acceptability was high. The study provides further impetus for moving policy beyond syndromic management of STIs in South Africa.
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Affiliation(s)
- Rebecca Marcus
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
- North Middlesex University Hospital, London, UK.
| | - Pike C
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - K Gill
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - P Smith
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - S Rouhani
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - A Mendelsohn
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - E Mendel
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - N Lince-Deroche
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - K Naidoo
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - N Ahmed
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Mortimer Market Centre, Central North West London NHS Trust, London, UK
| | - O Stirrup
- Institute for Global Health, University College London, London, UK
| | - J Roseleur
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - R Leuner
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - G Meyer-Rath
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, School of Public Health, Boston University, Massachusetts, USA
| | - L G Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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Long LC, Girdwood S, Govender K, Meyer-Rath G, Miot J. Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa. BMC Health Serv Res 2023; 23:240. [PMID: 36906559 PMCID: PMC10007767 DOI: 10.1186/s12913-023-09147-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/03/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND While South Africa's national HIV program is the largest in the world, it has yet to reach the UNAIDS 95-95-95 targets. To reach these targets, the expansion of the HIV treatment program may be accelerated through the use private sector delivery models. This study identified three innovative non-governmental primary health care models (private sector) providing HIV treatment, as well as two government primary health clinics (public sector) that served similar populations. We estimated the resources used, and costs and outcomes of HIV treatment across these models to provide inputs to inform decisions around how these services might best be provided through National Health Insurance (NHI). METHODS A review of potential private sector models for HIV treatment in a primary health care setting was conducted. Models actively offering HIV treatment (i.e. in 2019) were considered for inclusion in the evaluation, subject to data availability and location. These models were augmented by government primary health clinics offering HIV services in similar locations. We conducted a cost-outcomes analysis by collecting patient-level resource usage and treatment outcomes through retrospective medical record reviews and a bottom-up micro-costing from the provider perspective (public or private payer). Patient outcomes were based on whether the patient was still in care at the end of the follow up period and viral load (VL) status, to create the following outcome categories: in care and responding (VL suppressed), in care and not responding (VL unsuppressed), in care (VL unknown) and not in care (LTFU or deceased). Data collection was conducted in 2019 and reflects services provided during the 4 years prior to that (2016-2019). RESULTS Three hundred seventy-six patients were included across the five HIV treatment models. Across the three private sector models there were differences in the costs and outcomes of HIV treatment delivery, two of the models had results similar to the public sector primary health clinics. The nurse-led model appears to have a cost-outcome profile distinct from the others. CONCLUSION The results show that across the private sector models studied the costs and outcomes of HIV treatment delivery vary, yet there were models that provided costs and outcomes similar to those found with public sector delivery. Offering HIV treatment under NHI through private delivery models could therefore be an option to increase access beyond the current public sector capacity.
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Affiliation(s)
- L C Long
- Health Economics and Epidemiology Research Office (HE²RO), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
- Department of Global Health, Boston University School of Public Health, Boston, United States.
| | - S Girdwood
- Health Economics and Epidemiology Research Office (HE²RO), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - K Govender
- Health Economics and Epidemiology Research Office (HE²RO), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - G Meyer-Rath
- Health Economics and Epidemiology Research Office (HE²RO), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, United States
| | - J Miot
- Health Economics and Epidemiology Research Office (HE²RO), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, United States
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Govender K, Girdwood S, Letswalo D, Long L, Meyer-Rath G, Miot J. Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa. BMC Public Health 2021; 21:1649. [PMID: 34503478 PMCID: PMC8431853 DOI: 10.1186/s12889-021-11678-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/29/2021] [Indexed: 01/21/2023] Open
Abstract
Background The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had private medical insurance and predominately utilised private providers. However, it is estimated that up to 28% of the population access private PHC services, with a meaningful segment of the low-income, uninsured population paying for these services out-of-pocket. The study objective was to characterise the health seeking behaviour of low-income, patients accessing PHC services in both the public and private sectors, patient movement between sectors, and factors influencing their facility choice. Methods We conducted once-off patient interviews on a random sample of 153 patients at 7 private PHC providers (primarily providing services to the low-income mostly uninsured patient population) and their matched public PHC clinic (7 facilities). Results The majority of participants were economically active (96/153, 63%), 139/153 (91%) did not have health insurance, and 104/153 (68%) earned up to $621/month. A multiple response question found affordability (67%) and convenience (60%) were ranked as the most important reasons for choosing to usually access care at public clinics (48%); whilst convenience (71%) and quality of care (59%) were key reasons for choosing the private sector (32%). There is movement between sectors: 23/76 (30%) of those interviewed at a private facility and 8/77 (10%) of those interviewed at a public facility indicated usually accessing PHC services at a mix of private and public facilities. Results indicate cycling between the private and public sectors with different factors influencing facility choice. Conclusions It is imperative to understand the potential impact on where PHC services are accessed once affordability is mitigated through the NHI as this has implications on planning and contracting of services under the NHI.
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Affiliation(s)
- Kerensa Govender
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa.
| | - Sarah Girdwood
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Letswalo
- Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa.,Department of Global Health, Boston University School of Public Health, Boston, Mass, USA
| | - G Meyer-Rath
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa.,Department of Global Health, Boston University School of Public Health, Boston, Mass, USA
| | - J Miot
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa
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Siegel G, Meyer-Rath G, Ermilov E, Rodríguez M, Malmsten M, Claesson P, Saunders R, Hetzer R, Lindman B. Flow sensing in the cardiovascular system. Colloids Surf A Physicochem Eng Asp 2015. [DOI: 10.1016/j.colsurfa.2014.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McCarthy K, Chersich MF, Vearey J, Meyer-Rath G, Jaffer A, Simpwalo S, Venter WDF. Good treatment outcomes among foreigners receiving antiretroviral therapy in Johannesburg, South Africa. Int J STD AIDS 2009; 20:858-62. [DOI: 10.1258/ijsa.2009.009258] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Foreigners, including displaced persons, often have limited health-care access, especially to HIV services. Outcomes of antiretroviral therapy (ART) in South Africans and foreigners were compared at a Johannesburg non-governmental clinic. Records were reviewed of 1297 adults enrolled between April 2004 and March 2007 (568 self-identified foreigners, 431 South Africans citizens and 298 with unknown origin). Compared with citizens, foreigners had fewer hospital admissions (39%, 90/303 versus 51%, 126/244; P < 0.001), less missed appointments for ART initiation (20%, 39/200 versus 25%, 51/206; P < 0.001), faster median time to ART initiation (14 versus 21 days, P = 0.008), better retention in care (88%, 325/369 versus 69%, 155/226; P < 0.001) and lower mortality (2.5%, 14/568 versus 10%, 44/431; P < 0.001) after 426 person-years. In logistic regression, after controlling for baseline CD4 count and tuberculosis status, foreigners were 55% less likely to fail ART than citizens (95% CI = 0.23–0.87). These findings support United Nations High Commissioner for Refugees recommendations that ART should not be withheld from displaced persons.
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Affiliation(s)
- K McCarthy
- Reproductive Health and HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - M F Chersich
- Reproductive Health and HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Obstetrics and Gynaecology, University of Gent, Gent, Belgium
| | - J Vearey
- Forced Migration Studies Programme, University of the Witwatersrand, Johannesburg, South Africa
| | - G Meyer-Rath
- London School of Hygiene and Tropical Medicine, London, UK
| | - A Jaffer
- Reproductive Health and HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - S Simpwalo
- Nazareth House, Johannesburg, South Africa
| | - W D F Venter
- Reproductive Health and HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Renaud A, Basenya O, de Borman N, Greindl I, Meyer-Rath G. The cost effectiveness of integrated care for people living with HIV including antiretroviral treatment in a primary health care centre in Bujumbura, Burundi. AIDS Care 2009; 21:1388-94. [DOI: 10.1080/09540120902884042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Renaud
- a Agence Européenne pour le Développement et la Santé , Bruxelles , Belgium
| | - O. Basenya
- b Institut National de Santé Publique , Bujumbura , Burundi
| | - N. de Borman
- c Agence Européenne pour le Développement et la Santé , Bruxelles , Belgium
| | - I. Greindl
- c Agence Européenne pour le Développement et la Santé , Bruxelles , Belgium
| | - G. Meyer-Rath
- d Health Policy Unit , London School of Hygiene and Tropical Medicine , London , UK
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Böhme C, Meyer-Rath G, Magdorf K, Luck W, Krenn V, Wahn U, Keitzer R. Abdominelle Tuberkulose im Kindesalter. Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-005-1152-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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