Browsing by Author "Draper, Beverly"

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    Depot medroxyprogesterone acetate versus norethisterone oenanthate for long-acting progestogenic contraception : a systematic review
    (2006) Draper, Beverly; Hoffman, Margaret
    [Background] Two injectable progestogen-only contraceptives (IPCs) depot medroxyprogesterone acetate (DMPA) and norethisterone oenanthate (NET-EN) continue to be extensively used in some countries, forming a large proportion of the health system's expenditure on contraception. Both these highly effective contraceptives receive wide acceptance amongst women in their fertile years. They differ in cost and frequently of administration. A systematic comparison was undertaken to investiage their rational use. [Objectives] To determine if there are differences between depot medroxyprogesterone acetate given at a dose of 150mg IM every three months and norethisterone oenathate given at a dose of 200mg IM every two months, in terms of contraceptive effectiveness, reversibility and discontinuation patterns, and adverse clinical effects. [Study Design] A Cochrane systematic review was used to answer the question posed in the research objective. This included a systematic search for all available literature comapring DMPA and NET-EN, followed by appraisal of all studies for inclusion in the review. Meta-analysis was then applied to the included study.
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    Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: a qualitative process evaluation of the STRETCH trial
    (BioMed Central Ltd, 2012) Georgeu, Daniella; Colvin, Christopher; Lewin, Simon; Fairall, Lara; Bachmann, Max; Uebel, Kerry; Zwarenstein, Merrick; Draper, Beverly; Bateman, Eric
    BACKGROUND:Task-shifting is promoted widely as a mechanism for expanding antiretroviral treatment (ART) access. However, the evidence for nurse-initiated and managed ART (NIMART) in Africa is limited, and little is known about the key barriers and enablers to implementing NIMART programmes on a large scale. The STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) programme was a complex educational and organisational intervention implemented in the Free State Province of South Africa to enable nurses providing primary HIV/AIDS care to expand their roles and include aspects of care and treatment usually provided by physicians. STRETCH used a phased implementation approach and ART treatment guidelines tailored specifically to nurses. The effects of STRETCH on pre-ART mortality, ART provision, and the quality of HIV/ART care were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of factors affecting the implementation of the programme. METHODS: This study was a qualitative process evaluation using in-depth interviews and focus group discussions with patients, health workers, health managers, and other key informants as well as observation in clinics. Research questions focused on perceptions of STRETCH, changes in health provider roles, attitudes and patient relationships, and impact of the implementation context on trial outcomes. Data were analysed collaboratively by the research team using thematic analysis. RESULTS: NIMART appears to be highly acceptable among nurses, patients, and physicians. Managers and nurses expressed confidence in their ability to deliver ART successfully. This confidence developed slowly and unevenly, through a phased and well-supported approach that guided nurses through training, re-prescription, and initiation. The research also shows that NIMART changes the working and referral relationships between health staff, demands significant training and support, and faces workload and capacity constraints, and logistical and infrastructural challenges. CONCLUSIONS: Large-scale NIMART appears to be feasible and acceptable in the primary level public sector health services in South Africa. Successful implementation requires a comprehensive approach with: an incremental and well supported approach to implementation; clinical guidelines tailored to nurses; and significant health services reorganisation to accommodate the knock-on effects of shifts in practice.TRIAL REGISTRATION:ISRCTN46836853