Browsing by Author "Gausi, Blessings"

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    Open Access
    Assessing the effectiveness of integrated non-communicable disease and antiretroviral adherence clubs in Cape Town, South Africa
    (2020) Gausi, Blessings; Oni, Tolullah; Jacob, Nisha
    The growing burden of HIV and non- communicable disease (NCD) syndemic in Sub Saharan Africa, has necessitated introduction of integrated models of care in order to leverage existing HIV care infrastructure for NCDs. However, there is paucity of literature on long term treatment outcomes for multimorbid patients attending integrated care. We describe long term treatment outcomes among multimorbid patients who attended integrated ART and NCD clubs (IC), a novel model of care piloted in 2014 by the Western Cape Government in South Africa. We followed up multimorbid patients for 12 months, who enrolled for IC at Matthew Goniwe and Town II clinics before September 2016. Median adherence proportions, HIV viral suppression and retention rates were calculated at 12 months before and after IC enrolment. Rates for achieving targets for blood pressure and glycosylated haemoglobin were determined at 12 months prior, at IC enrolment and at 12 months post IC enrolment. We describe demographic and clinical variables among all patients at IC enrolment and used multivariable logistic regression to evaluate for predictors of NCD control 12 months post IC enrolment. As of 31 August 2017, 247 patients in total had been enrolled into IC for at least 12 months. Of these, 221 (89.5%) had hypertension, 4 (1.6%) had diabetes mellitus and 22 (8.9%) had both in addition to HIV. Adherence was maintained before and after IC enrolment with median adherence proportions of 1 (IQR 1-1) and 1 (IQR 1-1) respectively. HIV viral suppression rates were 98.6%, 99.5% and 99.4% at the three time points respectively. Retention in care was high with 6.9% lost to follow up at 12 months post IC enrolment. Optimal blood pressure control was achieved in 43.1%, 58.9% and 49.4% of participants whereas optimal glycaemic control was achieved in 47.4%, 87.5% and 53.3% of diabetic participants at the three time points respectively. Multivariable logistic analyses showed no independent variables significantly associated with NCD control. Multi-morbid people living with HIV achieved high levels of HIV control in integrated HIV and NCD clubs. However, intensified interventions are needed to maintain NCD control in the long term.
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    Open Access
    Missed opportunities for NCD multimorbidity prevention in adolescents and youth living with HIV in urban South Africa
    (2020-06-01) Kamkuemah, Monika; Gausi, Blessings; Oni, Tolu
    Abstract Background Epidemiological transition in high HIV-burden settings is resulting in a rise in HIV/NCD multimorbidity. The majority of NCD risk behaviours start during adolescence, making this an important target group for NCD prevention and multimorbidity prevention in adolescents with a chronic condition such as HIV. However, there is data paucity on NCD risk and prevention in adolescents with HIV in high HIV-burden settings. The aim of this study was to investigate the extent to which NCD comorbidity (prevention, diagnosis, and management) is incorporated within existing adolescent HIV primary healthcare services in Cape Town, South Africa. Methods We reviewed medical records of 491 adolescents and youth living with HIV (AYLHIV) aged 10–24 years across nine primary care facilities in Cape Town from November 2018–March 2019. Folders were systematically sampled from a master list of all AYLHIV per facility and information on HIV management and care, NCDs, NCD risk and NCD-related health promotion extracted. Results The median age was 20 years (IQR: 14–23); median age at ART initiation 18 years (IQR: 6–21) and median duration on ART 3 years (IQR: 1.1–8.9). Fifty five percent of participants had a documented comorbidity, of which 11% had an NCD diagnosis with chronic respiratory diseases (60%) and mental disorders (37%) most common. Of those with documented anthropometrics (62%), 48% were overweight or obese. Fifty nine percent of participants had a documented blood pressure, of which 27% were abnormal. Twenty-six percent had a documented health promoting intervention, 42% of which were NCD-related; ranging from alcohol or substance abuse (13%); smoking (9%); healthy weight or diet (9%) and mental health counselling (10%). Conclusions Our study demonstrates limited NCD screening and health promotion in AYLHIV accessing healthcare services. Where documented, our data demonstrates existing NCD comorbidity and NCD risk factors highlighting a missed opportunity for multimorbidity prevention through NCD screening and health promotion. Addressing this missed opportunity requires an integrated health system and intersectoral action on upstream NCD determinants to turn the tide on the rising NCD and multimorbidity epidemic.
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    A Systematic Review of Interventions to Improve HPV Vaccination Coverage
    (2021-06-23) Mavundza, Edison J; Iwu-Jaja, Chinwe J; Wiyeh, Alison B; Gausi, Blessings; Abdullahi, Leila H; Halle-Ekane, Gregory; Wiysonge, Charles S
    Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide. Although most HPV infections are transient and asymptomatic, persistent infection with high-risk HPV types may results in diseases. Although there are currently three effective and safe prophylactic HPV vaccines that are used across the world, HPV vaccination coverage remains low. This review evaluates the effects of the interventions to improve HPV vaccination coverage. We searched the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Scopus, and the World Health Organization International Clinical Trials Registry Platform and checked the reference lists of relevant articles for eligible studies. Thirty-five studies met inclusion criteria. Our review found that various evaluated interventions have improved HPV vaccination coverage, including narrative education, outreach plus reminders, reminders, financial incentives plus reminders, brief motivational behavioral interventions, provider prompts, training, training plus assessment and feedback, consultation, funding, and multicomponent interventions. However, the evaluation of these intervention was conducted in high-income countries, mainly the United States of America. There is, therefore, a need for studies to evaluate the effect of these interventions in low-and middle-income countries, where there is a high burden of HPV and limited HPV vaccination programs.