Browsing by Author "Grimsrud, Anna"

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    A cluster randomized controlled trial of extending ART refill intervals to six-monthly for anti-retroviral adherence clubs
    (2019-07-30) Wilkinson, Lynne; Grimsrud, Anna; Cassidy, Tali; Orrell, Catherine; Voget, Jacqueline; Hayes, Helen; Keene, Claire; Steele, Sarah J; Gerstenhaber, Rodd
    Abstract Background The antiretroviral therapy (ART) adherence club (AC) differentiated service delivery model, where clinically stable ART patients receive their ART refills and psychosocial support in groups has supported clinically stable patients’ retention and viral suppression. Patients and health systems could benefit further by reducing visit frequency and increasing ART refills. We designed a cluster-randomized control trial comparing standard of care (SoC) ACs and six-month ART refill (Intervention) ACs in a large primary care facility in Khayelitsha, South Africa. Methods Existing ACs were randomized to either the control (SOC ACs) or intervention (Intervention ACs) arm. SoC ACs meet five times annually, receiving two-month ART refills with a four-month ART refill over year-end. Blood is drawn at the AC visit ahead of the clinical assessment visit. Intervention ACs meet twice annually receiving six-month ART refills, with a third individual visit for routine blood collection anytime two-four weeks before the annual clinical assessment AC visit. Primary outcomes will be retention in care, annual viral load assessment completion and viral load suppression. (<400copies/mL) after 2 years. Ethics approval has been granted by the University of Cape Town (HREC 652/2016) and the Medecins Sans Frontieres (MSF) Ethics Review Board (#1639). Results will be published in peer-reviewed journals and made widely available through presentations and briefing documents. Discussion Evaluation of an extended ART refill interval in adherence clubs will provide evidence towards novel model adaptions that can be made to further improve convenience for patients and leverage health system efficiencies. Trial registration Registered with the Pan African Clinical Trial Registry: PACTR201810631281009. Registered 11 September 2018.
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    The antiretroviral moratorium in the Free State Province of South Africa: Contributing factors and implications
    (2011) Hodes, Rebecca; Grimsrud, Anna
    In November 2008, a moratorium on initiating new patients onto antiretroviral (ARV) treatment was enacted by the Provincial Department of Health in the Free State province of South Africa. The moratorium, which was part of a series of cost curtailment measures, lasted for four months. During this time, an estimated thirty additional patients in the province died from AIDS each day. The moratorium contradicted national government’s commitment to scaling-up of ARV treatment to 80% of those in need by 2011. This article uses the health systems components outlined by Harries et al. as crucial to the delivery of quality care as a conceptual framework to assess the causal elements of the antiretroviral moratorium. It examines the factors that contributed to the moratorium, including poor financial management systems, human resource and equipment shortages, weak monitoring and evaluation systems, and bureaucratic malfunctioning. This article describes South Africa’s system of fiscal federalism and its impact on health budgeting. As the first official cessation of provincial roll-out, the moratorium served as a litmus test for government’s reaction to critical challenges in the expansion of the ARV treatment programme at both national and provincial levels. It therefore provides a valuable case study for the state’s response to some of the systematic and health infrastructural problems that have characterised South Africa’s ARV roll-out since its inception.
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    The association between hypertension and depression and anxiety disorders: results from a nationally-representative sample of South African adults
    (Public Library of Science, 2009) Grimsrud, Anna; Stein, Dan J; Seedat, Soraya; Williams, David; Myer, Landon
    Objective: Growing evidence suggests high levels of comorbidity between hypertension and mental illness but there are few data from low- and middle-income countries. We examined the association between hypertension and depression and anxiety in South Africa. METHODS: Data come from a nationally-representative survey of adults (n = 4351). The Composite International Diagnostic Interview was used to measure DSM-IV mental disorders during the previous 12-months. The relationships between self-reported hypertension and anxiety disorders, depressive disorders and comorbid anxiety-depression were assessed after adjustment for participant characteristics including experience of trauma and other chronic physical conditions. RESULTS: Overall 16.7% reported a previous medical diagnosis of hypertension, and 8.1% and 4.9% were found to have a 12-month anxiety or depressive disorder, respectively. In adjusted analyses, hypertension diagnosis was associated with 12-month anxiety disorders [Odds ratio (OR) = 1.55, 95% Confidence interval (CI) = 1.10-2.18] but not 12-month depressive disorders or 12-month comorbid anxiety-depression. Hypertension in the absence of other chronic physical conditions was not associated with any of the 12-month mental health outcomes (p-values all <0.05), while being diagnosed with both hypertension and another chronic physical condition were associated with 12-month anxiety disorders (OR = 2.25, 95% CI = 1.46-3.45), but not 12-month depressive disorders or comorbid anxiety-depression. CONCLUSIONS: These are the first population-based estimates to demonstrate an association between hypertension and mental disorders in sub-Saharan Africa. Further investigation is needed into role of traumatic life events in the aetiology of hypertension as well as the temporality of the association between hypertension and mental disorders.
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    Causes and implications of the 2008/2009 Antiretroviral moratorium in the Free State province of South Africa
    (2010) Hodes, Rebecca; Grimsrud, Anna
    In November 2008, a moratorium on initiating new patients onto antiretrovirals was enacted by the provincial Department of Health in the Free State. This paper examines the causes and implications of the Free State antiretroviral moratorium in the context of South Africa's provincial expansion of antiretroviral coverage. It argues that financial mismanagement, bureaucratic malfunctioning and a lack of monitoring and evaluation were the root causes of the moratorium. The more immediate causes are also discussed, primarily the change in financial delegations in November 2008, in which Provincial Treasury abruptly prevented health officials from further overspending. As the first official cessation of a provincial antiretroviral programme, the Free State moratorium provided a litmus test for government's reaction to a critical challenge in the provincial ART scale-up. Its therefore provides a valuable case study for the state's response to systematic and health infrastructural problems that have characterised the national roll-out since its inception.
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    Hypertension and common mental disorders in a nationally-representative sample of South African adults
    (2007) Grimsrud, Anna; Myer, Landon
    This thesis examines the associations between self-reported hypertension diagnosis and Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) defined a) anxiety disorders b) depressive disorders and c) comorbid anxiety-depression, both lifetime and 12-month, adjusting for potential confounding variables.
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    The relationship between household wealth and HIV prevalence in Ethiopia
    (2014) Yenehun, Meseret; Cornell, Morna Brigit; Grimsrud, Anna; Ehrlich, Rodney
    Epidemiologic research shows that socioeconomic status influences different health outcomes including HIV/AIDS. Although poverty (low socioeconomic status (SES)) and HIV prevalence are correlated at the global level, the association between SES and HIV prevalence is rather mixed in sub-Saharan Africa. Differences in findings could be attributed to context and thus context specific evidence is needed to develop interventions that could have greater impact in those settings. However there are few studies that investigate the association between SES and HIV prevalence in Ethiopia. In 2011, the Central Statistics Agency (CSA) in collaboration with Federal Ministry of Health and ORC-MACRO collected a broad range of demographic, socioeconomic and health data on a representative sample of the population of Ethiopia. This included information on HIV status, demographic and socioeconomic variables (age, gender, religion, marital status, place of residence, household wealth, education, occupation and others) and behavioural risk factors. The present study took advantage of this dataset to describe the relationships between SES and demographic factors and HIV prevalence in the Ethiopian adult population, and to explore the relationship between household wealth and HIV prevalence. Part A of this dissertation (Protocol) describes the characteristics of the Ethiopian Demographic and Health Survey (EDHS2011) dataset, gives details on the sampling and data collection in the original study, and delineates the methodology of the secondary analysis. Part B (Literature review) illustrates the main findings of the conflicting epidemiological literature on the socioeconomic determinants of HIV/AIDS in sub-Saharan Africa and presents a summary of the major studies on wealth, education and place of residence as risk factors for HIV prevalence. Part C (Article) presents the methodological details, results, and possible interpretations of the analyses carried out on the EDHS2011 dataset. The estimated prevalence of HIV in the Ethiopian population aged between 15 to 49 years was 1.47% (95% CI: 1.25% to 1.68%). The analysis showed that household wealth and education were the main socioeconomic status determinants and were independently associated with higher HIV prevalence in Ethiopia, though having education beyond high school was protective against HIV. Data also suggested that living in urban areas, religion and age were the main demographic determinants of HIV prevalence in Ethiopia. Behavioural factors, especially having multiple sexual partners and condom use in the last 12 months were more prevalent both among HIV positive individuals and among more educated and relatively wealthier individuals. It is possible that these factors could be involved in the causal pathway between household wealth and HIV prevalence. The results confirm the pattern of association between education and HIV prevalence in sub-Saharan African countries undergoing epidemiological transition. Those with higher educational attainment had lower HIV prevalence compared to those with no education as the epidemic matured. The evidence generated in this study can be used to develop and update prevention strategies in order to target areas which have higher HIV prevalence.