Browsing by Author "Pienaar, David"

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    Open Access
    An evaluation of the role of an Intermediate Care facility in the continuum of care in Western Cape, South Africa
    (2015) Mabunda, Sikhumbuzo Advisor; London, Leslie; Pienaar, David
    BACKGROUND: A comprehensive Primary Health Care approach includes clear referral and continuity of care pathways. South Africa lacks data that describe Intermediate Care (IC) services and its role in the health system. This study aimed to describe the model of service provision at an IC facility and the role it plays in the continuity of care in Cape Town. METHODS: Sixty-eight patients (65% Response Rate) were recruited in a prospective cohort design over a one-month period in mid-2011. Patient data were collected from a clinical record review and an interviewer-administered questionnaire, administered at a median interval between admission and interview of 11 days to assess primary and second ary diagnosis, knowledge of and previous use of Home Based Care (HBC) services, reason for admission, demographics and information on referring institution. A telephonic interviewer-administered questionnaire to patients or their family members post-discharge recorded their vital status, use of HBC post-discharge and their level of satisfaction with care received at the IC facility. A Cox regression model was run to identify predictors of survival and the effect of a Care-plan on survival. Seventy staff members (82%) were recruited in a cross-sectional study using a self-administered questionnaire to describe demographics, level of education and skills in relation to what they did for patients and what they thought patients needed. RESULTS: Of the 68 participants, 38 % and 24% were referred from a secondary and tertiary hospital, respectively, and 78% were resident of a higher income community. Stroke (35%) was the most common single reason for admission at acute hospital. The three most common reasons reported by patients why care was better at the IC facility than the referring institution was the caring and friendly staff, the presence of physiotherapy and the wound care. Even though a large proportion of the IC inpatients had been admitted in a health facility on the year preceding the study, only 13 patients (21%) had used a Community Health Worker (CHW) ever before and only 25% (n=15) of the discharged patients had a confirmed CHW visit post-discharge. The presence of a Care-plan was significantly associated with a 62% lower risk of death (Hazard Ratio: 0.380; CI 0.149-0.972). Notably, 46% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks. In addition, of the 57 patients that could be traced on follow-up 21(37%) had died. CONCLUSION: Patients and family understood this service as a caring environment that is primarily responsible for rehabilitation services. Furthermore, a Care-plan which extends beyond admission could have a significant impact on reducing mortality. IC services should therefore be recognised as an integral part of the health system and it should be accessed by all who need it.
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    Open Access
    HIV surveillance : a 12 year analysis of HIV prevalence trends and comparing HIV prevalence from sentinel antenatal clinic surveys and prevention of mother-to-child programmes
    (2015) Essel, Vivien; Boulle, Andrew; Pienaar, David
    Background Sentinel antenatal clinic (ANC) surveys remain a key source of data on HIV prevalence trends. Recently though, with an increase in the uptake of prevention of mother-to-child transmission (PMTCT) programmes, there have been debates on the prospects of using PMTCT data for reporting antenatal HIV prevalence and trends. Aim To describe the HIV prevalence trends for the Western Cape Province and to compare prevalence from ANC surveys to PMTCT programmes. Methods HIV prevalence and 95% confidence intervals were estimated from ANC surveys from 2001-2012 for the province as well as the 6 health districts and the 8 City of Cape Town Metropolitan sub-districts in the province. HIV prevalence from expanded provincial ANC survey sampling was compared to the nationally reported provincial and district estimates, before and after re-weighting to account for differences between the realized sample and updated sampling frame. A regression line was fitted with calendar year included as both a linear and quadratic term to create smoothed trend lines of the change in HIV prevalence over time by province, district, sub-district and age group. A multivariable logistic regression model was fitted to the multi-year ANC survey data to explore associations with HIV prevalence. ANC survey HIV prevalence estimates were compared to those from routinely reported HIV testing data from the PMTCT program for 2009-2012.