Browsing by Subject "Data management"
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- ItemOpen AccessEffectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa(Public Library of Science, 2013) Luque-Fernandez, Miguel Angel; Cutsem, Gilles Van; Goemaere, Eric; Hilderbrand, Katherine; Schomaker, Michael; Mantangana, Nompumelelo; Mathee, Shaheed; Dubula, Vuyiseka; Ford, Nathan; Hernán, Miguel ABACKGROUND: Innovative models of care are required to cope with the ever-increasing number of patients on antiretroviral therapy in the most affected countries. This study, in Khayelitsha, South Africa, evaluates the effectiveness of a group-based model of care run predominantly by non-clinical staff in retaining patients in care and maintaining adherence. Methods and FINDINGS: Participation in "adherence clubs" was offered to adults who had been on ART for at least 18 months, had a current CD4 count >200 cells/ml and were virologically suppressed. Embedded in an ongoing cohort study, we compared loss to care and virologic rebound in patients receiving the intervention with patients attending routine nurse-led care from November 2007 to February 2011. We used inverse probability weighting to estimate the intention-to-treat effect of adherence club participation, adjusted for measured baseline and time-varying confounders. The principal outcome was the combination of death or loss to follow-up. The secondary outcome was virologic rebound in patients who were virologically suppressed at study entry. Of 2829 patients on ART for >18 months with a CD4 count above 200 cells/µl, 502 accepted club participation. At the end of the study, 97% of club patients remained in care compared with 85% of other patients. In adjusted analyses club participation reduced loss-to-care by 57% (hazard ratio [HR] 0.43, 95% CI = 0.21-0.91) and virologic rebound in patients who were initially suppressed by 67% (HR 0.33, 95% CI = 0.16-0.67). DISCUSSION: Patient adherence groups were found to be an effective model for improving retention and documented virologic suppression for stable patients in long term ART care. Out-of-clinic group-based models facilitated by non-clinical staff are a promising approach to assist in the long-term management of people on ART in high burden low or middle-income settings.
- ItemOpen AccessImplementation of an electronic monitoring and evaluation system for the antiretroviral treatment programme in the Cape Winelands district, South Africa: a qualitative evaluation(Public Library of Science, 2015) Myburgh, Hanlie; Murphy, Joshua P; van Huyssteen, Mea; Foster, Nicola; Grobbelaar, Cornelius J; Struthers, Helen E; McIntyre, James A; Hurter, Theunis; Peters, Remco P HBACKGROUND: A pragmatic three-tiered approach to monitor the world's largest antiretroviral treatment (ART) programme was adopted by the South African National Department of Health in 2010. With the rapid expansion of the programme, the limitations of the paper-based register (tier 1) were the catalyst for implementation of the stand-alone electronic register (tier 2), which offers simple digitisation of the paper-based register. This article engages with theory on implementation to identify and contextualise enabling and constraining factors for implementation of the electronic register, to describe experiences and use of the register, and to make recommendations for implementation in similar settings where standardisation of ART monitoring and evaluation has not been achieved. METHODS: We conducted a qualitative evaluation of the roll-out of the register. This comprised twenty in-depth interviews with a diverse sample of stakeholders at facility, sub-district, and district levels of the health system. Facility-level participants were selected across five sub-districts, including one facility per sub-district. Responses were coded and analysed using a thematic approach. An implementation science framework guided interpretation of the data. Results & DISCUSSION: We identified the following seven themes: 1) ease of implementation, 2) perceived value of an electronic M&E system, 3) importance of stakeholder engagement, 4) influence of a data champion, 5) operational and logistical factors, 6) workload and role clarity, and 7) importance of integrating the electronic register with routine facility monitoring and evaluation. Interpreting our findings through an implementation theory enabled us to construct the scaffolding for implementation across the five facility-settings. This approach illustrated that implementation was not a linear process but occurred at two nodes: at the adoption of the register for roll-out, and at implementation at facility-level. CONCLUSION: In this study we found that relative advantage of an intervention and stakeholder engagement are critical to implementation. We suggest that without these aspects of implementation, formative and summative outcomes of implementation at both the adoption and coalface stages of implementation would be negatively affected.
- ItemOpen AccessInfluence of real-time information provided by a mobile phone on the management of rural water supply quality(2012) Wilson-Jones, Toni; Rivett, UlrikeIn South Africa, access to safe drinking water is a human right that is explicitly stated in the constitution. Most metro municipalities are meeting the drinking water quality targets, but the smaller rural environments are failing to provide water of acceptable drinking water quality. Reasons contributing to the high incidence of unacceptable water quality are the rural municipalities' inadequate institutional capacity and lack of management and monitoring of drinking water services. This study investigates the possibilities of supporting rural water service institutions to manage their remote water supply schemes better by addressing the challenge of distance monitoring. Through the creation of real-time information flow between the water service authorities and the water supply caretakers in remote villages, it is to be tested if better information can be received and the status of the rural water supply quality can be monitored. The improvement of information flow is based on introducing a mobile phone application. The hypothesis is that through improving the information flow, decisions on water supply management will be improved. Case study research was conducted in rural municipalities situated in the Northern Cape Province and Eastern Cape Province of South Africa. Four different municipalities were chosen to reveal the diverse municipal set-up and different challenges facing rural municipalities. Data was gathered through interviews conducted with the municipal mangers over a seven month period, as well as through field investigations. The findings reveal that the mobile reporting system has improved information flow from water supply caretakers to government service providers. The mobile application allowed for distance monitoring of rural water supply schemes. It has helped address the municipalities' institutional capacity problems by improving access to information relevant to decision making. Through the data records displayed on the mobile application, municipal mangers were able to track the supply caretakers' performance and subsequently hold them accountable. Through an increase in data availability, water quality failures were easily identified, resulting in improved confidence in the quality of rural water supply. The access to real-time information has improved the monitoring and communication of rural water quality. Early intervention and the management of non-compliance improved. The mobile technology provided the municipal managers with a tool to monitor their rural water supply schemes more regularly, but it also became apparent that the management of such schemes only improved if relevant action was taken based on the information received. Greater improvement was seen in municipalities where the tool was used consistently, where time was set aside to follow up on data warnings and protocols existed to follow up on non-compliance issues. Management of the resources did not improve in areas where management staff was severely overstretched and response strategies to problems were non-existent before the implementation of the tool.
- ItemOpen AccessMissed opportunities for retention in pre-ART care in Cape Town, South Africa(Public Library of Science, 2014) du Toit, Elizabeth; van Schalkwyk, Cari; Dunbar, Rory; Jennings, Karen; Yang, Blia; Coetzee, David; Beyers, NuldaBACKGROUND: Few studies have evaluated access to and retention in pre-ART care. Objectives To evaluate the proportion of People Living With HIV (PLWH) in pre-ART and ART care and factors associated with retention in pre-ART and ART care from a community cohort. METHODS: A cross sectional survey was conducted from February - April 2011. Self reported HIV positive, negative or participants of unknown status completed a questionnaire on their HIV testing history, access to pre-ART and retention in pre-ART and ART care. RESULTS: 872 randomly selected adults who reported being HIV positive in the ZAMSTAR 2010 prevalence survey were included and revisited. 579 (66%) reconfirmed their positive status and were included in this analysis. 380 (66%) had initiated ART with 357 of these (94%) retained in ART care. 199 (34%) had never initiated ART of whom 186 (93%) accessed pre-ART care, and 86 (43%) were retained in pre-ART care. In a univariable analysis none of the factors analysed were significantly associated with retention in care in the pre-ART group. Due to the high retention in ART care, factors associated with retention in ART care, were not analysed further. CONCLUSION: Retention in ART care was high; however it was low in pre-ART care. The opportunity exists, if care is better integrated, to engage with clients in primary health care facilities to bring them back to, and retain them in, pre-ART care.
- ItemOpen AccessMyDas, an extensible Java DAS server(Public Library of Science, 2012) Salazar, Gustavo A; García, Leyla J; Jones, Philip; Jimenez, Rafael C; Quinn, Antony F; Jenkinson, Andrew M; Mulder, Nicola; Martin, Maria; Hunter, Sarah; Hermjakob, HenningA large number of diverse, complex, and distributed data resources are currently available in the Bioinformatics domain. The pace of discovery and the diversity of information means that centralised reference databases like UniProt and Ensembl cannot integrate all potentially relevant information sources. From a user perspective however, centralised access to all relevant information concerning a specific query is essential. The Distributed Annotation System (DAS) defines a communication protocol to exchange annotations on genomic and protein sequences; this standardisation enables clients to retrieve data from a myriad of sources, thus offering centralised access to end-users. We introduce MyDas, a web server that facilitates the publishing of biological annotations according to the DAS specification. It deals with the common functionality requirements of making data available, while also providing an extension mechanism in order to implement the specifics of data store interaction. MyDas allows the user to define where the required information is located along with its structure, and is then responsible for the communication protocol details.
- ItemOpen AccessWho bites the bullet first? the susceptibility of Leopards Panthera Pardus to trophy hunting(Public Library of Science, 2015) Braczkowski, Alex Richard; Balme, Guy Andrew; Dickman, Amy; Macdonald, David Whyte; Fattebert, Julien; Dickerson, Tristan; Johnson, Paul; Hunter, LukeReliable data is fundamentally important for managing large carnivore populations, and vital for informing hunting quota levels if those populations are subject to trophy hunting. Camera-trapping and spoor counts can provide reliable population estimates for many carnivores, but governments typically lack the resources to implement such surveys over the spatial scales required to inform robust quota setting. It may therefore be prudent to shift focus away from estimating population size and instead focus on monitoring population trend. In this paper we assess the susceptibility of African leopards Panthera pardus to trophy hunting. This has management ramifications, particularly if the use of harvest composition is to be explored as a metric of population trend. We explore the susceptibility of different leopard age and sex cohorts to trophy hunting; first by examining their intrinsic susceptibility to encountering trophy hunters using camera-traps as surrogates, and second by assessing their extrinsic susceptibility using photographic questionnaire surveys to determine their attractiveness to hunters. We show that adult male and female leopards share similar incident rates to encountering hunters but adult males are the most susceptible to hunting due to hunter preference for large trophies. In contrast, sub-adult leopards rarely encounter hunters and are the least attractive trophies. We suggest that our findings be used as a foundation for the exploration of a harvest composition scheme in the Kwazulu-Natal and Limpopo provinces where post mortem information is collected from hunted leopards and submitted to the local provincial authorities.