Nzapfurundi Chabikuli

Sexually transmitted infections - factors associated with quality of care among private general practitioners

OBJECTIVES To study the factors associated with quality of sexually transmitted infection (STI) care among private general practitioners in Gauteng. METHODS We analysed 1 194 records of patients attending 26 randomly selected GP practices in the first 3 months of 2000 and 2002, for 3 STI syndromes, namely urethral discharge, pelvic inflammatory disease and genital ulcers. We assessed adherence to nationally accepted STI treatment guidelines and analysed the influence of patient and practice-level variables on effectiveness of STI drug regimens and trends over time. RESULTS After controlling for syndrome mix, district and time period, appropriate drug treatment for STIs was significantly associated with the client having medical aid (p < 0.001), recent graduation as a medical practitioner (p < 0.001) and male GP gender (p = 0.007). Between 2000 and 2002, STI care improved for clients with medical aids but for not cash clients. CONCLUSIONS There was variation in the quality of prescribing for STIs among GPs and positive trends in this prescribing. There is a need for interventions that address the financial incentives that may hamper quality of STI care for cash clients.

Adherence to antiretroviral therapy, virologic failure and workload at the Rustenburg provincial hospital

Abstract Background: Adherence to antiretroviral therapy (ART) is a strong predictor of progression to AIDS and death. It remains the most important potentially alterable factor that determines treatment outcomes. Methods: The study is a cross-sectional survey of self-reported adherence to ART and associated factors. It included a randomly selected sample of 100 adult patients who began ART between June 2006 and December 2007. A modified Adult AIDS Clinical Trials Group questionnaire was used. The analysis compared self-reported adherence levels by factor and viral load test results. Results: Only 71 % of patients had an adherence > 95%. Poor adherence was related to changes in daily routines (being away from home [21%] and busy with other things [17%]). All patients with symptoms suggestive of clinical depression had virologic failure. More unemployed patients (50.7%) had virologic failure than did employed patients (40%) (p = < 0.05). The clinic had a tenfold increase in patient enrolment and a ninefold decline in staff-to-patient ratio, and the proportion of patients lost to follow-up doubled in the preceding four years. Conclusion: Adherence to ART was poor. The capacity of the clinic to manage patients adequately has declined significantly. Decentralisation of ART services to primary health care facilities should be considered.

Improving the quality of STI care by private general practitioners: a South African case study.

Objectives: Evaluation of an intervention to improve quality of sexually transmitted infections (STI) care among 64 private general practitioners (GPs) working in two urban districts in Gauteng Province, South Africa. Methods: We implemented a multifaceted intervention, the core of which were four interactive continuing medical education seminars. Changes in STI treatment practices were evaluated through record reviews before and after the continuing medical education intervention in 17 randomly selected practices in the intervention districts and in nine randomly selected practices from a reference GP group (n = 34). Results: There were statistically significant improvements in the quality of drug treatment for urethral discharge but not pelvic inflammatory disease among both intervention and reference GPs. Conclusions: Improvements in STI quality were possibly the result of a background secular trend rather than the intervention itself. Further research is needed on financial and other incentives to improved quality of STI care in the private sector environment.