Rajen Govender

Understanding the Impact of Hazardous and Harmful Use of Alcohol and/or Other Drugs on ARV Adherence and Disease Progression.

The objective of this study was to understand the impact of hazardous and harmful use of alcohol and/or other drugs on ARV adherence and disease progression among HIV patients. A cross-sectional study design was used. A total of 1503 patients attending HIV clinics in Cape Town, South Africa were screened for problematic substance use. A sub-sample of 607 patients (303 patients who screened positive for problematic substance use and 304 who did not) participated in this study. Hazardous or harmful alcohol use and problematic drug use predicted missing and stopping ARVs which, in turn, was associated with a decrease in CD4 counts and more rapid HIV-disease progression and poorer health outcomes in people living with HIV/AIDS (PLWHA). The findings of this study underscore the need for an integrated approach to managing substance-use disorders in PLWHA.

Identifying perceived barriers to monitoring service quality among substance abuse treatment providers in South Africa

BackgroundA performance measurement system is planned for South African substance abuse treatment services. Provider-level barriers to implementing these systems have been identified in the United States, but little is known about the nature of these barriers in South Africa. This study explored the willingness of South African substance abuse treatment providers’ to adopt a performance measurement system and perceived barriers to monitoring service quality that would need to be addressed during system development.MethodsThree focus group discussions were held with treatment providers from two of the nine provinces in South Africa. These providers represented the diverse spread of substance abuse treatment services available in the country. The final sample comprised 21 representatives from 12 treatment facilities: eight treatment centres in the Western Cape and four in KwaZulu-Natal. Content analysis was used to extract core themes from these discussions.ResultsParticipants identified barriers to the monitoring of service quality that included outdated modes of collecting data, personnel who were already burdened by paperwork, lack of time to collect data, and limited skills to analyse and interpret data. Participants recommended that developers engage with service providers in a participatory manner to ensure that service providers are invested in the proposed performance measurement system.ConclusionFindings show that substance abuse treatment providers are willing to adopt a performance measurement system and highlight several barriers that need to be addressed during system development in order to enhance the likelihood that this system will be successfully implemented.

Development and psychometric validation of a novel patient survey to assess perceived quality of substance abuse treatment in South Africa

BackgroundA hybrid performance measurement system that combines patient-reported outcome data with administrative data has been developed for South African substance abuse treatment services. This paper describes the development and psychometric validation of one component of this system, the South African Addiction Treatment Services Assessment (SAATSA).MethodsFirst, a national steering committee identified five domains and corresponding indicators on which treatment quality should be assessed. A decision was made to develop a patient survey to assess several of these indicators. A stakeholder work group sourced survey items and generated additional items where appropriate. The feasibility and face validity of these items were examined during cognitive response testing with 16 patients. This led to the elimination of several items. Next, we conducted an initial psychometric validation of the SAATSA with 364 patients from residential and outpatient services. Exploratory (EFA) and confirmatory factor analyses (CFA) were conducted to assess the latent structure of the SAATSA. Findings highlighted areas where the SAATSA required revision. Following revision, we conducted another psychometric validation with an additional sample of 285 patients. We used EFA and CFA to assess construct validity and we assessed reliability using Cronbach’s measure of internal consistency.ResultsThe final version of the SAATSA comprised 31 items (rated on a four-point response scale) that correspond to six scales. Four of these scales are patient-reported outcome measures (substance use, quality of life, social connectedness and HIV risk outcomes) that together assess the perceived effectiveness of treatment. The remaining two scales assess patients’ perceptions of access to and quality of care. The models for the final revised scales had good fit and the internal reliability of these scales was good to excellent, with Cronbach’s α ranging from 0.72 to 0.89.ConclusionA lack of adequate measurement tools hampers efforts to improve the quality of substance abuse treatment. Our preliminary evidence suggests that the SAATSA, a novel patient survey that assesses patients’ perceptions of the outcomes and quality of substance abuse treatment, is a psychometrically robust tool that can help fill this void.

An integrated model of HIV/AIDS testing behaviour in the construction industry

The South African construction industry is one of the economic sectors most adversely affected by the HIV/AIDS pandemic. Prevalence rates exceed those of most other sectors. Little is known about the antibody testing behaviour of construction workers, and the determinants thereof. A field-administered questionnaire survey, using an item catalogue based on similar surveys, gathered data from 512 site-based construction employees in the Western Cape, South Africa. An integrated hypothesized conceptual model of testing behaviour, derived from the literature, was proposed as a starting point for data analysis. This model comprising demographic factors, lifestyle risk and condom use, alcohol consumption, drug use, knowledge about HIV/AIDS, prejudice towards HIV+ persons, and attitudinal fear of being tested, was used to explain testing behaviour. Bivariate analysis, regression modelling, and structural equation modelling were then used to test the conceptual model. A revised model was proposed. The findings indicate that: (1) employment type, alcohol consumption, drug use, and HIV/AIDS knowledge are the terminal predictors of testing behaviour; (2) knowledge about the disease is determined by education level and ethnicity; (3) age, gender, ethnicity and education behave as significant predictors of alcohol consumption; (4) drug use is predicted by employment type, education and alcohol consumption (marginally); and (5) the interrelationship between knowledge, prejudice, and fear of being tested is nuanced and complex. In strategies for positively influencing employee testing behaviour, employers should first ensure that effective communication is established with workers in all employment categories. Interventions relating to alcohol consumption and drug use by employees need particular attention. Existing peer educator training, and awareness campaign media, should be particularly sensitive to ethnic and cultural values that are likely to influence HIV/AIDS testing behaviour.

Substance abuse treatment engagement, completion and short-term outcomes in the Western Cape province, South Africa: Findings from the Service Quality Measures Initiative

BACKGROUND Optimizing the effectiveness of substance use disorder (SUD) treatment is critical in low-and middle-income countries (LMICs) with limited opportunities for SUD treatment. This is the first study to identify targets for interventions to improve the quality of SUD treatment in a LMIC. METHOD We explored correlates of three indicators of treatment quality (treatment engagement, completion and abstinence at treatment exit) using data from a SUD performance measurement system implemented in the Western Cape Province of South Africa. The sample included data from 1094 adult treatment episodes representing 53% of the treatment episodes in 2016. Using multivariate logistic regression analyses, we modeled socio-demographic, substance use and program correlates of treatment engagement, completion, and abstinence at treatment exit. RESULTS Overall, 59% of patients completed treatment (48% of patients from outpatient services). Treatment completion was associated with greater likelihood of abstinence at treatment exit. Patients were more likely to complete treatment if they engaged in treatment, were older, and had more severe drug problems (characterized by daily drug use and heroin problems) and attended programs of shorter duration. Residential treatment was associated with greater likelihood of treatment engagement, completion, and abstinence at treatment exit. CONCLUSION Improving rates of outpatient treatment completion will enhance the effectiveness of South Africas SUD treatment system. Interventions that promote engagement in treatment, particularly among younger patients; reduce program length through referral to step-down continuing care; and ensure better matching of drug problem to treatment level and type could improve rates of treatment completion.

Factors Determining South African Construction Workers’ Prejudice towards and Discrimination against HIV+ Persons

AbstractStigma and fear of discrimination are powerful deterrents against human immunodeficiency virus (HIV) antibody testing. Prejudice and discrimination against people living with acquired immune deficiency syndrome (AIDS) are deterrents to their willingness to disclose their status and thereby avail themselves of treatment. Stigma impairs employees’ general well-being, affecting their work capacity, and thus directly impacting upon project management success. Little is known about construction workers’ prejudice towards and discrimination against HIV+ persons, and the determinants thereof. A field-administered questionnaire survey gathered data from 512 site-based construction employees in the Western Cape, South Africa. Following bivariate and regression analyses of the survey response data, a structural equations model comprising demographic factors, lifestyle risk, substance use (alcohol consumption and drug use), knowledge about HIV/AIDS, and attitudinal fear of testing is posited to explain preju...

HIV testing of construction workers in the Western Cape, South Africa

With an infection rate estimated at 14%, the South African construction industry is one of the economic sectors most adversely affected by the HIV/AIDS pandemic. Construction workers are considered a high-risk group. The provision and uptake of voluntary counselling and testing (VCT) is critical to reducing transmission rates. This study examined the testing behaviour of site-based construction workers in terms of demographic and lifestyle risk behaviour characteristics to help inform better strategies for work-based interventions by construction firms. A total of 512 workers drawn from six firms operating on 18 construction sites in the Western Cape province participated in the study. Twenty-seven per cent of the participants reported never having been tested for HIV. Results indicate that females (aOR = 4.45, 95% CI, 1.25–15.82), older workers (aOR = 1.40, 95% CI, 1.08–1.81), permanent workers (aOR = 1.67, 95% CI, 1.11–2.50) and workers whom had previously used a condom (aOR = 1.93, 95% CI, 1.02–3.65) were significantly more likely to have been tested. Ethnicity was not significantly related to prior testing. Identification of these subgroups within the industry has implications for the development of targeted work-based intervention programmes to promote greater HIV testing among construction workers in South Africa.

HIV infection in the South African construction industry

Abstract South Africa has one of the highest HIV prevalences in the world, and compared with other sectors of the national economy, the construction industry is disproportionately adversely affected. Using data collected nationally from more than 57,000 construction workers, HIV infection among South African construction workers was estimated, together with an assessment of the association between worker HIV serostatus and worker characteristics of gender, age, nature of employment, occupation, and HIV testing history. The HIV infection of construction workers was estimated to be lower than that found in a smaller 2008 sample. All worker characteristics are significantly associated with HIV serostatus. In terms of most at-risk categories: females are more at risk of HIV infection than males; workers in the 30–49 year old age group are more at risk than other age groups; workers employed on a less permanent basis are more at risk; as are workers not having recently tested for HIV. Among occupations in the construction industry, general workers, artisans, and operator/drivers are those most at risk. Besides yielding more up-to-date estimated infection statistics, this research also identifies vulnerable sub-groups as valuable pointers for more targeted workplace interventions by construction firms.

An explanatory model of attitudinal fear of HIV/AIDS testing in the construction industry

Purpose – Prevalence of HIV/AIDS infection in the South African construction industry exceeds that of most other economic sectors. Voluntary counselling and testing is pivotal in combatting the spread of the disease. Little is known about the attitudinal fear of testing among construction workers, and the determinants thereof. The purpose of this paper is to address these shortcomings. Design/methodology/approach – A conceptual integrated model of fear of testing is proposed. Demographic characteristics and behavioural and cognitive factors are posited to explain attitudinal fear of testing. Regression analysis and structural equation modelling are used to test the model, using data gathered from 512 site-based participants in a questionnaire survey. Findings – Prejudice and lifestyle risk are the terminal predictors of fear of testing. Prejudice is determined by education level and HIV/AIDS transmission knowledge. Knowledge is predicted by education level and ethnicity. Lifestyle risk is determined by ag...