Browsing by Author "Leon, Natalie"

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    Availability and acceptability of HIV counselling and testing services. a qualitative study comparing clients’ experiences of accessing HIV testing at public sector primary health care facilities or non-governmental mobile services in Cape Town, South Africa
    (BioMed Central, 2015) Meehan, Sue-Ann; Leon, Natalie; Naidoo, Pren; Jennings, Karen; Burger, Ronelle; Beyers, Nulda
    Background: The South African government is striving for universal access to HIV counselling and testing (HCT), a fundamental component of HIV care and prevention. In the Cape Town district, Western Cape Province of South Africa, HCT is provided free of charge at publically funded primary health care (PHC) facilities and through non-governmental organizations (NGOs). This study investigated the availability and accessibility of HCT services; comparing health seeking behaviour and client experiences of HCT across public PHC facilities (fixed sites) and NGO mobile services. Methods: This qualitative study used semi-structured interviews. Systematic sampling was used to select 16 participants who accessed HCT in either a PHC facility (8) or a NGO mobile service (8). Interviews, conducted between March and June 2011, were digitally recorded, transcribed and where required, translated into English. Constant comparative and thematic analysis was used to identify common and divergent responses and themes in relation to the key questions (reasons for testing, choice of service provider and experience of HCT). Results: The sample consisted of 12 females and 4 males with an age range of 19–60 years (median age 28 years). Motivations for accessing health facilities and NGO services were similar; opportunity to test, being affected by HIV and a perceived personal risk for contracting HIV. Participants chose a particular service provider based on accessibility, familiarity with and acceptability of that service. Experiences of both services were largely positive, though instances of poor staff attitude and long waiting times were reported at PHC facilities. Those attending NGO services reported shorter waiting times and overall positive testing experiences. Concerns about lack of adequate privacy and associated stigma were expressed about both services. Conclusions: Realised access to HCT is dependent on availability and acceptability of HCT services. Those whoutilised either a NGO mobile service or a public PHC facility perceived both service types as available and acceptable. Mobile NGO services provided an accessible opportunity for those who would otherwise not have tested at that time. Policy makers should consider the perceptions and experiences of those accessing HCT services when increasing access to HCT.
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    Healthcare workers' perceptions and experience on using mHealth technologies to deliver primary healthcare services : qualitative evidence synthesis
    (Cochrane, 2015) Tomlinson, Mark Robin; Odendaal, Willem A.; Goudge, Jane; Griffiths, Frances; Leon, Natalie; Daniels, Karen
    This is the protocol for a review and there is no abstract. The objectives are as follows: The review has the following two objectives. To identify, appraise and synthesise qualitative research evidence on healthcare workers’ perceptions and experiences regarding their use of mHealth technologies to provide and support the delivery of primary healthcare services. To identify hypotheses, for subsequent consideration and assessment in effectiveness reviews, about why some technologies are more effective than others.
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    Pathways to multidrug-resistant tuberculosis diagnosis and treatment initiation : a qualitative comparison of patients’ experiences in the era of rapid molecular diagnostic tests
    (BioMed Central, 2015-10-28) Naidoo, Pren; Van Niekerk, Margaret; Du Toit, Elizabeth; Beyers, Nulda; Leon, Natalie
    Background Although new molecular diagnostic tests such as GenoType MTBDRplus and Xpert® MTB/RIF have reduced multidrug-resistant tuberculosis (MDR-TB) treatment initiation times, patients’ experiences of diagnosis and treatment initiation are not known. This study aimed to explore and compare MDR-TB patients’ experiences of their diagnostic and treatment initiation pathway in GenoType MTBDRplus and Xpert® MTB/RIF-based diagnostic algorithms. Methods The study was undertaken in Cape Town, South Africa where primary health-care services provided free TB diagnosis and treatment. A smear, culture and GenoType MTBDRplus diagnostic algorithm was used in 2010, with Xpert® MTB/RIF phased in from 2011–2013. Participants diagnosed in each algorithm at four facilities were purposively sampled, stratifying by age, gender and MDR-TB risk profiles. We conducted in-depth qualitative interviews using a semi-structured interview guide. Through constant comparative analysis we induced common and divergent themes related to symptom recognition, health-care access, testing for MDR-TB and treatment initiation within and between groups. Data were triangulated with clinical information and health visit data from a structured questionnaire. Results We identified both enablers and barriers to early MDR-TB diagnosis and treatment. Half the patients had previously been treated for TB; most recognised recurring symptoms and reported early health-seeking. Those who attributed symptoms to other causes delayed health-seeking. Perceptions of poor public sector services were prevalent and may have contributed both to deferred health-seeking and to patient’s use of the private sector, contributing to delays. However, once on treatment, most patients expressed satisfaction with public sector care. Two patients in the Xpert® MTB/RIF-based algorithm exemplified its potential to reduce delays, commencing MDR-TB treatment within a week of their first health contact. However, most patients in both algorithms experienced substantial delays. Avoidable health system delays resulted from providers not testing for TB at initial health contact, non-adherence to testing algorithms, results not being available and failure to promptly recall patients with positive results. Conclusion Whilst the introduction of rapid tests such as Xpert® MTB/RIF can expedite MDR-TB diagnosis and treatment initiation, the full benefits are unlikely to be realised without reducing delays in health-seeking and addressing the structural barriers present in the health-care system.
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    Researching complex interventions in health : the state of the art
    (BMC Health Services Research, 2016) Craig, Peter; Rahm-Hallberg, Ingalill; Britten, Nicky; Borglin, Gunilla; Meyer, Gabriele; Kopke, Sascha; Noyes, Jane; Chandler, Jackie; Levati, Sara; Sales, Anne; Thabane, Lehana; Giangregorio, Lora; Feeley, Nancy; Cossette, Sylvie; Taylor, Rod; Hill, Jacqueline; Richards, David A.; Kuyken, Willem; von Essen, Louise; Williams, Andrew; Hemming, Karla; Lilford, Richard; Girling, Alan; Taljaard, Monica; Dimairo, Munyaradzi; Petticrew, Mark; Baird, Janis; Moore, Graham; Odendaal, Willem; Atkins, Salla; Lutge, Elizabeth; Leon, Natalie; Lewin, Simon; Payne, Katherine; Van Achterberg, Theo; Sermeus, Walter; Pitt, Martin; Monks, Thomas
    ENGLISH SUMMARY : Keynote presentations