Page 173 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 4 of 8 Original Research

Unit (27 May 2013) for an operational implementation
File number Date data recorded
ART programme to conduct a health systems intervention at
Regimen 1 Regimen 1 Regimen 1 Regimen 1 Regimen 1 the PHC. The eThekwini Health Unit has a MoU with
the Department of Health for the use of routine data for
ART research purposes at municipal facilities. Informed consent
Date started and study-related documents were not required for the
Date stopped
Reason ART operational implementation programme as no patient contact
changed was involved.
TB
Episode 1 Episode 2 Episode 3 Results
TB type Pre-intervention
Date treatment
commenced In-depth review
Date treatment
completed The cohort was predominantly female (77%; 159/206).
Weight and laboratory results from baseline Median age of females was 32 years and males 36.5 years.
Wassermann reac on Hepa s B surface an gen Approximately 26% of patients (54/206) were already on
Date ART when transferred into the PHC. Of those initiated
Date at Lancers Road, 64% (97/152) started care with
Months on ART CD4 counts < 200 cells/mm . The majority of patients
3
+
Weight on ART (76%; 156/206) were on the single-dose
VL regimen of tenofovir, emtricitabine and efavirenz (TDF–
CD4 + FTC–EFV).
Crea nine
ALT
Haemoglobin Viral load and retention in care review (Figure 1)
Urine dipsitck Viral load testing (test data and recorded results) and
Blood sugar retention status were available for 87.1% (1339/1538) of
Blood pressure
patients. Seventy-nine per cent of patients were retained in
Pregnancy care (1058/1339), 15% lost to follow-up (201/1339) and 6%
Expected delivery were transferred out (80/1339). There were 116 patients
date
Date and outcome (8.7%) not eligible for VL testing, leaving 1223 patients
eligible for VL testing.
Annual cervical smear
Date
Result Overall, there were 997 VL test results in 1223 eligible
patients; 82% of results were in the patients’ files and 18% on
FIGURE 2: Clinical summary chart. the NHLS website. In these 997 patients with VL test results,
73% were suppressed; 3% were 400 copies/mL – 1000 copies/
specimens, reports, study data collection, and administrative mL; 5% were > 1000 copies/mL; 1% were not processed and
forms and folders were identified using the clinic patient 18% were not adequately monitored according to standard
number. guidelines.

Data analysis One hundred and seventy patient files from the in-depth
review cohort (n = 206) were used to compare access to VL
Continuous variables, such as age, were summarised as results pre- and post-intervention. Of the 170 patients with
means with standard deviations, or medians and interquartile files reviewed, 70.6% (120/170) were eligible for VL testing
ranges, where appropriate. T-tests or Wilcoxon rank-sum pre-intervention, while 158/170 were eligible post-
tests were used to determine whether the distribution of the intervention. The remaining 50 and 12 patients, respectively,
outcome significantly differed between groups. Categorical had not yet reached the VL testing period of 6 months and
variables were analysed using frequency tables, and the chi- did not have VL tests.
square or Fisher’s exact test to test the relationship between
two categorical variables. Pre-intervention, 78% (94/120) had VL tests conducted, 76%
(71/94) of VL tests were filed and 59% (71/120) had access to
Ethical considerations their results (Table 2).

Permission was granted by the eThekwini Health Research Possible reasons for failure to receive a laboratory result were
Committee as part of the Memorandum of Understanding as follows: blood tests not requested nor performed; transport
(MOU) between the eThekwini Health Unit and the logistics; rejection of blood specimens and misplacing of the
Medical Research Council (MRC) HIV Prevention Research printed laboratory result form at the clinic.

http://www.sajhivmed.org.za 166 Open Access