Models of care for antiretroviral treatment delivery : a faith-based organization's response

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dc.contributor.advisorBotma, Y.
dc.contributor.advisorStark, R.
dc.contributor.advisorVan Rensburg, H. C. J.
dc.contributor.authorWilke, Marisa
dc.date.accessioned2016-01-12T07:22:45Z
dc.date.available2016-01-12T07:22:45Z
dc.date.copyright2012-04-14
dc.date.issued2012-04-14
dc.date.submitted2012-04-14
dc.description.abstractBackground: Since 1849, Catholic religious have provided health services in South Africa. They have established hospitals, clinics, and have provided community-based preventive and curative services throughout the country. Today faith-based organizations (FBOs) continue to play an important role in healthcare delivery and are crucial to the goal of providing universal access to antiretroviral therapy (ART). In order to scale up HIV care and treatment, there is a need to describe and analyze ART models of care (MOC) that address the challenges faced by developing countries. The South African Catholic Bishops’ Conference (SACBC) manages twenty ART clinics in medically underserved South African communities, where the need is great, but the resources limited. These SACBC managed ART clinics operate on different MOC. A study to describe, analyze and compare the different MOC can inform future directions in healthcare delivery in resource-constrained settings. Method: A single case-study design was used to describe, analyze and compare four different MOC (managed by the SACBC) for ART delivery, as embedded units of analysis. A mixed method approach was used, incorporating qualitative and quantitative information. Data were collected using structured interviews (n=1,006 adult ART patients), file audits (n=1,006 files of the respondents), semistructured interviews (n=27 healthcare workers) and nominal groups (n=12 groups with Home Based Care-workers). Descriptive and inferential data analyses were conducted by a biostatistician from the Department of Biostatistics at the University of the Free State and the researcher. Findings: In the study, patients accessed care late (CD4=119 cells/mm3). Decentralized care provided better access. Family members are a potential source of support because disclosure rates to relatives and others were high (95.63%). Nurse-driven, doctor supported care was not inferior to doctor-driven care. Task-shifting to registered nurses and HBC-workers can be implemented successfully with support. Differences exist between the South African Government (SAG) -managed model and the FBO–managed models. Partnership between the SAG and FBO strengthened the SAG-managed MOC, while capitalizing on the sustainability of the government services. Functional information systems, developed by the FBO, were implemented at all the MOC in 2009. All the MOC focused on acute care. Conclusions: Nurse-driven decentralized service can most effectively and appropriately address the chronic nature of HIV and strengthen the healthcare system by a paradigm shift to a chronic care model. Based on the findings, a chronic care model was adapted for South Africa that has seven elements: (1) an integrated, decentralized chronic care system based within a primary health setting; (2) partnerships with NGOs; (3) an effective information management system; (4) patients and their families; (5) self-management support to patients; (6) provider decision support and (7) delivery system redesign. Implications for the nursing profession include adaptation of focus and training, as well as the recognition of the nurse practitioners/specialist role in South Africa.en_ZA
dc.description.sponsorshipNational Research Foundation (NRF)en_ZA
dc.identifier.urihttp://hdl.handle.net/11660/2133
dc.language.isoenen_ZA
dc.publisherUniversity of the Free Stateen_ZA
dc.rights.holderUniversity of the Free Stateen_ZA
dc.subjectThesis (Ph.D. (Nursing))--University of the Free State, 2012en_ZA
dc.subjectAIDS (Disease) -- Nursingen_ZA
dc.subjectAntiretroviral agentsen_ZA
dc.subjectCommunity-based social servicesen_ZA
dc.subjectPatient profileen_ZA
dc.subjectRole of nursesen_ZA
dc.subjectNurse specialistsen_ZA
dc.subjectModels of careen_ZA
dc.subjectFaith-based response to healthen_ZA
dc.subjectHuman immunodeficiency virusen_ZA
dc.subjectHistory of faith-based healthcareen_ZA
dc.subjectCommunity-based supporten_ZA
dc.subjectChronic care modelen_ZA
dc.subjectCatholic healthcareen_ZA
dc.subjectAccess to antiretroviral therapyen_ZA
dc.subjectAntiretroviral therapy servicesen_ZA
dc.titleModels of care for antiretroviral treatment delivery : a faith-based organization's responseen_ZA
dc.typeDissertationen_ZA
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