Hloli Chiya - Academia.edu (original) (raw)

Papers by Hloli Chiya

Research paper thumbnail of Mapping evidence of interventions and strategies to bridge the gap in the implementation of the prevention of mother-to-child transmission of HIV programme policy in sub-Saharan countries: A scoping review

African Journal of Primary Health Care & Family Medicine, 2017

Background: Prevention of mother-to-child transmission (PMTCT) of HIV is a life-saving public hea... more Background: Prevention of mother-to-child transmission (PMTCT) of HIV is a life-saving public health intervention. Sub-Saharan African (SSA) countries have made significant progress in the programme, but little is known about the strategies used by them to eliminate mother-to-child transmission of HIV.Aim: To map evidence of strategies and interventions employed by SSA in bridging the implementation gap in the rapidly changing PMTCT of HIV programme policy.Methods: Electronic search of the databases MEDLINE, PubMed and SABINET for articles published in English between 2001 and August 2016. Key words included ‘Sub-Saharan African countries’, ‘implementation strategies’, ‘interventions to bridge implementation gap’, ‘prevention of mother-to-child transmission of HIV’ and ‘closing implementation gap’.Results: Of a total of 743 articles, 25 articles that met the inclusion criteria were included in the study. Manual content analysis resulted in the identification of three categories of s...

Research paper thumbnail of A case report of evaluating a large-scale health systems improvement project in an uncontrolled setting: a quality improvement initiative in KwaZulu-Natal, South Africa

BMJ Quality & Safety, 2012

New approaches are needed to evaluate quality improvement (QI) within large-scale public health e... more New approaches are needed to evaluate quality improvement (QI) within large-scale public health efforts. This case report details challenges to large-scale QI evaluation, and proposes solutions relying on adaptive study design. We used two sequential evaluative methods to study a QI effort to improve delivery of HIV preventive care in public health facilities in three districts in KwaZulu-Natal, South Africa, over a 3-year period. We initially used a cluster randomised controlled trial (RCT) design. During the RCT study period, tensions arose between intervention implementation and evaluation design due to loss of integrity of the randomisation unit over time, pressure to implement changes across the randomisation unit boundaries, and use of administrative rather than functional structures for the randomisation. In response to this loss of design integrity, we switched to a more flexible intervention design and a mixed-methods quasiexperimental evaluation relying on both a qualitative analysis and an interrupted time series quantitative analysis. Cluster RCT designs may not be optimal for evaluating complex interventions to improve implementation in uncontrolled 'real world' settings. More flexible, context-sensitive evaluation designs offer a better balance of the need to adjust the intervention during the evaluation to meet implementation challenges while providing the data required to evaluate effectiveness. Our case study involved HIV care in a resource-limited setting, but these issues likely apply to complex improvement interventions in other settings.

Research paper thumbnail of A retrospective clinical chart review study on the core PMTCT activities at a regional hospital in Durban, KwaZulu-Natal

Background: Despite years of implementation, the program for PMTCT is not reaching the HIV positi... more Background: Despite years of implementation, the program for PMTCT is not reaching the HIV positive pregnant women. Poor documentation as well as poor monitoring and evaluation for the program has contributed to the poor performance. This has led to South Africa being one of the 12 countries in the world with an increasing child mortality rate which is related to HIV/AIDS. Multi-steps and the complexity of the program and poor documentation have resulted in gaps in the provision of care. Objective: The aim of the study was to assess the documentation of the core activities of Prevention of Mother-to-Child Transmission of HIV program provided to pregnant women from antenatal, maternity and post-natal care at a selected Regional hospital in Ethekwini District. Methods: A non-experimental retrospective descriptive exploratory design informs the study. Provides a description of whether the activities of PMTCT are perfomed through the use of documented activities on patient's charts. A data extraction tool was used to extract information, with the demographic information as well as the key activities of PMTCT. One hundred and thirty charts of women who had delivered in the hospital of study were sampled. Results: The study revealed gaps in the documentation of some activities, with dual therapy initiated at antenatal clinic documented to be n=98(75%), whilst NVP to the baby was 105/130 (80%). The results are in contrast with Horwood's (2010) study which reported 91% receiving the Nevirapine prophylaxis. Although there are children missed by the program, it is interesting to note that more babies are receiving prophylaxis compared to women receiving NVP. The cd4 count, n=78(60%) uptake, seems not to be doing well, with only n=45(35%) , which is supported by Horwood's (2010) study that showed much improvement in the cd4 uptake (70%) compared to the study results of 60%, but less cd4 results documented were reported by Horwood (2010), showing 33% respectively. Conclusion: The National strategic Plan's (SADOH, 2007-2011/2013) for South Africa, as well as the global Millennium Development Goals can only be achieved if all the activities for the PMTCT are improved. Documentation of activities remains the key to improved care.

Research paper thumbnail of Using a Campaign Approach Among Health Workers to Increase Access to Antiretroviral Therapy for Pregnant HIV-Infected Women in South Africa

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2013

Background: In 2010, WHO guidelines modified eligibility criteria for persons living with HIV to ... more Background: In 2010, WHO guidelines modified eligibility criteria for persons living with HIV to start on lifelong antiretroviral therapy. Pregnant HIV-infected women were identified as a priority group. Yet, despite the availability of key resources and medications, antiretroviral treatment rates for pregnant women in South Africa remained low. Methods: A prospective, nonrandomized, controlled study to evaluate the impact of a campaign approach among health workers to improve referral and initiation rates of antiretroviral therapy for eligible pregnant HIV-infected women in 2 matched districts in KwaZulu-Natal Province. Results: The average number of referrals of pregnant women for antiretroviral therapy increased from 79 per month (95% confidence interval [CI]: 69 to 89) at baseline to 188 per month (95% CI: 167 to 209) 6 months after the intervention (P , 0.001). Similarly, the number of pregnant women initiated on antiretroviral therapy increased from 21 per month (95% CI: 2 to 40) at baseline to 124 per month (95% CI: 108 to 140) after the intervention (P , 0.001). Unlike in the control district, where no improvements were seen, the intervention district showed a greater than 4-fold increase in women initiated on antiretroviral therapy. Conclusion: A targeted campaign among health workers can accelerate access to antiretroviral therapy for pregnant HIVinfected women.

Research paper thumbnail of Mapping evidence of interventions and strategies to bridge the gap in the implementation of the prevention of mother-to-child transmission of HIV programme policy in sub-Saharan countries: A scoping review

African Journal of Primary Health Care & Family Medicine, 2017

Background: Prevention of mother-to-child transmission (PMTCT) of HIV is a life-saving public hea... more Background: Prevention of mother-to-child transmission (PMTCT) of HIV is a life-saving public health intervention. Sub-Saharan African (SSA) countries have made significant progress in the programme, but little is known about the strategies used by them to eliminate mother-to-child transmission of HIV.Aim: To map evidence of strategies and interventions employed by SSA in bridging the implementation gap in the rapidly changing PMTCT of HIV programme policy.Methods: Electronic search of the databases MEDLINE, PubMed and SABINET for articles published in English between 2001 and August 2016. Key words included ‘Sub-Saharan African countries’, ‘implementation strategies’, ‘interventions to bridge implementation gap’, ‘prevention of mother-to-child transmission of HIV’ and ‘closing implementation gap’.Results: Of a total of 743 articles, 25 articles that met the inclusion criteria were included in the study. Manual content analysis resulted in the identification of three categories of s...

Research paper thumbnail of A case report of evaluating a large-scale health systems improvement project in an uncontrolled setting: a quality improvement initiative in KwaZulu-Natal, South Africa

BMJ Quality & Safety, 2012

New approaches are needed to evaluate quality improvement (QI) within large-scale public health e... more New approaches are needed to evaluate quality improvement (QI) within large-scale public health efforts. This case report details challenges to large-scale QI evaluation, and proposes solutions relying on adaptive study design. We used two sequential evaluative methods to study a QI effort to improve delivery of HIV preventive care in public health facilities in three districts in KwaZulu-Natal, South Africa, over a 3-year period. We initially used a cluster randomised controlled trial (RCT) design. During the RCT study period, tensions arose between intervention implementation and evaluation design due to loss of integrity of the randomisation unit over time, pressure to implement changes across the randomisation unit boundaries, and use of administrative rather than functional structures for the randomisation. In response to this loss of design integrity, we switched to a more flexible intervention design and a mixed-methods quasiexperimental evaluation relying on both a qualitative analysis and an interrupted time series quantitative analysis. Cluster RCT designs may not be optimal for evaluating complex interventions to improve implementation in uncontrolled 'real world' settings. More flexible, context-sensitive evaluation designs offer a better balance of the need to adjust the intervention during the evaluation to meet implementation challenges while providing the data required to evaluate effectiveness. Our case study involved HIV care in a resource-limited setting, but these issues likely apply to complex improvement interventions in other settings.

Research paper thumbnail of A retrospective clinical chart review study on the core PMTCT activities at a regional hospital in Durban, KwaZulu-Natal

Background: Despite years of implementation, the program for PMTCT is not reaching the HIV positi... more Background: Despite years of implementation, the program for PMTCT is not reaching the HIV positive pregnant women. Poor documentation as well as poor monitoring and evaluation for the program has contributed to the poor performance. This has led to South Africa being one of the 12 countries in the world with an increasing child mortality rate which is related to HIV/AIDS. Multi-steps and the complexity of the program and poor documentation have resulted in gaps in the provision of care. Objective: The aim of the study was to assess the documentation of the core activities of Prevention of Mother-to-Child Transmission of HIV program provided to pregnant women from antenatal, maternity and post-natal care at a selected Regional hospital in Ethekwini District. Methods: A non-experimental retrospective descriptive exploratory design informs the study. Provides a description of whether the activities of PMTCT are perfomed through the use of documented activities on patient's charts. A data extraction tool was used to extract information, with the demographic information as well as the key activities of PMTCT. One hundred and thirty charts of women who had delivered in the hospital of study were sampled. Results: The study revealed gaps in the documentation of some activities, with dual therapy initiated at antenatal clinic documented to be n=98(75%), whilst NVP to the baby was 105/130 (80%). The results are in contrast with Horwood's (2010) study which reported 91% receiving the Nevirapine prophylaxis. Although there are children missed by the program, it is interesting to note that more babies are receiving prophylaxis compared to women receiving NVP. The cd4 count, n=78(60%) uptake, seems not to be doing well, with only n=45(35%) , which is supported by Horwood's (2010) study that showed much improvement in the cd4 uptake (70%) compared to the study results of 60%, but less cd4 results documented were reported by Horwood (2010), showing 33% respectively. Conclusion: The National strategic Plan's (SADOH, 2007-2011/2013) for South Africa, as well as the global Millennium Development Goals can only be achieved if all the activities for the PMTCT are improved. Documentation of activities remains the key to improved care.

Research paper thumbnail of Using a Campaign Approach Among Health Workers to Increase Access to Antiretroviral Therapy for Pregnant HIV-Infected Women in South Africa

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2013

Background: In 2010, WHO guidelines modified eligibility criteria for persons living with HIV to ... more Background: In 2010, WHO guidelines modified eligibility criteria for persons living with HIV to start on lifelong antiretroviral therapy. Pregnant HIV-infected women were identified as a priority group. Yet, despite the availability of key resources and medications, antiretroviral treatment rates for pregnant women in South Africa remained low. Methods: A prospective, nonrandomized, controlled study to evaluate the impact of a campaign approach among health workers to improve referral and initiation rates of antiretroviral therapy for eligible pregnant HIV-infected women in 2 matched districts in KwaZulu-Natal Province. Results: The average number of referrals of pregnant women for antiretroviral therapy increased from 79 per month (95% confidence interval [CI]: 69 to 89) at baseline to 188 per month (95% CI: 167 to 209) 6 months after the intervention (P , 0.001). Similarly, the number of pregnant women initiated on antiretroviral therapy increased from 21 per month (95% CI: 2 to 40) at baseline to 124 per month (95% CI: 108 to 140) after the intervention (P , 0.001). Unlike in the control district, where no improvements were seen, the intervention district showed a greater than 4-fold increase in women initiated on antiretroviral therapy. Conclusion: A targeted campaign among health workers can accelerate access to antiretroviral therapy for pregnant HIVinfected women.