Anna Voce | University of KwaZulu-Natal (original) (raw)
Papers by Anna Voce
PLoS ONE, 2014
To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship... more To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship between health system performance and patient treatment outcomes at 4 decentralised MDR-TB sites. In this mixed methods case study which included prospective comparative data, we measured health system performance using a framework of domains comprising key health service components. Using Pearson Product Moment Correlation coefficients we quantified the direction and magnitude of the association between health system performance and MDR-TB treatment outcomes. Qualitative data from participant observation and interviews analysed using systematic text condensation (STC) complemented our quantitative findings. We found significant differences in treatment outcomes across the sites with successful outcomes varying from 72% at Site 1 to 52% at Site 4 (p<0.01). Health systems performance scores also varied considerably across the sites. Our findings suggest there is a correlation between treatment outcomes and overall health system performance which is significant (r = 0.99, p<0.01), with Site 1 having the highest number of successful treatment outcomes and the highest health system performance. Although the 'integration' domain, which measured integration of MDR-TB services into existing services appeared to have the strongest association with successful treatment outcomes (r = 0.99, p<0.01), qualitative data indicated that the 'context' domain influenced the other domains. We suggest that there is an association between treatment outcomes and health system performance. The chance of treatment success is greater if decentralised MDR-TB services are integrated into existing services. To optimise successful treatment outcomes, regular monitoring and support are needed at a district, facility and individual level to ensure the local context is supportive of new programmes and implementation is according to guidelines.
i Dedication I dedicate this work to the memory of my father, Angelo Gabriele Antonio Voce, who t... more i Dedication I dedicate this work to the memory of my father, Angelo Gabriele Antonio Voce, who taught me always to say YES to life and all its gifts and challenges.
Protocol Submission Administration, Feb 6, 2010
Protocol Submission Administration, Apr 5, 2011
Social Science and Medicine, 2010
BACKGROUND: Human Immunodeficiency Virus(HIV) transmission via breast milk, in an era of a global... more BACKGROUND: Human Immunodeficiency Virus(HIV) transmission via breast milk, in an era of a global HIV pandemic, complicated breast feeding practices and triggered responsive changes in IYCF guidelines during the past decade. The KZN Department of Health was the first South African health authority to embrace the WHO 2010 IYCF policy revision. Effective 1 January 2011, exclusive breast feeding(EBF) during the first 6-months of life, including EBF of infants of HIV-infected mothers, was recommended, with antiretroviral(ARV) prophylaxis for HIV-exposed infants whose mothers weren’t receiving ARV therapy, and the phasing out of free formula-feed. This study aimed to investigate early outcomes and the impact of IYCF policy revisions in KZN, by assessing infant feeding practices, infant morbidity, and infant mortality. METHODS: The study was conducted at first-level IYCF service points in KZN, during June and July,2012. Mixed-method, observational study designs were used. Thirty facilitie...
The International Journal of Tuberculosis and Lung Disease, 2015
KwaZulu-Natal, South Africa, a predominantly rural province with a high burden of tuberculosis (T... more KwaZulu-Natal, South Africa, a predominantly rural province with a high burden of tuberculosis (TB), multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection. To determine the most effective care model by comparing MDR-TB treatment outcomes at community-based sites with traditional care at a central, specialised hospital. A non-randomised observational prospective cohort study comparing community-based and centralised care. Patients at community-based sites were closer to home and had easier access to care, and home-based care was available from treatment initiation. Four community-based sites treated 736 patients, while 813 were treated at the centralised hospital (total = 1549 patients). Overall, 75% were HIV co-infected (community: 76% vs. hospitalised: 73%, P = 0.45) and 86% received antiretroviral therapy (community: 91% vs. hospitalised: 82%, P = 0.22). On multivariate analysis, MDR-TB patients were more likely to have a successful treatment outcome if they were treated at a community-based site (adjusted OR 1.43, P = 0.01). However, outcomes at the four community-based sites were heterogeneous, with Site 1 demonstrating that home-based care was associated with an increased treatment success of 72% compared with success rates of 52-60% at the other three sites. Community-based care for MDR-TB patients was more effective than care in a central, specialised hospital. Home-based care further increased treatment success.
Social Science & Medicine, 2010
PLoS ONE, 2014
Objective: To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the r... more Objective: To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship between health system performance and patient treatment outcomes at 4 decentralised MDR-TB sites.
The International Journal of Tuberculosis and Lung Disease, 2012
Setting-In KwaZulu-Natal, South Africa, a TB and HIV endemic setting, prolonged hospitalisation f... more Setting-In KwaZulu-Natal, South Africa, a TB and HIV endemic setting, prolonged hospitalisation for the treatment of the growing number of MDR-TB patients is not possible or effective.
![Research paper thumbnail of The treatment journey of a patient with multidrug-resistant tuberculosis in South Africa: is it patient-centred? [Notes from the field]](https://attachments.academia-assets.com/43976615/thumbnails/1.jpg)
](The International Journal of Tuberculosis and Lung Disease, 2013
To improve the treatment of patients co-infected with multidrug-resistant tuberculosis (MDR-TB) a... more To improve the treatment of patients co-infected with multidrug-resistant tuberculosis (MDR-TB) and the human immunodeficiency virus, we measured the relationship between treatment outcomes and hospital performance at four decentralised MDR-TB sites in South Africa. We describe hospital performance from the patient's perspective by the use of a graphic that visually represents a patient's treatment journey. The graphic was used to report study findings to study sites and as a catalyst for a quality improvement process. K E Y W O R D S : MDR-TB treatment; health systems; patient-centred
BMC Pediatrics, 2009
Background: Integrated Management of Childhood Illness (IMCI) is a strategy to reduce mortality a... more Background: Integrated Management of Childhood Illness (IMCI) is a strategy to reduce mortality and morbidity in children under-5 years by improving management of common illnesses at primary level. IMCI has been shown to improve health worker performance, but constraints have been identified in achieving sufficient coverage to improve child survival, and implementation remains sub-optimal. At the core of the IMCI strategy is a clinical guideline whereby health workers use a series of algorithms to assess and manage a sick child, and give counselling to carers. IMCI is taught using a structured 11-day training course that combines classroom work with clinical practise; a variety of training techniques are used, supported by comprehensive training materials and detailed instructions for facilitators.
BMC Health Services Research, 2011
Background: Audit and feedback is an established strategy for improving maternal, neonatal and ch... more Background: Audit and feedback is an established strategy for improving maternal, neonatal and child health. The Perinatal Problem Identification Programme (PPIP), implemented in South African public hospitals in the late 1990s, measures perinatal mortality rates and identifies avoidable factors associated with each death. The aim of this study was to elucidate the processes involved in the implementation and sustainability of this programme. Methods: Clinicians' experiences of the implementation and maintenance of PPIP were explored qualitatively in two workshop sessions. An analytical framework comprising six stages of change, divided into three phases, was used: pre-implementation (create awareness, commit to implementation); implementation (prepare to implement, implement) and institutionalisation (integrate into routine practice, sustain new practices).
AIDS and Behavior, 2014
Disclosure of HIV status is widely promoted in the prevention of mother-to-child transmission (PM... more Disclosure of HIV status is widely promoted in the prevention of mother-to-child transmission (PMTCT), but a number of context-specific factors may mediate disclosure outcomes. To better understand HIV-disclosure dynamics, we conducted in-depth interviews among 62 HIV-positive pregnant women accessing PMTCT services in Durban, South Africa. Transcripts were coded for emergent themes and categories. Thirty-nine women (63 %) had been recently diagnosed with HIV; most (n = 37; 95 %) were diagnosed following routine antenatal HIV testing. Forty-two women (68 %) reported unplanned pregnancies. Overall, 37 women (60 %) reported an unintended pregnancy and recent HIV diagnosis. For them, 2 life-changing diagnoses had resulted in a double-disclosure bind. The timing and stigma surrounding these events strongly influenced disclosure of pregnancy and/or HIV. PMTCT-related counseling must be responsive to the complex personal implications of contemporaneous, life-changing events, especially their effect on HIV-disclosure dynamics and, ultimately, on achieving better maternal mental-health outcomes.
Implementation science : IS, Jan 3, 2014
BackgroundCombination antiretroviral therapy (cART) is the current strategy to prevent mother-to-... more BackgroundCombination antiretroviral therapy (cART) is the current strategy to prevent mother-to-child transmission (PMTCT) of HIV. Women initiated on cART should continue taking treatment life-long or stop after cessation of breastfeeding depending on their CD4 cell count or World Health Organization (WHO) staging. Keeping people living with HIV on treatment is essential for the success of any anti-retroviral therapy (ART) programme. There has been a rapid scale-up of cART in the PMTCT programme in South Africa. cART is supposed to be taken life-long or until cessation of breastfeeding, but premature or unmanaged discontinuation of cART postpartum is not unusual in South Africa and is confirmed by studies from around the world. Discontinuation of cART can lead to mother-to-child transmission (MTCT), drug resistance and poor maternal outcomes. The extent of this problem in the South African context however is unclear. This study aims to determine the prevalence of and identify risk ...
PLoS ONE, 2014
To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship... more To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship between health system performance and patient treatment outcomes at 4 decentralised MDR-TB sites. In this mixed methods case study which included prospective comparative data, we measured health system performance using a framework of domains comprising key health service components. Using Pearson Product Moment Correlation coefficients we quantified the direction and magnitude of the association between health system performance and MDR-TB treatment outcomes. Qualitative data from participant observation and interviews analysed using systematic text condensation (STC) complemented our quantitative findings. We found significant differences in treatment outcomes across the sites with successful outcomes varying from 72% at Site 1 to 52% at Site 4 (p<0.01). Health systems performance scores also varied considerably across the sites. Our findings suggest there is a correlation between treatment outcomes and overall health system performance which is significant (r = 0.99, p<0.01), with Site 1 having the highest number of successful treatment outcomes and the highest health system performance. Although the 'integration' domain, which measured integration of MDR-TB services into existing services appeared to have the strongest association with successful treatment outcomes (r = 0.99, p<0.01), qualitative data indicated that the 'context' domain influenced the other domains. We suggest that there is an association between treatment outcomes and health system performance. The chance of treatment success is greater if decentralised MDR-TB services are integrated into existing services. To optimise successful treatment outcomes, regular monitoring and support are needed at a district, facility and individual level to ensure the local context is supportive of new programmes and implementation is according to guidelines.
i Dedication I dedicate this work to the memory of my father, Angelo Gabriele Antonio Voce, who t... more i Dedication I dedicate this work to the memory of my father, Angelo Gabriele Antonio Voce, who taught me always to say YES to life and all its gifts and challenges.
Protocol Submission Administration, Feb 6, 2010
Protocol Submission Administration, Apr 5, 2011
Social Science and Medicine, 2010
BACKGROUND: Human Immunodeficiency Virus(HIV) transmission via breast milk, in an era of a global... more BACKGROUND: Human Immunodeficiency Virus(HIV) transmission via breast milk, in an era of a global HIV pandemic, complicated breast feeding practices and triggered responsive changes in IYCF guidelines during the past decade. The KZN Department of Health was the first South African health authority to embrace the WHO 2010 IYCF policy revision. Effective 1 January 2011, exclusive breast feeding(EBF) during the first 6-months of life, including EBF of infants of HIV-infected mothers, was recommended, with antiretroviral(ARV) prophylaxis for HIV-exposed infants whose mothers weren’t receiving ARV therapy, and the phasing out of free formula-feed. This study aimed to investigate early outcomes and the impact of IYCF policy revisions in KZN, by assessing infant feeding practices, infant morbidity, and infant mortality. METHODS: The study was conducted at first-level IYCF service points in KZN, during June and July,2012. Mixed-method, observational study designs were used. Thirty facilitie...
The International Journal of Tuberculosis and Lung Disease, 2015
KwaZulu-Natal, South Africa, a predominantly rural province with a high burden of tuberculosis (T... more KwaZulu-Natal, South Africa, a predominantly rural province with a high burden of tuberculosis (TB), multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection. To determine the most effective care model by comparing MDR-TB treatment outcomes at community-based sites with traditional care at a central, specialised hospital. A non-randomised observational prospective cohort study comparing community-based and centralised care. Patients at community-based sites were closer to home and had easier access to care, and home-based care was available from treatment initiation. Four community-based sites treated 736 patients, while 813 were treated at the centralised hospital (total = 1549 patients). Overall, 75% were HIV co-infected (community: 76% vs. hospitalised: 73%, P = 0.45) and 86% received antiretroviral therapy (community: 91% vs. hospitalised: 82%, P = 0.22). On multivariate analysis, MDR-TB patients were more likely to have a successful treatment outcome if they were treated at a community-based site (adjusted OR 1.43, P = 0.01). However, outcomes at the four community-based sites were heterogeneous, with Site 1 demonstrating that home-based care was associated with an increased treatment success of 72% compared with success rates of 52-60% at the other three sites. Community-based care for MDR-TB patients was more effective than care in a central, specialised hospital. Home-based care further increased treatment success.
Social Science & Medicine, 2010
PLoS ONE, 2014
Objective: To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the r... more Objective: To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship between health system performance and patient treatment outcomes at 4 decentralised MDR-TB sites.
The International Journal of Tuberculosis and Lung Disease, 2012
Setting-In KwaZulu-Natal, South Africa, a TB and HIV endemic setting, prolonged hospitalisation f... more Setting-In KwaZulu-Natal, South Africa, a TB and HIV endemic setting, prolonged hospitalisation for the treatment of the growing number of MDR-TB patients is not possible or effective.
The International Journal of Tuberculosis and Lung Disease, 2013
To improve the treatment of patients co-infected with multidrug-resistant tuberculosis (MDR-TB) a... more To improve the treatment of patients co-infected with multidrug-resistant tuberculosis (MDR-TB) and the human immunodeficiency virus, we measured the relationship between treatment outcomes and hospital performance at four decentralised MDR-TB sites in South Africa. We describe hospital performance from the patient's perspective by the use of a graphic that visually represents a patient's treatment journey. The graphic was used to report study findings to study sites and as a catalyst for a quality improvement process. K E Y W O R D S : MDR-TB treatment; health systems; patient-centred
BMC Pediatrics, 2009
Background: Integrated Management of Childhood Illness (IMCI) is a strategy to reduce mortality a... more Background: Integrated Management of Childhood Illness (IMCI) is a strategy to reduce mortality and morbidity in children under-5 years by improving management of common illnesses at primary level. IMCI has been shown to improve health worker performance, but constraints have been identified in achieving sufficient coverage to improve child survival, and implementation remains sub-optimal. At the core of the IMCI strategy is a clinical guideline whereby health workers use a series of algorithms to assess and manage a sick child, and give counselling to carers. IMCI is taught using a structured 11-day training course that combines classroom work with clinical practise; a variety of training techniques are used, supported by comprehensive training materials and detailed instructions for facilitators.
BMC Health Services Research, 2011
Background: Audit and feedback is an established strategy for improving maternal, neonatal and ch... more Background: Audit and feedback is an established strategy for improving maternal, neonatal and child health. The Perinatal Problem Identification Programme (PPIP), implemented in South African public hospitals in the late 1990s, measures perinatal mortality rates and identifies avoidable factors associated with each death. The aim of this study was to elucidate the processes involved in the implementation and sustainability of this programme. Methods: Clinicians' experiences of the implementation and maintenance of PPIP were explored qualitatively in two workshop sessions. An analytical framework comprising six stages of change, divided into three phases, was used: pre-implementation (create awareness, commit to implementation); implementation (prepare to implement, implement) and institutionalisation (integrate into routine practice, sustain new practices).
AIDS and Behavior, 2014
Disclosure of HIV status is widely promoted in the prevention of mother-to-child transmission (PM... more Disclosure of HIV status is widely promoted in the prevention of mother-to-child transmission (PMTCT), but a number of context-specific factors may mediate disclosure outcomes. To better understand HIV-disclosure dynamics, we conducted in-depth interviews among 62 HIV-positive pregnant women accessing PMTCT services in Durban, South Africa. Transcripts were coded for emergent themes and categories. Thirty-nine women (63 %) had been recently diagnosed with HIV; most (n = 37; 95 %) were diagnosed following routine antenatal HIV testing. Forty-two women (68 %) reported unplanned pregnancies. Overall, 37 women (60 %) reported an unintended pregnancy and recent HIV diagnosis. For them, 2 life-changing diagnoses had resulted in a double-disclosure bind. The timing and stigma surrounding these events strongly influenced disclosure of pregnancy and/or HIV. PMTCT-related counseling must be responsive to the complex personal implications of contemporaneous, life-changing events, especially their effect on HIV-disclosure dynamics and, ultimately, on achieving better maternal mental-health outcomes.
Implementation science : IS, Jan 3, 2014
BackgroundCombination antiretroviral therapy (cART) is the current strategy to prevent mother-to-... more BackgroundCombination antiretroviral therapy (cART) is the current strategy to prevent mother-to-child transmission (PMTCT) of HIV. Women initiated on cART should continue taking treatment life-long or stop after cessation of breastfeeding depending on their CD4 cell count or World Health Organization (WHO) staging. Keeping people living with HIV on treatment is essential for the success of any anti-retroviral therapy (ART) programme. There has been a rapid scale-up of cART in the PMTCT programme in South Africa. cART is supposed to be taken life-long or until cessation of breastfeeding, but premature or unmanaged discontinuation of cART postpartum is not unusual in South Africa and is confirmed by studies from around the world. Discontinuation of cART can lead to mother-to-child transmission (MTCT), drug resistance and poor maternal outcomes. The extent of this problem in the South African context however is unclear. This study aims to determine the prevalence of and identify risk ...