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[ID] => 1715
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[post_date] => 2021-07-16 14:54:02
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[post_content] => Although access to healthcare has improved since South Africa’s democratic transition, neoliberal reforms have had detrimental effects on clinic-community and nurse-patient relationships, undermining efforts to control tuberculosis (TB). This article focuses upon the work of nurses in three public health clinics in the Western Cape, South Africa. We explore how they experienced, made sense of and grappled with the challenges of TB control, especially patients “defaulting” on medication. Paying particular attention to confrontations between nurses and patients, we build upon previous qualitative studies that have contested popular constructions of nurses as “rude” and “uncaring.” We argue that patient blaming and scolding need to be understood in light of nurses having to tread a fine line between compassion and assertiveness, individual and public good against the backdrop of a dissonance between the theory and reality of TB control. Nurses’ confrontational approaches are responses to the messy reality of TB control on the ground, solutions to which require attention to the socioeconomic and historical context of nursing and primary healthcare. In the absence of such attention, animosities between clinics and communities could continue being cyclically reproduced.
Dixon, J., & Tameris, M. (2018). A disease beyond reach: nurse perspectives on the past and present of tuberculosis control in South Africa.
Anthropology Southern Africa,
41(4), 257-269.
[post_title] => A disease beyond reach: nurse perspectives on the past and present of tuberculosis control in South Africa
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[1] => WP_Post Object
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[post_date] => 2021-07-16 14:53:25
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[post_content] => During ethnographic research at a tuberculosis vaccine trial site in South Africa, trial participants often evoked the idiom of “clean blood.” In this article, we illustrate how the trials enacted a form of moral triage in which “objective” bioscientific knowledge and moral subjectivity were coproduced. Participation created possibilities to demonstrate healthiness, respectability, and godliness in a context where positive self-imaginings were hard won, but could also lead to dejection and shame. We suggest that struggles to be recognized as virtuous are often overlooked in anthropological critiques of clinical trials and bioethics, but are important for understanding how trials meld with local moral worlds.
Dixon, J., & Tameris, M. (2018). Clean blood, religion, and moral triage in tuberculosis vaccine trials.
Medical anthropology,
37(8), 708-721.
[post_title] => Clean Blood, Religion, and Moral Triage in Tuberculosis Vaccine Trials
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[post_date] => 2021-07-16 14:52:31
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[post_content] => Understanding Tuberculosis and its Control: Anthropological and ethnographic Approaches
Over the last two decades, attempts to control the problem of tuberculosis have become increasingly more complex, as countries adopt and adapt to evolving global TB strategies. Significant funding has also increased apace, diagnostic possibilities have evolved, and greater attention is being paid to developing broader health systems. Against this background, this book examines tuberculosis control through an anthropological lens. Drawing on ethnographic case studies from China, India, Nepal, South Africa, Romania, Brazil, Ghana and France, the volume considers: the relationship between global and national policies and their unintended effects; the emergence and impact of introducing new diagnostics; the reliance on and use of statistical numbers for representing tuberculosis, and the politics of this; the impact of the disease on health workers, as well as patients; the rise of drug-resistant forms; and issues of attempted control. Together, the examples showcase the value of an anthropological understanding to demonstrate the broader bio-political and social dimensions of tuberculosis and attempts to deal with it.
MacDonald, H., & Harper, I. (Eds.). (2019).
Understanding Tuberculosis and Its Control: Anthropological and Ethnographic Approaches. Routledge.
[post_title] => Between representing and intervening: Diagnosing childhood tuberculosis during a vaccine trial in South Africa
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[ID] => 1718
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[post_date] => 2021-07-16 14:50:25
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[post_content] => Rising concerns around antimicrobial resistance (AMR) have led to a renewed push to rationalise antibiotic prescribing in low- and middle-income countries (LMICs). There is increasing unease in conceptualising antibiotic use as individuals behaving ‘(ir)rationally’ and recognition that rising use is emergent of and contributing to wider economic and political challenges. But in between these individual and societal ‘drivers’ of antibiotic use is an everyday articulation of care through these substances, written-in to the scripts, delivery chains and pedagogics of global healthcare. This article focuses on this everyday ‘architecture’ that over time and across spaces has knitted-in antibiotics and rhetorics of control that inform current responses to AMR. Based on historically informed ethnographic research in Zimbabwe, we examine points of continuity and change between 20th Century rational drug use (RDU) discourses and contemporary socio-political formations around AMR and antimicrobial stewardship (AMS), paying particular attention to their co-evolution with the process of pharmaceuticalisation. We illustrate how the framework and techniques of RDU were embedded within programmes to increase access to essential medicines and as such complemented the building of one of Africa's strongest postcolonial health systems in Zimbabwe. Whilst 20th Century RDU was focused on securing the health and safety of patients and affordability for systems, AMS programmes aim to secure medicines. Continuous through both RDU and AMS programmes is the persistent rhetoric of ‘irrational use’. Health workers in Harare, attuned to the values and language of these programmes, enact in their everyday practice an architecture in which antibiotics have been designed-in. This research illustrates the struggle to optimise antibiotic use within current framings for action. We propose a reconfiguring of the architecture of global health such that frontline prescribers are able to provide ‘good’ care without necessarily turning to antibiotics. To design-out antibiotic reliance would require attention beyond '(ir)rationality', to the redrafting of blueprints that inscribe practice.
Dixon, J., Manyau, S., Kandiye, F., Kranzer, K., & Chandler, C. I. (2021). Antibiotics, rational drug use and the architecture of global health in Zimbabwe.
Social Science & Medicine,
272, 113594.
[post_title] => Antibiotics, rational drug use and the architecture of global health in Zimbabwe
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[post_date] => 2021-05-18 09:57:28
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[post_content] =>
Background
There is a need for innovative strategies to improve TB testing uptake and patient retention along the continuum of TB care early-on in treatment without burdening under-resourced health systems. We used a mixed methods approach to develop and pilot test a tuberculosis literacy and counselling intervention at an urban clinic in KwaZulu Natal, South Africa, to improve TB testing uptake and retention in tuberculosis care.
Methods
We engaged in discussions with clinic staff to plan and develop the intervention, which was delivered by senior social work students who received one-week training. The intervention included: 1) group health talks with all patients attending the primary clinic; and 2) individual counselling sessions, using motivational interviewing techniques, with newly diagnosed tuberculosis patients. We compared social work students’ tuberculosis knowledge, attitudes, and practices before and after their training. We assessed the change in number of tuberculosis diagnostic tests performed after implementation via an interrupted time series analysis with a quasi-Poisson regression model. We compared pre- and post-intervention probabilities of treatment initiation and completion using regression analyses, adjusting for potential baseline confounders. We conducted focus groups with the students, as well as brief surveys and one-on-one interviews with patients, to assess acceptability, feasibility, and implementation.
Results
During the study period, 1226 individuals received tuberculosis diagnostic testing and 163 patients started tuberculosis treatment, of whom 84 (51.5%) received individual counselling. The number of diagnostic tuberculosis tests performed increased by 1.36 (95%CI 1.23–1.58) times post-intervention, adjusting for background calendar trend. Probabilities of TB treatment initiation and treatment completion increased by 10.1% (95%CI 1.5–21.3%) and 4.4% (95%CI -7.3-16.0%), respectively. Patients found the counselling sessions alleviated anxiety and increased treatment self-efficacy. Social work students felt the clinic staff were collaborative and highly supportive of the intervention, and that it improved patient engagement and adherence.
Conclusions
Engaging clinic staff in the development of an intervention ensures buy-in and collaboration. Education and counselling before and early-on in tuberculosis treatment can increase tuberculosis testing and treatment uptake. Training junior social workers can enable task-shifting in under-resourced settings, while addressing important service gaps in tuberculosis care.
Law, S., Seepamore, B., Oxlade, O., Sikhakhane, N., Dawood, H., Chetty, S., Padayatchi, N., Menzies, D., & Daftary, A. (2021). Acceptability, feasibility, and impact of a pilot tuberculosis literacy and treatment counselling intervention: a mixed methods study.
BMC Infectious Diseases, 21(449).
[post_title] => Acceptability, feasibility, and impact of a pilot tuberculosis literacy and treatment counselling intervention: a mixed methods study
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[post_modified] => 2021-07-15 00:29:46
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[5] => WP_Post Object
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[ID] => 1618
[post_author] => 28
[post_date] => 2021-04-19 17:19:52
[post_date_gmt] => 2021-04-19 21:19:52
[post_content] =>
Background South Africa has high burdens of tuberculosis (TB) and TB-HIV, yet the quality of patient care in the private sector is unknown. We describe quality of TB and TB-HIV care among private general practitioners (GPs) in two South African cities using standardised patients (SPs).
Methods Sixteen SPs presented one of three cases during unannounced visits to private GPs in selected high-TB burden communities in Durban and Cape Town: case 1, typical TB symptoms, HIV-positive; case 2, TB-specified laboratory report, HIV-negative and case 3, history of incomplete TB treatment, HIV-positive. Clinical practices were recorded in standardised exit interviews. Ideal management was defined as relevant testing or public sector referral for any reason. The difference between knowledge and practice (know-do gap) was assessed through case 1 vignettes among 25% of GPs. Factors associated with ideal management were assessed using bivariate logistic regression.
Results 511 SP visits were completed with 212 GPs. Respectively, TB and HIV were ideally managed in 43% (95% CI 36% to 50%) and 41% (95% CI 34% to 48%) of case 1, 85% (95% CI 78% to 90%) and 61% (95% CI 73% to 86%) of case 2 and 69% (95% CI 61% to 76%) and 80% (95% CI 52% to 68%) of case 3 presentations. HIV status was queried in 35% (95% CI 31% to 39%) of visits, least with case 1 (24%, 95% CI 18% to 30%). The difference between knowledge and practice was 80% versus 43% for TB and 55% versus 37% for HIV, resulting in know-do gaps of 37% (95% CI 19% to 55%) and 18% (95% CI −1% to 38%), respectively. Ideal TB management was associated with longer visit time (OR=1.1, 95% CI 1.1 to 1.2), female GPs (3.2, 95% CI 2.0 to 5.1), basic symptom inquiry (2.0, 95% CI 1.7 to 2.3), HIV-status inquiry (OR=11.2, 95% CI 6.4 to 19.6), fewer medications dispensed (OR=0.6, 95% CI 0.5 to 0.7) and Cape Town (OR=2.2, 95% CI 1.5 to 3.1). Similar associations were observed for HIV.
Conclusions Private providers ideally managed TB more often when a diagnosis or history of TB was implied or provided. Management of HIV in the context of TB was less than optimal.
Boffa, J., Moyo, S, Chikovore, J., Salomon, A., Daniels, B., Kwan, A. T., Pai, M. & Daftary, A. (2021). Quality of care for tuberculosis and HIV in the private health sector: a cross-sectional, standardised patient study in South Africa.
BMJ Global Health, 6(5).
[post_title] => Quality of care for tuberculosis and HIV in the private health sector: a cross-sectional, standardised patient study in South Africa
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[post_modified] => 2021-07-15 13:21:53
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[ID] => 1626
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[post_date] => 2021-02-13 18:55:09
[post_date_gmt] => 2021-02-13 23:55:09
[post_content] =>
In 2011, the South African National TB Programme launched a policy of decentralized management of drug-resistant tuberculosis (DR-TB) in order to expand the capacity of facilities to treat patients with DR-TB, minimize delays to access care and improve patient outcomes. This policy directive was implemented to varying degrees within a rapidly evolving diagnostic and treatment landscape for DR-TB, placing new demands on already-stressed health systems. The variable readiness of district-level systems to implement the policy prompted questions not only about differences in health systems resources but also front-line actors’ capacity to implement change in resource-constrained facilities. Using a grounded theory approach, we analysed data from in-depth interviews and small group discussions conducted between 2016 and 2018 with managers (n = 9), co-ordinators (n = 15), doctors (n = 7) and nurses (n = 18) providing DR-TB care. Data were collected over two phases in district-level decentralized sites of three South African provinces. While health systems readiness assessments conventionally map the availability of ‘hardware’, i.e. resources and skills to deliver an intervention, a notable absence of systems ‘hardware’ meant that systems ‘software’, i.e. health care workers (HCWs) agency, behaviours and interactions provided the basis of locally relevant strategies for decentralized DR-TB care. ‘Software readiness’ was manifest in four areas of DR-TB care: re-organization of service delivery, redressal of resource shortages, creation of treatment adherence support systems and extension of care parameters for vulnerable patients. These strategies demonstrate adaptive capacity and everyday resilience among HCW to withstand the demands of policy change and innovation in stressed systems. Our work suggests that a useful extension of health systems ‘readiness’ assessments would include definition and evaluation of HCW ‘software’ and adaptive capacities in the face of systems hardware gaps.
Kielmann, K., Dickson-Hall, L., Jassat, W., Le Roux, S., Moshabela, M., Cox, H., ... & Black, J. (2021). ‘We had to manage what we had on hand, in whatever way we could’: adaptive responses in policy for decentralized drug-resistant tuberculosis care in South Africa. Health policy and planning, 36(3), 249-259.
[post_title] => ‘We had to manage what we had on hand, in whatever way we could’: adaptive responses in policy for decentralized drug-resistant tuberculosis care in South Africa
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[post_modified] => 2021-07-08 18:08:36
[post_modified_gmt] => 2021-07-08 22:08:36
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[post_date] => 2020-09-01 00:00:48
[post_date_gmt] => 2020-09-01 04:00:48
[post_content] => This report details the findings of the Botswana Miners Right to Health Project’s two-year assessment of the right to health of miners and ex-miners in Botswana. This Project is motivated by the fact that while Botswana’s mineral wealth has made it one of the richest nations in Africa it remains a deeply unequal country. And the people who have fueled Botswana’s remarkable development—miners and ex-miners—suffer severe deprivations of their health. This central truth illuminates the content of this report: All Risk and No Reward: How the Government and Mine Companies Fail to Protect the Right to Health of Miners and Ex-Miners in Botswana.
Citro, B., Mankad, M., & Phiri, K. (2020).
All Risk and No Reward: How the Government and Mine Companies Fail to Protect the Right to Health of Miners and Ex-Miners in Botswana. Botswana Labour Migrants Association, Center for Economic and Social Rights, Northwestern Pritzker School of Law Center for International Human Rights.
[post_title] => All Risk and No Reward: How the Government and Mine Companies Fail to Protect the Right to Health of Miners and Ex-Miners in Botswana
[post_excerpt] =>
[post_status] => publish
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[post_name] => all-risk-and-no-reward
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[post_modified] => 2021-07-15 22:11:23
[post_modified_gmt] => 2021-07-16 02:11:23
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[post_date] => 2020-08-24 01:00:45
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[post_content] =>
This is a randomized controlled trial (RCT) to determine whether Video Observed Treatment (VDOT) using social internet bundle incentives for tuberculosis (TB) is an effective way to improve medication adherence in TB treatment, compared with standard in-person treatment (home-/ community-based).
The study will include two study arms: one will receive TB treatment using the standard in-person DOT, and the other through VDOT. All patients (regardless of study arm) will receive daily TB treatment under home- or community-based observation . For patients in the In-person DOT arm, this will be observed and recorded daily by a study nurse. Patients in the VDOT arm however, will be required to record and upload their daily medication intake using a mobile phone App. As a form of incentive, these patients will be rewarded with social internet bundles for every 7 consecutive video uploads. Additionally, they will be sent motivational text messages to encourage treatment compliance.
Regardless of study arm, all patients will have 2,4, and 6 monthly clinic visits for clinical and/or sputum assessments. Each patient will also complete a Morisky Medication Adherence Scale (MMAS) questionnaire at treatment completion.
Sekandi, J.N. & Buregyeya, E. (2020). DOT Selfie: A Mobile Technology Intervention to Evaluate Treatment Adherence Among Tuberculosis Patients.
ClinicalTrials.gov, 10(1).
[post_title] => DOT Selfie: A Mobile Technology Intervention to Evaluate Treatment Adherence Among Tuberculosis Patients
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[post_date] => 2020-02-19 15:28:17
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[post_content] => Implementing new diagnostics in public health programs can involve difficult trade-off decisions between individual patient benefits and public health considerations. Such decision-making processes are often not documented and may not include engagement of affected communities. This paper examines the perspectives of stakeholders on the trade-off between over-treatment and missed diagnosis captured during decision-making workshops on the transition from use of Xpert MTB/RIF to diagnose tuberculosis to Xpert MTB/RIF Ultra in Kenya and Swaziland. Xpert MTB/RIF Ultra has an overall increase in sensitivity but a decrease in specificity when compared to its predecessor. We conducted a qualitative study using four focus group discussions with a total of 47 participants and non-participant observation. The analysis reveals how participants deemed Xpert MTB/RIF Ultra’s reduced specificity vis-à-vis its increased sensitivity to be an acceptable trade-off. The way participants assessed this trade-off was shaped by their experiences with the general uncertainty of all diagnostic tests, alternative testing options, historical evolution of diagnostic practices, epidemiological factors and resource constraints. In assessing the trade-off community and individual benefit and harm was frequently discussed together. Qualitative research on stakeholder engagement activities for diagnostic development and implementation can identify everyday experiences and situate assessments and perspectives of key stakeholders and as such aid in decision-making, improving implementation as well as patient outcomes. Further research is needed on the intended and unintended consequences of such engagement activities, how findings are being incorporated by decision-makers, and the impact on programmatic implementation.
Mwaura, M., Kao, K., Wambugu, J., Tropllip, A., Sikhondze, W., Omesa, E., Dlamini, S., Mzizi, N., Dlamini, M., Sibandze, B., Dlamini, B., Albert, H., Dondorp, W., & Engel, N. (2020). Situating trade-offs: Stakeholder perspectives on overtreatment versus missed diagnosis in transition to Xpert MTB/RIF Ultra in Kenya and Swaziland.
PLOS ONE, 15(2).
[post_title] => Situating trade-offs: Stakeholder perspectives on overtreatment versus missed diagnosis in transition to Xpert MTB/RIF Ultra in Kenya and Swaziland
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[post_date] => 2021-07-16 14:54:02
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[post_content] => Although access to healthcare has improved since South Africa’s democratic transition, neoliberal reforms have had detrimental effects on clinic-community and nurse-patient relationships, undermining efforts to control tuberculosis (TB). This article focuses upon the work of nurses in three public health clinics in the Western Cape, South Africa. We explore how they experienced, made sense of and grappled with the challenges of TB control, especially patients “defaulting” on medication. Paying particular attention to confrontations between nurses and patients, we build upon previous qualitative studies that have contested popular constructions of nurses as “rude” and “uncaring.” We argue that patient blaming and scolding need to be understood in light of nurses having to tread a fine line between compassion and assertiveness, individual and public good against the backdrop of a dissonance between the theory and reality of TB control. Nurses’ confrontational approaches are responses to the messy reality of TB control on the ground, solutions to which require attention to the socioeconomic and historical context of nursing and primary healthcare. In the absence of such attention, animosities between clinics and communities could continue being cyclically reproduced.
Dixon, J., & Tameris, M. (2018). A disease beyond reach: nurse perspectives on the past and present of tuberculosis control in South Africa.
Anthropology Southern Africa,
41(4), 257-269.
[post_title] => A disease beyond reach: nurse perspectives on the past and present of tuberculosis control in South Africa
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