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The Institute for Global Health and Development

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9

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Author: search.filters.author.Grant, Alison D.Subject: search.filters.subject.Health Systems

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Now showing 1 - 4 of 4
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    Modelling the effect of infection prevention and control measures on rate of Mycobacterium tuberculosis transmission to clinic attendees in primary health clinics in South Africa
    (BMJ, 2021-10-25) McCreesh, Nicky; Karat, Aaron S.; Baisley, Kathy; Diaconu, Karin; Bozzani, Fiammetta; Govender, Indira; Beckwith, Peter; Yates, Tom A.; Deol, Arminder K.; Houben, Rein M. G. J.; Kielmann, Karina; White, Richard G.; Grant, Alison D.
    Background Elevated rates of tuberculosis in health care workers demonstrate the high rate of Mycobacterium tuberculosis (Mtb) transmission in health facilities in high burden settings. In the context of a project taking a whole systems approach to tuberculosis infection prevention and control (IPC), we aimed to evaluate the potential impact of conventional and novel IPC measures on Mtb transmission to patients and other clinic attendees.
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    Diverse clinical and social circumstances: Developing patient-centred care for DR-TB patients in South Africa
    (The Union, 2021-09-21) Mitrani, Leila; Dickson-Hall, Lindy; Le Roux, Sacha; Grant, Alison D.; Kielmann, Karina; Mlisana, Koleka; Moshabela, Mosa; Nicol, Mark P.; Black, John; Cox, Helen
    Objective: To describe the medical, socio-economic and geographical profiles of patients with rifampicin-resistant TB (RR-TB) and the implications for the provision of patient-centred care.
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    "We had to manage what we had on hand, in whatever way we could": Adaptive responses in policy for decentralised drug-resistant tuberculosis care in South Africa
    (Oxford University Press, 2021-02-13) Kielmann, Karina; Dickson-Hall, Lindy; Jassat, Waasila; Le Roux, Sacha; Moshabela, Mosa; Cox, Helen; Grant, Alison D.; Loveday, Marian; Hill, Jeremy; Nicol, Mark P.; Mlisana, Koleka; Black, John
    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 indepth 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.
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    Drug-resistant tuberculosis patient care journeys in South Africa: A pilot study using routine laboratory data
    (Ingenta, 2020-01-01) Hill, Jeremy Stewart; Dickson-Hall, Lindy; Grant, Alison D.; Grundy, Chris; Black, John; Kielmann, Karina; Mlisana, Koleka; Mitrani, Leila; Loveday, Marian; Moshabela, Mosa; Le Roux, Sacha; Jassat, Waasila; Nicol, Mark; Cox, Helen Suzanne
    SETTING: Thirteen districts in Eastern Cape (EC), KwaZulu-Natal (KZN) and Western Cape (WC) Provinces, South Africa.