South African Family Practice

Brain drain in South Africa is affecting health care

Indiran Govender — 2024-01-25

No Abstract

Enhancing sexual health in primary care: Guidance for practitioners

Padaruth Ramlachan — 2024-01-25

Sexual health is an integral aspect of overall health and well-being and is fundamental to the sustainable development of societies worldwide. The World Health Organization (WHO) defines sexual health as ‘a state of physical, emotional, mental, and social well-being in relation to sexuality’. However, addressing sexual health has been afforded low priority in primary healthcare systems. Primary care practitioners (PCPs), who play a crucial role in providing comprehensive care to communities, receive little training on screening and managing individuals with sexual health problems. The scope of services ranges from education, prevention and screening, to management of sexual health matters. Patients with noncommunicable diseases (NCDs), such as stroke, cancer, heart disease and diabetes, are at increased risk for sexual dysfunction, possibly because of common pathogenetic mechanisms, such as inflammation. This is of considerable importance in the sub-Saharan African context where there is a rapidly increasing prevalence of NCDs, as well as a high burden of HIV. Strategies to improve the quality of sexual health services in primary care include creating a safe and non- judgemental practice environment for history-taking among gender-diverse populations, utilising effective screening tools aligned with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for sexual dysfunctions. In particular, the International Consultation on Sexual Medicine (ICSM -5) diagnostic and treatment algorithm can empower primary care providers to effectively address sexual dysfunctions among patients and improve the quality of care provided to communities regarding sexual and reproductive health.

Assessing index CD4 and associated outcomes at 1-year in a tertiary HIV clinic, KwaZulu-Natal

Zanele R. Moya — 2024-01-25

Background: Human immunodeficiency virus (HIV) management guidelines have evolved from initiating therapy at CD4 counts of ≤ 200 cells/m³ to implementing universal test and treat (UTT). This study aimed to assess whether in clinical practice, patients are presenting with higher baseline CD4 counts, describe the incidence of opportunistic infections and the proportion that achieved viral suppression.

Methods: A retrospective cohort design with convenience sampling was conducted. Cohort 1 included patients initiated on antiretroviral therapy (ART) between 01 January 2014 and 31 December 2014, when criteria were set at CD4 count ≤ 350 cells/mm³ . Cohort 2 included patients initiated on ART between 01 January 2019 and 31 December 2019, during the UTT era.

Results: At ART initiation, the median CD4 cell was 170 cells/mm3 (interquartile range [IQR]: 85.5–287) in Cohort 1 cells/mm³ and 243 cells/mm³ (IQR: 120–411) in Cohort 2. Tuberculosis was the predominant OI in the group with CD4 cell count ≤ 200 cells/m³ in both Cohort 1 (26.8%) and Cohort 2 (27.9%), p = 0.039. At 1 year, virological suppression was achieved in only 77.7% and 84.7% of Cohorts 1 and 2 patients.

Conclusion: A notable portion of patients at King Edward VIII Hospital’s HIV clinic commenced ART with CD4 counts significantly below the recommended guideline thresholds.

Contribution: The research revealed a delay in initiating ART. A comprehensive reevaluation is essential to pinpoint the factors contributing to this delay and to devise customised interventions.

Mastering your fellowship: Part 1, 2024

Klaus B. von Pressentin — 2024-01-25

The series, ‘Mastering your Fellowship’, provides examples of the question formats encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians (South Africa) (FCFP [SA]) examination. The series is aimed at helping family medicine registrars (and their supervisors) in preparing for this examination.

Mental illness attitudes, service provision interest and further training preferences of clinical associates

Saiendhra V. Moodley — 2024-01-25

Background: Non-specialist health professionals are required to provide mental health services given the burden of disease due to mental illness. The study aimed to explore the attitudes of clinical associates towards those with mental illness as well as their interest in mental health work and additional mental health training.

Methods: A cross-sectional study design was utilised. The study population consisted of clinical associates based in South Africa. An electronic questionnaire was developed that incorporated the 16-item Mental Illness Clinicians’ Attitudes version 4 scale (MICA-4), which is scored out of 96 with higher scores indicating more stigmatising attitudes. Multivariate linear regression was used to determine factors associated with the MICA-4 score.

Results: The mean MICA-4 score for the 166 participants who completed all 16 questions was 37.55 (standard deviation 7.33). In multivariate analysis, the factors associated with significantly lower MICA-4 scores were falling in the 25- to 29-year-old age category and indicating that a mental health rotation formed part of the undergraduate degree. More than 80% of the participants (140/167, 83.8%) indicated an interest in mental health work. Two- thirds of the participants (111/167, 66.5%) indicated an interest in a specialisation in mental health.

Conclusion: The mean MICA-4 score recorded for clinical associates indicates low stigma levels towards those with mental illness. Additionally, there is significant interest in working and training in mental health.

Contribution: Training programmes should take note of the contribution of a mental health rotation to a positive attitude to mental health patients. Clinical associates’ attitudes towards mental illness together with their interest in working and training in mental health suggest that they could be more widely utilised in mental health service provision.