Factors associated with mortality among laboratory-diagnosed drug-resistant tuberculosis patients on treatment, KwaZulu-Natal Province, 2017-2019.

Introduction: tuberculosis (TB) remains a leading cause of death in South Africa. KwaZulu-Natal (KZN) is one of the provinces with a high burden of TB/drug-resistant TB cases and deaths. We determined predictors for mortality among drug-resistant TB patients on treatment in KZN province.

Provision of HIV testing services and its impact on the HIV positivity rate in the public health sector in KwaZulu-Natal: a ten-year review.

South Africa has been rated as having the most severe HIV epidemic in the world since it has one of the largest populations of people living with HIV (PLHIV). KwaZulu-Natal (KZN) is the epicentre of the HIV epidemic. The HIV test and treat services in the public health sector are critical to managing the epidemic and responding to the increase in HIV infections.

Operational manager's knowledge and attitudes toward data and universal health coverage indicators in primary health clinics in Ugu, South Africa.

Universal health coverage (UHC) aims to ensure people have access to the health services they need. Sixteen tracer indicators were developed for implementation by countries to measure UHC in the health system. South Africa uses 15 of the proposed 16 indicators.

Tracking the Trauma Epidemic in KwaZulu-Natal, South Africa.

Background: Trauma remains an important cause of morbidity and mortality in South Africa, but attempts to track the epidemic are often based on mortality data, or derived from individual health facilities. This project is based on the routine collection of trauma data from all public health facilities in the province of KwaZulu-Natal (KZN), between 2012 and 2022.

Methods: Hospital level data on trauma over the past ten years was drawn from the district health information system (DHIS).

Exploring how outreach team leaders perceive community health workers' experiences of providing HIV services in KwaZulu-Natal, South Africa.

In 2018, the KwaZulu-Natal Department of Health launched the ward-based primary health care outreach teams policy framework which sought to expand the community health worker (CHW) programme's provision of longitudinal patient support, including human immunodeficiency virus (HIV) services in communities. This study sought to explore the perceptions of outreach team leaders who supervise CHWs on their experiences of providing HIV services in the province. This was a qualitative, phenomenology study.

Facility Managers' Perceptions of Support and Supervision of Ward Based Primary Health Care Outreach Teams in National Health Insurance Pilot Districts in KwaZulu-Natal, South Africa. A Qualitative Study.

Introduction: Evidence from many countries suggests that provision of home and community-based health services, linked to care at fixed primary health care facilities, is critical to good health outcomes. In South Africa, the Ward-Based Primary Health Care Outreach Teams are well placed to provide these services. The teams report to a primary health care facility through their outreach team leader.

Barriers and facilitators of rendering HIV services by community health workers in sub-Saharan Africa: a meta-synthesis.

Objectives: To synthesise qualitative studies that address the barriers to and facilitators of providing HIV services by community health workers (CHWs) in sub-Saharan Africa (SSA).

Design: This meta-synthesis was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We included studies that were published between 2009 and 2019.

The Burden of Emergency Abdominal Surgery Heavily Outweighs Elective Procedures in KwaZulu-Natal Province, South Africa.

Background: South Africa is a middle-income country with major discrepancies in wealth and access to care. There is a significant burden of surgical disease and limited access to quality health care for a large proportion of the population. This article quantifies the burden of abdominal surgery over a 6-month period in KwaZulu-Natal (KZN) province and quantifies the emergency to elective (Ee) ratio for these operations.

Barriers and facilitators of rendering HIV services by community health workers in sub-Saharan Africa: a meta-synthesis protocol.

Introduction: In sub-Saharan Africa (SSA), Human Immunodeficiency Virus (HIV) is the leading cause of morbidity and mortality. Community healthcare workers (CHWs) worldwide have been reported to be effective in strengthening the HIV programme by providing services such as adherence support, HIV education and safe sex education as part of their roles. The main aim of this meta-synthesis is to synthesise qualitative evidence on studies that have been conducted in SSA countries to understand the barriers to and facilitators of providing HIV services by CHWs across all settings METHODS AND ANALYSIS: This meta-synthesis will be guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

The roles, responsibilities and perceptions of community health workers and ward-based primary health care outreach teams: a scoping review.

Background: Community health workers play important roles in rural primary health care settings. They work within ward-based primary health care outreach teams yet their roles are not always clearly defined and operationalized. There is thus a need to explore perceptions about the roles and responsibilities of community health workers.

Soft Tissue Sepsis Places a Massive Burden on Regional and Tertiary Surgical Services in KZN Province South Africa.

Background: Frequently, surgical intervention is needed to treat soft tissue sepsis (STS). Ideally, most STS should be managed at the lowest level of surgical care close to the patient's home and a well-functioning surgical service will be able to deliver this safely and effectively. This study interrogates the burden of STS in the province of KwaZulu-Natal and reviews at which level in the health system the operative management of STS is being dealt with.

Spatial-temporal trends and risk factors for undernutrition and obesity among children (<5 years) in South Africa, 2008-2017: findings from a nationally representative longitudinal panel survey.

Objectives: To assess space-time trends in malnutrition and associated risk factors among children (<5 years) in South Africa.

Design: Multiround national panel survey using multistage random sampling.

Setting: National, community based.

The roles, responsibilities and perceptions of community health workers and ward-based primary health care outreach teams (WBPHCOTs) in South Africa: a scoping review protocol.

Background: Human resource for health (HRH) challenges jeopardise the South African health system, undermining the efforts made to curb the burden of disease. There is a demand for a category of health workers, which will meet the basic health needs of people at the grassroots level to ensure accessible, affordable health care using appropriate technologies acceptable to the recipients of care. The ward-based primary health care outreach teams are well placed to provide community-based primary health care services, which encompass activities in communities, households and referral networks with community-based providers.

The Operative Output of District Hospitals in KwaZulu-Natal Province is Heavily Skewed Toward Obstetrical Care.

Introduction: District hospitals are key to providing universal coverage of essential surgery and for strengthening surgical care in general. This audit set out to quantify the surgical output of all the district hospitals in KwaZulu-Natal Province (KZN) over a 6-month period to see whether district hospitals were delivering the surgical care they are expected to deliver.

Results: There were a total of 18,871 operations performed at 37 district hospitals in KwaZulu-Natal from July to December 2015.

Defining and Negotiating the Social Value of Research in Public Health Facilities: Perceptions of Stakeholders in a Research-Active Province of South Africa.

This article reports on qualitative research conducted in KwaZulu-Natal, South Africa, among researchers and gate-keepers of health facilities in the province. Results suggest disparate but not irreconcilable perceptions of the social value of research in provincial health facilities. This study found that researchers tended to emphasize the contribution of research to the generation of knowledge and to the health of future patients while gate-keepers of health facilities tended to emphasize its contribution to the healthcare system and to current patients.

Researching Complex Interventions in Health: The State of the Art : Exeter, UK. 14-15 October 2015.

KEYNOTE PRESENTATIONS K1 Researching complex interventions: the need for robust approaches Peter Craig K2 Complex intervention studies: an important step in developing knowledge for practice Ingalill Rahm-Hallberg K3 Public and patient involvement in research: what, why and how? Nicky Britten K4 Mixed methods in health service research – where do we go from here? Gunilla Borglin SPEAKER PRESENTATIONS S1 Exploring complexity in systematic reviews of complex interventions Gabriele Meyer, Sascha Köpke, Jane Noyes, Jackie Chandler S2 Can complex health interventions be optimised before moving to a definitive RCT? Strategies and methods currently in use Sara Levati S3 A systematic approach to develop theory based implementation interventions Anne Sales S4 Pilot studies and feasibility studies for complex interventions: an introduction Lehana Thabane, Lora Giangregorio S5 What can be done to pilot complex interventions? Nancy Feeley, Sylvie Cossette S6 Using feasibility and pilot trials to test alternative methodologies and methodological procedures prior to full scale trials Rod Taylor S7 A mixed methods feasibility study in practice Jacqueline Hill, David A Richards, Willem Kuyken S8 Non-standard experimental designs and preference designs Louise von Essen S9 Evaluation gone wild: using natural experimental approaches to evaluate complex interventions Andrew Williams S10 The stepped wedge cluster randomised trial: an opportunity to increase the quality of evaluations of service delivery and public policy interventions Karla Hemming, Richard Lilford, Alan Girling, Monica Taljaard S11 Adaptive designs in confirmatory clinical trials: opportunities in investigating complex interventions Munyaradzi Dimairo S12 Processes, contexts and outcomes in complex interventions, and the implications for evaluation Mark Petticrew S13 Processes, contexts and outcomes in complex interventions, and the implications for evaluation Janis Baird, Graham Moore S14 Qualitative evaluation alongside RCTs: what to consider to get relevant and valuable results Willem Odendaal, Salla Atkins, Elizabeth Lutge, Natalie Leon, Simon Lewin S15 Using economic evaluations to understand the value of complex interventions: when maximising health status is not sufficient Katherine Payne S16 How to arrive at an implementation plan Theo van Achterberg S17 Modelling process and outcomes in complex interventions Walter Sermeus S18 Systems modelling for improving health care Martin Pitt, Thomas Monks

A hospital based surveillance system to assess the burden of trauma in KwaZulu-Natal Province South Africa.

Introduction: In response to the ongoing excessive burden of trauma in South Africa the Data Management and Epidemiology Units of the Department of Health in conjunction with a group of trauma specialists developed a number of trauma data variables for inclusion on the routine District Health Information System (DHIS). The aim of this study is to describe the process followed and review the 2012-2014 data.

Methodology: The variables collected included: total patient numbers assessed in the emergency room with a diagnosis of trauma; the mechanisms of trauma (blunt assault, motor vehicle accident, pedestrian vehicle accident, stab, gunshot wound, other); any trauma patient admitted to a health facility ward/ICU for longer than 12h; and whether the patient required transfer to a higher centre of care.

Incentives and enablers to improve adherence in tuberculosis.

Background: Patient adherence to medications, particularly for conditions requiring prolonged treatment such as tuberculosis (TB), is frequently less than ideal and can result in poor treatment outcomes. Material incentives to reward good behaviour and enablers to remove economic barriers to accessing care are sometimes given in the form of cash, vouchers, or food to improve adherence.

Objectives: To evaluate the effects of material incentives and enablers in patients undergoing diagnostic testing, or receiving prophylactic or curative therapy, for TB.

Economic support to improve tuberculosis treatment outcomes in South Africa: a qualitative process evaluation of a cluster randomized controlled trial.

Background: Poverty undermines the adherence of patients to tuberculosis treatment. A pragmatic cluster randomized controlled trial was conducted to investigate the extent to which economic support in the form of a voucher would improve patients' adherence to treatment, and their treatment outcomes. Although the trial showed a modest improvement in the treatment success rates of the intervention group, this was not statistically significant, due in part to the low fidelity to the trial intervention.

Economic support to improve tuberculosis treatment outcomes in South Africa: a pragmatic cluster-randomized controlled trial.

Background: Poverty undermines adherence to tuberculosis treatment. Economic support may both encourage and enable patients to complete treatment. In South Africa, which carries a high burden of tuberculosis, such support may improve the currently poor outcomes of patients on tuberculosis treatment.

The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS.

Background: The use of cannabis (marijuana) or of its psychoactive ingredient delta-9-tetrahydrocannabinol (THC) as a medicine has been highly contested in many settings.There have been claims that smoked or ingested cannabis, either in its natural form or artificial form (pharmaceutically manufactured drug such as dronabinol), improves the appetites of people with AIDS, results in weight gain and lifts mood, thus improving the quality of life.

Objectives: The objectives of this review were to assess whether cannabis (in its natural or artificially produced form), either smoked or ingested, decreases the morbidity or mortality of patients infected with HIV.

Material incentives and enablers in the management of tuberculosis.

Background: Patient adherence to medications, particularly for conditions requiring prolonged treatment such as tuberculosis, is frequently less than ideal, and can result in poor treatment outcomes. Material incentives (given as cash, vouchers and tokens), have been used to improve adherence.

Objectives: To assess the effects of material incentives in people undergoing diagnostic testing, or receiving prophylactic or curative therapy, for tuberculosis.