Publications by authors named "Lara Fairall"

Objective: To understand barriers and facilitators for strengthening health systems for person-centred care of people with multiple long-term conditions-multimorbidity (MLTC-M) at the primary healthcare (PHC) level in low-income and middle-income countries (LMICs).

Design: A scoping review.

Methods: We adopted a systematic scoping review approach to chart literature guided by Arksey and O'Malley's methodological framework.

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Background: Training primary care doctors and nurses to use Practical Approach to Care Kit (PACK) improved management of asthma and chronic obstructive pulmonary disease (COPD) in a previous randomised trial. The present study examined the training effects including a second year of follow-up with expanded coverage of repeated training sessions.

Methods: Using a stepped-wedge cluster randomised trial design, 48 clinics were randomly allocated either to sequence A: (1) no intervention, (2) no intervention, (3) intervention or sequence B: (1) no intervention, (2) intervention, (3) intervention, during three 12-month periods.

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Article Synopsis
  • * The Ethiopian Primary Healthcare Clinical Guideline (EPHCG) integrates comprehensive care for individuals over 5 and utilizes a structured implementation strategy to enhance healthcare delivery.
  • * Successful scale-up factors included strong ministry support, a detailed training approach, and community engagement, while challenges like resistance and procurement issues were also tackled effectively.
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The care of people with multiple long-term conditions (MLTCs) is complex and time-consuming, often denying them the agency to self-manage their conditions-or for the clinician they visit to provide streamlined, person-centred care. We reconfigured The Practical Approach to Care Kit, our established, evidence-based, policy-aligned clinical decision support tool for low-resource primary care settings, to provide consolidated clinical guidance for a patient journey through a primary care facility. This places the patient at the centre of that journey and shifts the screening, monitoring and health education activities of multimorbidity care more equitably among the members of the primary care team.

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Emerging infectious diseases present a significant challenge to healthcare systems with their need for a rapid response and reallocation of resources. This paper explores the implementation of the Practical Approach to Care Kit (PACK) programme in Florianópolis, Brazil as a strategic tool for reinforcing primary healthcare (PHC) responses to emergent communicable diseases. With its focus on enhancing PHC delivery in resource-limited settings, PACK provides a flexible, evidence-based framework that integrates into local health systems.

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Background: HIV is characterised by high rates of comorbidity with mental health conditions including depression, as such, the detection and treatment of comorbid depression is critical to achieve viral load suppression. This study evaluated the effectiveness of a collaborative care intervention for depression among adults with comorbid depression symptoms receiving ART in primary health care (PHC) facilities.

Methods: We conducted a pragmatic cluster-randomised trial in 40 clinics in the North West province of South Africa.

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Background: South Africa's first SARS-CoV-2 case was identified 5th March 2020 and national lockdown followed March 26th. Households are an important location for secondary SARS-CoV-2 infection. Physical distancing and sanitation - infection mitigation recommended by the World Health Organization (WHO) at the time - are difficult to implement in limited-resource settings because of overcrowded living conditions.

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Background: The Ethiopian Primary Healthcare Clinical Guidelines (EPHCG) seek to improve quality of primary health care, while also expanding access to care for people with Non-Communicable Diseases and Mental Health Conditions (NCDs/MHCs). The aim of this study was to identify barriers and enablers to implementation of the EPHCG with a particular focus on NCDs/MHCs.

Methods: A mixed-methods convergent-parallel design was employed after EPHCG implementation in 18 health facilities in southern Ethiopia.

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Article Synopsis
  • A statistical model was developed to analyze the prevalence and associations of multi-long-term conditions in South Africa, addressing the limitations of traditional meta-analysis methods for heterogeneous data.
  • The study identified strong associations between diseases like COPD and asthma, as well as combinations of prevalent conditions, highlighting hypertension's role in various comorbidities among individuals aged 15 and older.
  • Findings reveal that South Africa has notably high rates of conditions like HIV, hypertension, and diabetes, with specific combinations of these diseases being most common, while also noting that less prevalent conditions still have significant impacts on overall health.
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Introduction: South Africa has a high prevalence of gestational diabetes mellitus (GDM; 15%) and many of these women (48%) progress to type 2 diabetes mellitus (T2DM) within 5 years post partum. A significant proportion (47%) of the women are not aware of their diabetes status after the index pregnancy, which may be in part to low postnatal diabetes screening rates. Therefore, we aim to evaluate a intervention that reduces the subsequent risk of developing T2DM among women with recent GDM.

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Integration of mental health into routine primary health care (PHC) services in low-and middle-income countries is globally accepted to improve health outcomes of other conditions and narrow the mental health treatment gap. Yet implementation remains a challenge. The aim of this study was to identify implementation strategies that improve implementation outcomes of an evidence-based depression care collaborative implementation model integrated with routine PHC clinic services in South Africa.

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Background: The treatment gap for mental health services is a growing public health concern. A lay-counselling service located at primary health care (PHC) level could potentially help to close the large treatment gap for common mental disorders in South Africa. The aim of this study was to understand multilevel factors contributing to implementation and potential dissemination of such a service for depression at PHC level.

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Objectives: The adverse effects of the COVID-19 pandemic on tuberculosis (TB) detection have been well documented. Despite shared symptoms, guidance for integrated screening for TBand COVID-19 are limited, and opportunities for health systems strengthening curtailed by lockdowns. We partnered with a high TB burden district in KwaZulu-Natal, South Africa, to co-develop an integrated approach to assessing COVID-19 and TB, delivered using online learning and quality improvement, and evaluated its performance on TB testing and detection.

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Introduction: A task-sharing collaborative care model for integrated depression care for South Africa's burgeoning primary health care population with chronic conditions was developed and tested through two pragmatic cluster randomized controlled trials. One trial focused on patients with hypertension and was located in one district where a collaborative care model was co-designed with district stakeholders. The other trial, focused on patients on antiretroviral treatment, was located in the same district site, with the addition of a second neighbouring district, without adaptation of the original model.

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Article Synopsis
  • - The COVID-19 pandemic negatively affected global efforts to combat tuberculosis, particularly in South Africa, prompting researchers to develop a more integrated approach to address both health issues simultaneously in the Amajuba district.
  • - A sequential study conducted from 2018 to 2021 focused on creating a Theory of Change, designing interventions, and evaluating their effectiveness within primary healthcare settings through Learning Health Systems (LHS) frameworks.
  • - Key insights from the LHS approach highlighted the importance of building strong relationships, embracing co-learning and adaptive strategies, utilizing theory-driven improvements, and considering the LHS framework for improved health responses in crisis situations.
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Background: We aimed to assess the effectiveness of a single dose of the Ad26.COV2.S vaccine (Johnson & Johnson) in health-care workers in South Africa during two waves of the South African COVID-19 epidemic.

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Article Synopsis
  • The ASSET project aims to strengthen health systems in Sub-Saharan Africa over four years, focusing on delivering high-quality care through participatory research methods.
  • Key activities involve engaging diverse stakeholders—patients, clinicians, and policymakers—and using mixed methods like interviews and surveys to identify improvements needed in healthcare delivery.
  • The pre-implementation phase emphasizes thorough analysis and collective input from stakeholders to develop effective Health System Strengthening Interventions (HSSIs) tailored to each region's unique health system dynamics.
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Background: Integrating mental health services into primary healthcare platforms is an established health systems strategy in low-to-middle-income countries. In South Africa, this was pursued through the Programme for Improving Mental Health Care (PRIME), a multi-country initiative that relied on task-sharing as a principle implementation strategy. Towards better describing the implementation processes, qualitative comparative analysis was adopted to explore causal pathways in the intervention.

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Background: Despite progress towards End TB Strategy targets for reducing tuberculosis (TB) incidence and deaths by 2035, South Africa remains among the top ten high-burden tuberculosis countries globally. A large challenge lies in how policies to improve detection, diagnosis and treatment completion interact with social and structural drivers of TB. Detailed understanding and theoretical development of the contextual determinants of problems in TB care is required for developing effective interventions.

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Background: People with chronic general medical conditions who have comorbid depression experience poorer health outcomes. This problem has received scant attention in low- and middle-income countries. The aim of the ongoing study reported here is to refine and promote the scale-up of an evidence-based task-sharing collaborative care model, the Mental Health Integration (MhINT) program, to treat patients with comorbid depression and chronic disease in primary health care settings in South Africa.

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Background: The WHO's Integrated Management of Childhood Illness (IMCI) has resulted in progress in addressing infant and child mortality. However, unmet needs of children continue to present a burden upon primary healthcare services. The capacity of services and quality of care offered require greater support to address these needs by extending and integrating curative and preventive care for the child with a long-term health condition and the child older than 5, not prioritised in IMCI.

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