Exploring treatment burden and capacity for self care among patients with HIV/NCD multimorbidity in South Africa to inform interventions (EXTRA)

点击翻译按钮获取中文摘要

South Africa (SA) and other sub-Saharan African countries are experiencing a double burden of chronic disease epidemics: one of infectious disease, most notably HIV, and the other, a rapidly evolving epidemic of non- communicable diseases (NCDs) such as diabetes and cardiovascular disease. This is resulting in different patterns of multi-morbidities (two or more simultaneously occurring long term diseases or conditions) to those commonly seen in high income countries.Concerningly, these chronic diseases are being increasingly seen in younger people, which has implications for their families, economic productivity and healthcare costs.Currently, chronic healthcare for patients with multimorbidity in SA is fragmented and uncoordinated and does not take into account the increased challenges the patient faces in trying to manage their conditions. The primary aim of this Seed Funding Application is to identify and understand the illness 'workload' experienced by patients with HIV/NCD multimorbidity, as well as their caregivers. This information will be used to ensure that the patient perspective is fully considered in the healthcare reform initiatives that are currently underway in SA, which aim to improve chronic care services. A further aim is to explore the relevance and applicability of existing models that explain the workload involved in NCD treatment and patients' capacity to deal with it. Existing models have been developed in high income countries and we are interested to adapt them to our setting so that they can inform future research and interventions in South Africa and potentially in other low-and middle- income countries.We will use interviews and discussion groups for this study. We will interview a range of patients and their care givers to explore how they experience self-management workload and their capacity to deal with it. This will be in both an urban and rural setting in the Western Cape province as for example, peoples' access to services may differ. We will then recruit healthcare managers, doctors, nurses and community health workers from the same settings into 'task groups' to discuss these findings and consider what they mean for the redesign of local services and interventions that might reduce patient burden and increase their capacity. We will also hold further meetings to present our findings to policy and health managers at a provincial and national level to influence reforms in the health system.This project will help us develop a culturally and contextually appropriate model of HIV/NCD workload and capacity for a low -to- middle income setting such as SA. This work will contribute to development of interventions that can then be tested across different settings.