Health systems' strengthening is essential in South Africa in an era of the convergence of communicable and non-communicable diseases. Whilst TB is ranked first in all-cause mortality, non-communicable diseases which include cerebrovascular disease and diabetes mellitus follow; with HIV/AIDS in fourth place. In the Western Cape, diabetes mellitus and HIV are the top two causes of death accounting for 6.8% and 5.8% respectively (StatsSA, 2015b). As the burden of non-communicable disease continues to increase significantly due to more South Africans presenting these co-morbid conditions, the complexity of managing these chronic conditions has increased. The reorganisation of primary health services to better cater for patients with multiple chronic conditions has become an imperative in South Africa but still in its infancy. However, how chronic patients with multi-morbidities experience the current services and what their perceived needs are in order to enhance the management of their conditions both at point of healthcare and in their daily lives is not widely understood. Below, is an outline of the three parts presented in this dissertation. Part A is the study protocol, which gives a background of the intersection of communicable and noncommunicable diseases in South Africa, focusing on HIV and type two diabetes (hereafter HIV/T2D) co-morbidity. A qualitative design was employed. In-depth interviews were conducted with ten patients living with HIV/T2D co-morbidity and six health workers who interacted with these patients. Ethical considerations such as potential risks and benefits; confidentiality, autonomy and informed consent are also highlighted in the protocol. Part B is the structured literature review on chronic care in low and middle-income countries (LMICs). Two sub-sections are presented with the first focusing on LMICs excluding South Africa; and the second for South Africa only. Theoretical frameworks, which were applied to managing chronic conditions and empirical studies on HIV/T2D in these LMICs, are reviewed. Reference to the Cumulative Complexity Model (CCM), will also provide an indepth understanding of the prospects of strengthening the primary healthcare system in South Africa to address chronic conditions more effectively. Part C is the journal-ready manuscript of the data collected in the qualitative study. It consists of the background, methods, results, discussion and conclusions. Findings describe patients' experiences of the primary healthcare services and the daily challenges of living with and managing HIV and T2D among a sample of ten patients attending a clinic in Cape Town. Health worker perspectives on managing HIV/T2D co-morbidity are also presented. Both patients and healthworkers also shared strategies on how health interventions could be more responsive to HIV/T2D co-morbidity. Hence, further contributions are made in the knowledge base of strengthening chronic conditions. However, further research with different subsets of patients living with not only HIV/T2D but also other co-morbid or multi-morbid conditions is important for improvements in health policy-making in South Africa.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/20920 |
| Date | January 2016 |
| Creators | Matima, Rangarirai |
| Contributors | Oni, Tolu, Murphy, Katherine |
| Publisher | University of Cape Town, Faculty of Health Sciences, Health Policy and Systems Division |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MPH |
| Format | application/pdf |
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