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Care pathway for the newly diagnosed patients living with HIV/PTB co-infection in South Africa
Thesis (PhD)--Stellenbosch University, 2025.
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| Format: | Thesis |
| Language: | en_ZA |
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Stellenbosch : Stellenbosch University
2025
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| _version_ | 1867613955479830528 |
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| access_status_str | Open Access |
| author | Tokwe, Lwandile |
| author2 | Jordan, Portia Janine |
| author_browse | Jordan, Portia Janine Tokwe, Lwandile |
| author_facet | Jordan, Portia Janine Tokwe, Lwandile |
| author_sort | Tokwe, Lwandile |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description |
Thesis (PhD)--Stellenbosch University, 2025. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/132397 |
| institution | Stellenbosch University (South Africa) |
| language | en_ZA |
| last_indexed | 2026-06-10T12:44:21.913Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/132397 Care pathway for the newly diagnosed patients living with HIV/PTB co-infection in South Africa Tokwe, Lwandile Jordan, Portia Janine Modeste, Rugira Regis Marie Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing and Midwifery. Tuberculosis -- Patients -- South Africa Tuberculosis -- Treatment -- South Africa HIV-positive persons -- South Africa UCTD Thesis (PhD)--Stellenbosch University, 2025. Tokwe, L. 2025. Care Pathway for the Newly Diagnosed Patients Living with HIV/PTB Co-Infection in South Africa. Unpublished doctoral dissertation. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/items/8ef42289-7a5e-4a9a-865d-c097c6b747d7 ENGLISH SUMMARY: Background: Pulmonary tuberculosis (PTB) is a common opportunistic disease in people living with human immunodeficiency virus (PLWH). While this is noted, South Africa is burdened with HIV/PTB co-infection, which causes a strain on the primary health care (PHC) system. This burden further poses consequences on newly diagnosed patients living with HIV/PTB co-infection as they experience an array of challenges once initiated on medication. Moreover, the management provided by the healthcare team is fragmented and often leads to poor patient health outcomes in South Africa and across the world. Therefore, it is vital to support newly diagnosed patients living with HIV/PTB co-infection in PHC clinics. Aim: This doctoral thesis aimed at developing a care pathway for newly diagnosed patients living with HIV/PTB co-infection in South Africa. Methods: A multi-phased, multi-method approach was used to achieve the above aim. Phase One was a scoping review that assisted in mapping available evidence on the management of HIV/PTB co-infection in primary health care (PHC) clinics across the globe. Phase Two focused on newly diagnosed patients’ perspectives regarding living with HIV/PTB co-infection using a qualitative approach. Data were gathered using semi-structured interviews from 12 newly diagnosed patients. Phase Three focused on the voices of the healthcare team that is involved in the management of the newly diagnosed patients living with HIV/PTB co-infection by using a qualitative research design. Data were gathered using semi-structured interviews with eleven (11) professional nurses, five (5) data capturers, five (5) operational managers, and three (3) focus group discussions (FDGs) with 12 community health workers (CHWs). Phase Four was the development and the review of the care pathway. The study was conducted in PHC clinics in Mthatha in the King Sabata Dalindeyo (KSD) Sub-District within Oliver Tambo District in the Eastern Cape Province of South Africa. The data were analysed manually using Tesch’s eight steps and digitally using the ATLAS.ti version 2023 software. Results: The findings of this study highlight that patients experience non-adherence and side effects to HIV/PTB medication, lack of education, and social and behavioural challenges. The healthcare team in this study also experienced resource constraints and a lack of training. Furthermore, the scoping review identified 34 records, highlighting integrated care, use of Cotrimoxazole preventive therapy (CPT), side effects monitoring, and directly observed therapy as effective in managing HIV/PTB co-infection in PHC clinics. Conclusion: The need for a care pathway for the healthcare team as end users in the PHC clinics, as is evident from the study findings, results from fragmented guidelines and a lack of education and resources, which lead to patients’ poor health outcomes. This care pathway has the potential to address the needs of the patients while considering all the factors that patients interact with, and it further involves the healthcare team in the PHC clinics. To our knowledge, this is the first care pathway of its kind to be developed for newly diagnosed patients living with HIV/PTB co-infection in South Africa, especially in PHC clinics. AFRIKAANSE OPSOMMING: Agtergrond: Pulmonere tuberkulose (PTB) is 'n algemene opportunistiese siekte by mense wat met menslike immuniteitsgebreksvirus (PLWH) leef. Terwyl dit opgemerk word, is Suid-Afrika belas met MIV/PTB-gepaardgaande infeksie wat 'n stremming op die Primere Gesondheidsorg (PHC)-stelsel veroorsaak. Hierdie las hou verder gevolge in vir die nuut gediagnoseerde pasiente wat met MIV/PTB-gepaardgaande infeksie leef, aangesien hulle 'n verskeidenheid uitdagings ervaar sodra hulle met medikasie begin is. Boonop is die bestuur wat deur die gesondheidsorgspan verskaf word, gefragmenteerd en dit lei dikwels tot swak pasientgesondheidsuitkomste regoor die wereld en in Suid-Afrika. Daarom is dit belangrik om die nuut gediagnoseerde pasiente wat met MIV/PTB-ko-infeksie leef in die PGS-klinieke te ondersteun. Doel: Hierdie doktorale proefskrif was daarop gemik om 'n sorgpad te ontwikkel vir die nuut gediagnoseerde pasiente wat met MIV/PTB ko-infeksie in Suid-Afrika leef. Metodes: Om dit te bereik, is 'n multi-fase, multi-metode benadering gebruik. Fase Een was 'n omvangsoorsig wat gehelp het met die kartering van beskikbare bewyse oor die bestuur van MIV/PTB mede-infeksie in die primere gesondheidsorg (PHC) klinieke regoor die wereld. Fase Twee het gefokus op die nuut gediagnoseerde pasiente se stemme van lewe met MIV/PTB ko-infeksie, deur middel van 'n kwalitatiewe benadering. Data is ingesamel deur gebruik te maak van semi-gestruktureerde onderhoude van 12 pas gediagnoseerde pasiente. Fase Drie het gefokus op die stemme van die gesondheidsorgspan wat betrokke is by die sorglewering van die nuut gediagnoseerde pasiente wat met MIV/PTB ko-infeksie leef deur 'n kwalitatiewe navorsingsontwerp te gebruik. Data is ingesamel deur gebruik te maak van semi-gestruktureerde onderhoude van elf (11) professionele verpleegkundiges, vyf (5) datavasvangers, vyf (5) operasionele bestuurders en drie (3) fokusgroepbesprekings (FDG's) wat bestaan uit 12 Gemeenskapsgesondheidswerkers (CHWs). Fase Vier was die ontwikkeling en die hersiening van die sorgpad. Die studie is uitgevoer in die PHC-klinieke in Mthatha, gelee in die King Sabata Dalindeyo (KSD) sub-distrik binne Oliver Tambo Distrik in die Oos-Kaap Provinsie, Suid-Afrika. Die data is ontleed met behulp van Tesch se agt stappe met die hand en deur ATLAS.ti sagteware weergawe 2023. Resultate: Die bevindinge van hierdie studie het beklemtoon dat die pasiente nie-nakoming, newe-effekte van MIV/PTB-medikasie, gebrek aan opvoeding, sosiale en gedragsuitdagings ervaar het. Hulpbronbeperkings, gebrek aan opleiding is ook deur die gesondheidsorgspan in hierdie studie ervaar. Verder het die omvangsoorsig 34 rekords geidentifiseer wat die geintegreerde sorg, die gebruik van Cotrimoxazole voorkomende terapie (CPT), newe-effekte monitering en direk waargenome terapie uitgelig het as effektief in die bestuur van MIV/PTB mede-infeksie in die PHC-klinieke. Gevolgtrekking: Die behoefte aan 'n sorgroete vir die gesondheidsorgspan as eindgebruikers in die PGS-klinieke is duidelik in die bevindinge van die studie as gevolg van gefragmenteerde riglyne, gebrek aan opvoeding, hulpbronne wat lei tot swak gesondheidsuitkomste by die pasiente. Hierdie sorgroete wat ontwikkel is, het 'n potensiaal om die behoeftes van die pasiente aan te spreek terwyl al die faktore waarmee pasiente interaksie in ag geneem word, en dit betrek verder die gesondheidsorgspan in die PGS-klinieke. Na ons wete is dit die eerste versorgingsroete van sy soort wat ontwikkel is vir die nuut gediagnoseerde pasiente wat met MIV/PTB ko-infeksie in Suid-Afrika leef, veral in die PGS-klinieke. Doctoral 2025-06-06T05:59:10Z 2025-06-06T05:59:10Z 2025-03 Thesis https://scholar.sun.ac.za/handle/10019.1/132397 en_ZA Stellenbosch University xxi, 377 pages : illustrations, maps, includes annexures application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Tuberculosis -- Patients -- South Africa Tuberculosis -- Treatment -- South Africa HIV-positive persons -- South Africa UCTD Tokwe, Lwandile Care pathway for the newly diagnosed patients living with HIV/PTB co-infection in South Africa |
| title | Care pathway for the newly diagnosed patients living with HIV/PTB co-infection in South Africa |
| title_full | Care pathway for the newly diagnosed patients living with HIV/PTB co-infection in South Africa |
| title_fullStr | Care pathway for the newly diagnosed patients living with HIV/PTB co-infection in South Africa |
| title_full_unstemmed | Care pathway for the newly diagnosed patients living with HIV/PTB co-infection in South Africa |
| title_short | Care pathway for the newly diagnosed patients living with HIV/PTB co-infection in South Africa |
| title_sort | care pathway for the newly diagnosed patients living with hiv ptb co infection in south africa |
| topic | Tuberculosis -- Patients -- South Africa Tuberculosis -- Treatment -- South Africa HIV-positive persons -- South Africa UCTD |
| url | https://scholar.sun.ac.za/handle/10019.1/132397 |
| work_keys_str_mv | AT tokwelwandile carepathwayforthenewlydiagnosedpatientslivingwithhivptbcoinfectioninsouthafrica |