The page number in the footer is not for bibliographic referencingwww.tandfonline.com/ojfp 53 RESEARCH ARTICLE ABSTRACTS South African Family Practice is co-published by Medpharm Publications, NISC (Pty) Ltd and Cogent, Taylor & Francis Group S Afr Fam Pract ISSN 2078-6190 EISSN 2078-6204 © 2016 The Author(s) RESEARCH South African Family Practice 2016; 58(3):126–130 http://dx.doi.org/10.1080/20786190.2016.1182810 Open Access article distributed under the terms of the Creative Commons License [CC BY-NC-ND 4.0] http://creativecommons.org/licenses/by-nc-nd/4.0 Patient experiences with designated service provider medication delivery in a rural general practice in KwaZulu-Natal: a cross-sectional study on HIV patients VV Reddya and OH Mahomedb* a General practitioner in independent private practice, Tongaat, KwaZulu-Natal b Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa *Corresponding author, email: mahomedo@ukzn.ac.za Background: Healthcare funders (medical schemes) have established disease management programmes (DMPs) and designated service providers (DSPs) to reduce costs and improve patient outcomes to meet legislative requirements. However, there is a paucity of studies that have researched patient experiences and adherence to medication through the DSP process. Methodology: A retrospective cross-sectional descriptive study was conducted between January and June 2013 within the designated family practice amongst all HIV patients who were receiving antiretroviral treatment provided by healthcare funders via DSP agreements (Medipost, Direct Medicines, etc.) Data were collected using an anonymous self-administered questionnaire as well as a record review tool. Results: The majority of patients (77%; 26) reported receiving antiretroviral medication deliveries on time, receiving a reminder before delivery (88%; 30) and receiving correct medications (77%; 26). Short messaging services (SMS) were the most popular method used to inform patients of an impending medicine with 85% (28) of all respondents reporting that they received SMS messages. Some 70% of the patients rated their satisfaction with DSP medication delivery between good and excellent. However, 30% of the patients rated the service as satisfactory to poor. Conclusion and recommendation: DSP delivery of ART medication has fared well in this study, with the majority of patients satisfied with the services. This may in part be due to the higher level of education amongst the participants of the survey. A national study should be conducted using different population groups to identify the satisfaction and adherence to HIV medication amongst patients from a lower socio-demographic profile. Keywords: antiretroviral treatment, designated service providers, HIV and AIDS, private practice Introduction Approximately 6.3 million people were living with the human immune deficiency virus (HIV) in South Africa in 2013.1 The estimated HIV prevalence amongst adults between the ages of 15 and 49  years was 19.1% in 2013.2 Geographically KwaZulu- Natal has the highest HIV prevalence (40%) compared with 18% in the Northern Cape and Western Cape. In order to tackle this epidemic, the South African government has expanded its antiretroviral programme and currently has the largest treatment programme globally with approximately 42% of adults on antiretroviral treatment.1 The total number of patients receiving antiretroviral therapy (ART) increased from 47 500 (95% CI 42 900–51 800) to 1.79 million (95% CI 1.65–1.93 million) between the middle of 2004 and the end of June 2011.3 By October 2014, it was pronounced that approximately 2.7 million people were receiving ART in South Africa.4 This number was expected to reach 3.1 million by 2015, representing very good coverage of individuals with CD4+T-cell counts < 350 cells/μl.3 In June 2011, 85% of patients were receiving ART through the public health sector, 11% were receiving ART through disease management programmes in the private sector, and the remaining 4% were receiving ART through community treatment programmes run by non-governmental organisations (NGOs).3 Although the growth of the public sector HIV programme has outstripped that of the private sector, the private health sector plays an important role in HIV care. More than 200 000 patients are on treatment in the private sector through medical schemes.5 The private sector affords patients easier access to HIV and AIDS care, but concentrates more on ART with poor collaboration between this and the public health services.6 The private sector role players include medical scheme beneficiaries (15% of population), workplace treatment programmes, community treatment programmes and individuals paying for their own treatment.6 Healthcare funders (medical schemes) have established disease management programmes (DMPs) and designated service providers (DSPs) to reduce costs and to improve patient outcomes to meet legislative requirements. In 2006, there were over 17 DMPs providing ART to patients with five major players (Aids for Aids (36%), Lifesense (15%), Discovery (11%), Arum Health (11%), Qualsa (11%)), accounting for the majority of the patients. DMPs provided by medical schemes in South Africa consist of mainly two components — (a) health education and promotion and (b) a therapeutic component — that address the cost- effective treatment of patients using relevant guidelines and the delivery of patient medication using DSPs. DSP pharmacy services are increasingly being utilised by medical schemes to provide ART to patients. Successful HIV management is dependent on near perfect adherence to ART, which is in turn dependent on a reliable supply of antiretroviral medications. With this in mind, the DSPs have employed medical advisers to South African Family Practice is co-published by Medpharm Publications, NISC (Pty) Ltd and Cogent, Taylor & Francis Group S Afr Fam Pract ISSN 2078-6190 EISSN 2078-6204 © 2016 The Author(s) RESEARCH South African Family Practice 2016; 58(3):119–125 http://dx.doi.org/10.1080/20786190.2016.1191747 Open Access article distributed under the terms of the Creative Commons License [CC BY-NC-ND 4.0] http://creativecommons.org/licenses/by-nc-nd/4.0 Integrating mental health care services in primary health care clinics: a survey of primary health care nurses’ knowledge, attitudes and beliefs Faith Dubea* and Leana Nana Uysa a School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa *Corresponding author, emails: nana.dube@kznhealth.gov.za, dube_nana@yahoo.com Background: Nurses are the main providers of care at primary health care (PHC) clinics; the high incidence of mental health problems at these clinics means that PHC nurses are important providers of mental health care. The PHC nurses’ knowledge regarding provision and identification of mental health problems has been shown to be poor. Aim: The study aimed to investigate the knowledge, attitudes and beliefs concerning the care of psychiatric patients at PHC level amongst nurses. Setting: The study was conducted in uThungulu Health District in the Northern Area of KwaZulu-Natal Province. Six clinics were purposively selected based on their geographical location. Methods: The study used a quantitative survey using a structured questionnaire. Simple descriptive analysis and one-way ANOVA were used to analyse the data. Results: The study revealed that 39% of the nurses were between the ages of 41 and 50  years and 92% were females. The association between past experience in working with psychiatric patients and positive attitude of nurses was found to be significant. Conclusion: This study found that PHC nurses’ attitudes and beliefs towards people with mental illness were positive. PHC nurses were found to have inadequate knowledge to manage psychiatric patients. Keywords: attitudes, beliefs, integration, knowledge Introduction In South Africa, mental health promotion, prevention of mental disorders and provision of mental health care are basic services that are provided in primary health care (PHC) clinics.1 It is estimated that one in four people in the world suffer from mental health conditions during their life span and mental health conditions are the leading cause of disability.2 About 23% of people attending primary health care suffer from mental health disorders.3 Despite the high number of people with mental health conditions, mental health has a low priority in South Africa and people with mental health disorders do not receive the care they require in PHC clinics.4 Despite the important role PHC nurses play in the provision of health to the general population, their attitudes towards people with mental illness are often negative,5–7 and provision and identification of mental health problems by PHC nurses has been shown to be poor because their knowledge to deal with mental health conditions is inadequate.8,9 Many nurses lack knowledge and skills to identify and manage mental health conditions.10 The World Health Organization (WHO) is of the opinion that training of PHC nurses is effective in improving recognition of mental health disorders in PHC settings.10 In a study conducted by Hijazi, Weissbecker and Chammay nurses stated that training on mental health had helped them to share their experiences with colleagues and increased their awareness of mental health and improved their ability to listen to patients.11 Nordt, Rössler and Lauber found that healthcare workers’ ratings for negative attitudes were higher than for the general public and the desire for social distance was greater.12 Sartorius13 identified PHC nurses’ negative attitudes and beliefs as a major reason for patients with mental health conditions receiving poor mental health care. Personal beliefs are shaped by knowledge about mental health and this sets the measure for provision of mental health services by the healthcare worker.14 The usage of stigmatising terms and psychiatric labelling by health professionals has led to the development and maintenance of stigmatisation.12,13 Results of the study conducted by Pietrzak et al.15 among veterans who screened positive for mental health disorders revealed that negative beliefs about mental health care and decreased perceptions were associated with increased stigma and barriers to care. Stigma directed to a person with psychiatric illness is due to lack of knowledge about mental health, negative attitudes towards mental health and discrimination against people with psychiatric conditions.16 The stigmatising attitudes may vary according to gender or whether someone knows a person with mental illness.17 Thornicroft et al.16 recommended interventions that will bring about behaviour change to reduce negative attitudes towards people with mental illness. Given the high prevalence of mental health conditions in South Africa, there is a need for integrated mental health services at primary health care clinics.18 Integration of mental health services into PHC is supported by the WHO on the Optimal Mix of Services for Mental Health because the person can be treated as a whole and seeking care is less stigmatised.19 Integration of mental health into general PHC services ensures that all PHC health workers involved in the management of a psychiatric patient have a shared understanding of the patient’s progress and compliance with medication regimens.20 Problem statement Mental disorders account for 4 of the 10 leading causes of health disability.21 There is a relationship between mental disorders and S Afr Fam Pract 2015; DOI:10.1080/20786190.2016.1191747 S Afr Fam Pract 2015; DOI:10.1080/20786190.2016.1182810 Abstract (Full text available online at www.tandfonline.com/ojfp) Abstract (Full text available online at www.tandfonline.com/ojfp)