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Since the 1990s managerialism has spread across the public sector, implementing private sector practices targeting greater efficiency in public services. Consequently, reforms focusing on risk management, standardisation, fragmentation and accountability have increased demands for paperwork and procedure compliance from street-level bureaucrats (SLBs). Focusing specifically on the impact on social work, this paper presents the findings of a systematic literature review synthesising social workers experience of bureaucracy across thirty-nine published qualitative studies. Despite warnings being voiced about the risks associated with enforcing highly bureaucratic and managerial cultures in social work, evidence reinforces the consequences predicted over two decades prior. Major themes from the systematic synthesis include negative effects on social workers and service users, social workers’ resistance to bureaucratic structures and the coping strategies they employed. Although the review found some positive perspectives, this was sporadic and only reported in a minority of studies. As SLBs, social workers face an important question: What should be prioritised in the delivery of social services? Managing procedures, administration and documentation or pursuing sustainable change through meaningful engagement with service users?

Introduction: Acquired epidermodysplasia verruciformis (EV) is a skin disorder that has been described in individuals with perinatally acquired HIV. Many cases have been identified in sub-Saharan Africa in keeping with the epidemiology of HIV infection compared to the rest of the world, where cases are rare. Epidermodysplasia verruciformis skin lesions may undergo malignant transformation. There are few documented cases of malignant transformation of these skin lesions. We describe a patient with an EV-like skin rash who developed cutaneous squamous cell carcinoma (SCC).Patient presentation: A 25-year-old man, on antiretroviral treatment for 12 years, presented with a generalised skin rash since the age of 11 years, and a 7-month history of a persistent scalp ulcer. He had no history of trauma, radiation or other chronic conditions. Despite an undetectable HIV viral load, he had failed to immune reconstitute (CD4 42 cells/µL). Physical examination revealed a generalised hypopigmented, papular skin rash resembling verruca plana and a 3 cm × 3 cm ulcer with rolled edges on the right parietal region of the scalp. There were no palpable lymph nodes in the head and neck areas. Biopsy of the ulcer revealed moderately differentiated SCC.Management and outcome: Wide local excision of the lesion was done under local anaesthesia and histological analysis confirmed completely excised moderately differentiated SCC. Further examination four weeks later revealed two, smaller, histologically similar scalp lesions which were completely excised.Conclusion: Patients with acquired EV require thorough, frequent examination for skin lesions with possible malignant transformation. Early identification of malignant transformation and treatment with surgical intervention is curative.

Context:In response to the growth of evidence-based practice in social work, systematic literature reviews offer significant value to social work but are often met with concerns of time scarcity.Purpose:Through a case study search strategy addressing the research question “What are practicing frontline social workers’ experiences of bureaucracy?,” this article seeks to promote efficiency by providing a practical guide for conducting systematic literature searches and an appraisal of database performance in qualitative social work research.Method:The total citations, unique hits, sensitivity, and precision for each database were calculated before conducting a cross-study comparison with three previously published social work systematic searches to identify emerging performance trends.Results/Conclusion:Relying on a single database is subject to bias and will not provide comprehensive or sensitive findings; however, due to consistent high performance across four systematic searches, Applied Social Science Index and Abstracts, Social Services Abstracts, and Social Science Citation Index are recommended for future literature searching in social work.

This article explores how disability and disabled people were portrayed in New Zealand online media between 2006 and 2016, with specific reference to disasters. Following a process of content analy...

Background: Coinfection rates of HIV and sexually transmitted infections (STIs) are not widely reported in Zimbabwe and no local guidelines regarding the screening of STIs in people living with HIV exist. Objectives: This cross-sectional study was conducted to determine the prevalence and associated risk factors for STI coinfection in a cohort of HIV-infected women. Methods: Between January and June 2016, 385 HIV-infected women presenting for routine cervical cancer screening were tested for five STIs: Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Herpes Simplex Virus (HSV) type 2 and Treponema pallidum (TP). Socio-demographic characteristics and sexual history were recorded. Multiple logistic regression was used to identify factors associated with the diagnosis of non-viral STIs. Results: Two hundred and thirty-three participants (60.5%) had a confirmed positive result for at least one STI: HSV 2 prevalence 52.5%, TV 8.1%, CT 2.1%, NG 1.8% and TP 11.4%. Eighty-seven per cent of the women were asymptomatic for any STI; 62.3% of women with a non-viral STI were asymptomatic. Women who had attended tertiary education were 90% less likely to have a non-viral STI (adjusted odds ratio [aOR]: 0.10, 95% confidence interval [CI]: 0.03–0.39, p < 0.01). Having more than three lifetime sexual partners was a significant predictor for a non-viral STI diagnosis (aOR: 3.3, 95% CI: 1.5–7.2, p < 0.01). Conclusion: A high prevalence of predominantly asymptomatic STIs is reported in a cohort of HIV-infected women. Syndromic management results in underdiagnosis of asymptomatic patients. More than three lifetime sexual partners and less formal education are risk factors for coinfection with non-viral STI. High-risk women should be screened using aetiological methods.

Introduction: Zimbabwe, like other resource limited countries, manages HIV infection using the public health approach with standard antiretroviral therapy (ART) regimens for first, second and third-line treatment. Third-line ART is the last available treatment option and is based on dolutegravir and darunavir use after HIV drug resistance testing. Patient Presentation: We report here a 17-year-old patient on dolutegravir (DTG) and Darunavir based third-line antiretroviral therapy (ART) previously exposed to raltegravir who develops multidrug resistance HIV to the four ART classes available in Zimbabwe. Management and Outcome: A trophism assay revealed that patient has CXCR4 trophic virus and hence will not benefit from Maraviroc. Patient is currently stable and receiving a holding regimen of abacavir, lamivudine and lamivudine. Conclusion: This is the first documented case of multiclass resistance to the four available ART classes in Zimbabwe. The development and transmission of multiclass HIV drug resistance in resource limited settings has potential to undo the gains of national ART programs. There is need to ensure optimum adherence to ART even in the era of DTG.

Introduction: HIV infected patients on antiretroviral therapy (ART) are at risk of developing nephropathy and therefore require monitoring of renal function. Some medications used in the management of HIV, opportunistic infections (OIs) and other comorbidities are nephrotoxic and may further compromise renal function, underlining the importance of regular monitoring of renal function. This study was designed to determine the incidence of nephropathy in HIV infected patients on antiretroviral therapy (ART) at Newlands Clinic and to determine the associated risk factors. Methodology: A retrospective cohort study was conducted involving 1986 HIV-1 infected participants who were commenced on ART between January 2007 and December 2013 at Newlands Clinic. The majority of participants were female (1340 (67.5%)). All participants were aged 18 or older at ART commencement. Participants with pre-existing nephropathy at baseline were excluded. Nephropathy was defined as two consecutive calculated creatinine clearances (CrCl) less than 60 ml/min by the Cockcroft-Gault equation, or two consecutive urine dipsticks positive for protein (≥30 g/L albumin). Data collected during routine patient visits were exported from the clinic’s database and analysed for incidence of nephropathy and risk factors. Results: During the follow-up period, 93 of the 1986 participants (4.7%) developed nephropathy. The estimated incidence rate (IR) of nephropathy was 1.45/100 person years (CI: 1.17 - 1.78). In the multivariate analysis, statistically significant risk factors were baseline age > 45 (HR 2.30, CI: 1.50 - 3.55), diabetes mellitus (HR 4.12, CI: 1.75 - 9.69), pulmonary tuberculosis (HR 2.00, CI: 1.28 - 3.12), and HIV wasting syndrome (HR 2.72, CI: 1.30 - 5.68). Conclusion: The incidence of nephropathy was low in this cohort. The traditional risk factors for renal disease; older age and diabetes mellitus were significant, as well as HIV wasting syndrome and pulmonary tuberculosis. HIV care should be complimented with proper diabetic care and patients that develop pulmonary tuberculosis, HIV wasting syndrome or are initiated on ART above 45 years require regular monitoring for early detection of nephropathy.

Many HIV-infected children in Southern Africa have been started on antiretroviral therapy (ART), but loss to follow up (LTFU) can be substantial. We analyzed mortality in children retained in care and in all children starting ART, taking LTFU into account.Children who started ART before the age of 16 years in 10 ART programs in South Africa, Malawi, Mozambique, and Zimbabwe were included. Risk factors for death in the first year of ART were identified in Weibull models. A meta-analytic approach was used to estimate cumulative mortality at 1 year.Eight thousand two hundred twenty-five children (median age 49 months, median CD4 cell percent 11.6%) were included; 391 (4.8%) died and 523 (7.0%) were LTFU in the first year. Mortality at 1 year was 4.5% [95% confidence interval (CI): 2.8% to 7.4%] in children remaining in care, but 8.7% (5.4% to 12.1%) at the program level, after taking mortality in children and LTFU into account. Factors associated with mortality in children remaining in care included age [adjusted hazard ratio (HR) 0.37; 95% CI: 0.25 to 0.54 comparingor =120 months with18 months], CD4 cell percent (HR: 0.56; 95% CI: 0.39 to 0.78 comparingor =20% with10%), and clinical stage (HR: 0.12; 95% CI: 0.03 to 0.45 comparing World Health Organization stage I with III/IV).In children starting ART and remaining in care in Southern Africa mortality at 1 year is5% but almost twice as high at the program level, when taking LTFU into account. Age, CD4 percentage, and clinical stage are important predictors of mortality at the individual level.

To compare the gender distribution of HIV-infected adults receiving highly active antiretroviral treatment (HAART) in resource-constrained settings with estimates of the gender distribution of HIV infection; to describe the clinical characteristics of women and men receiving HAART.The Antiretroviral Therapy in Lower-Income Countries, ART-LINC Collaboration is a network of clinics providing HAART in Africa, Latin America, and Asia. We compared UNAIDS data on the gender distribution of HIV infection with the proportions of women and men receiving HAART in the ART-LINC Collaboration.Twenty-nine centers in 13 countries participated. Among 33,164 individuals, 19,989 (60.3%) were women. Proportions of women receiving HAART in ART-LINC centers were similar to, or higher than, UNAIDS estimates of the proportions of HIV-infected women in all but two centers. There were fewer women receiving HAART than expected from UNAIDS data in one center in Uganda and one center in India. Taking into account heterogeneity across cohorts, women were younger than men, less likely to have advanced HIV infection, and more likely to be anemic at HAART initiation.Women in resource-constrained settings are not necessarily disadvantaged in their access to HAART. More attention needs to be paid to ensuring that HIV-infected men are seeking care and starting HAART.

BACKGROUND: Tuberculosis (TB) is a common diagnosis in human immunodeficiency virus (HIV) infected patients on antiretroviral treatment (ART). OBJECTIVE: To describe TB-related practices in ART programmes in lower-income countries and identify risk factors for TB in the first year of ART. METHODS: Programme characteristics were assessed using standardised electronic questionnaire. Patient data from 2003 to 2008 were analysed and incidence rate ratios (IRRs) calculated using Poisson regression models. RESULTS: Fifteen ART programmes in 12 countries in Africa, South America and Asia were included. Chest X-ray, sputum microscopy and culture were available free of charge in respectively 13 (86.7%), 14 (93.3%) and eight (53.3%) programmes. Eight sites (53.3%) used directly observed treatment and five (33.3%) routinely administered isoniazid preventive treatment (IPT). A total of 19 413 patients aged ≥16 years contributed 13 227 person-years of follow-up; 1081 new TB events were diagnosed. Risk factors included CD4 cell count (>350 cells/μl vs.

New Zealand is considered an egalitarian society, with a progressive policy history in promoting gender equality, however, this paper illustrates how social policy does not always support this agenda. The objective of New Zealand Sole Parent Benefit is to provide temporal financial support to sole parents and their dependents while supporting a transition into formal paid employment. While ultimately aimed at increasing the labour force participation of sole parents, this paper queries to what extent the policy has achieved this objective and why. Recipient statistics are disaggregated by gender to highlight the disproportionate impact on, and unequal outcomes for women. Furthermore, a gendered analysis informed by feminist economists Naileer Kabeer, Diane Elson and Nancy Folbre, alongside statistical evidence of a gender pay gap, occupational segregation and motherhood penalty is applied to demonstrate how market constraints affect New Zealand women’s participation in the labour force, and contribute to the counter intuitive policy results. While these factors do not account for individual differences in motivation, nor individual aspirations, unless the gendered nature of the labour market is addressed, women will continue to face higher rates of engagement on the Sole Parent Benefit and continue to experience disproportionate economic disadvantage and financial insecurity. The consistent use of a gendered analysis in policy design and implementation is essential to reduce gender-based disadvantage, even in countries believed to promote gender equality.

INTRODUCTION: Despite minimal public attention, many social workers in Aotearoa New Zealand have been active contributors to disaster management practice. Disaster management comprises four stages: risk reduction; readiness; response; and recovery. Social workers, as professionals in multiple fields of practice, may be engaged in one or more of these stages. METHODS: This article draws from a four-stage project that explored the involvement of registered social workers from Aotearoa New Zealand in disaster management. In the final project stage, 11 social workers were interviewed for the purpose of developing case studies for research and teaching purposes. This article presents the practice observations of two of these social workers in a case study format. FINDINGS: The experiences of the two social workers emphasises the importance of understanding communities, debriefing and supervision, and having a suite of tools for post- disaster situations. The case studies highlight the complex and vital work undertaken by the social workers following the Canterbury 2011 earthquakes. CONCLUSION: It is important that social workers understand disaster management and how their skills and knowledge can be transferred into this space. Regular professional supervision, and adequate resources are essential components in the long-term recovery phase of disaster management. Social work as a profession can provide leadership in disaster management through celebrating previous social work practice in this field.

The coronavirus (COVID-19) pandemic caused widespread lockdowns, social distancing measures, restrictions to businesses and the closure of buildings. During this time social workers were required to adjust to remote practice, adopting technological adjuncts for continued engagement with service users. This article reports on qualitative interviews with fourteen front line social workers practicing during the pandemic in Northern Ireland, exploring the impact of remote delivery and technology on relationship-based practice. Findings highlight negative outcomes on relationship building and social worker self-care, alongside concerns that efficiency would be prioritised over future face-to-face contact with service users. The adoption of alternative methods of communication through technology has disrupted the core principles of relationship-based practice and has meant that, without proper planning or staff training, alternative models of delivery, which may have enabled some form of continuation and centralisation of relationship-based practice are under explored and require further investigation.