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Objectives: To determine the unmet need for care and barriers for consulting sexually transmitted infection (STI) services at six primary healthcare (PHC) facilities in rural South Africa., Methods: Cross-sectional study using three community-based strategies to mobilise adult individuals with STI-associated symptoms to access care. Participants were mobilised through clinic posters and referral by community healthcare workers (CHWs) and traditional leaders after training. Men with male urethritis syndrome and women with vaginal discharge syndrome were mobilised to visit participating PHC facilities on two designated days when an expert team visited the facility. Questionnaires were completed and HIV rapid tests offered. The minimal unmet need for care of individuals with STI-associated symptoms was calculated by dividing the number of cases over the adult catchment population of each PHC facility., Results: We successfully mobilised 177 symptomatic individuals: 134 (76%) women and 43 (24%) men. The estimated minimal unmet need for STI care was 1:364 (95% CI 1:350-1:380) individuals in this region; the rate was higher in village than township facilities, and among women. Mobilisation through clinic posters (57%) and by CHWs (23%) was most successful. Three-quarters of individuals (132/177) reported symptoms that had been present for >30 days; 49% (87/177) had symptoms >6 months. In addition, we identified 14 individuals with untreated HIV infection amounting to a 7% HIV testing yield. Lack of awareness of symptoms (34%), and disappointment in care due to persistent (23%) or recurrent (15%) symptoms after previous treatment, or disappointment with health services in general during previous visit(s) for any reason (10%) was the most common reasons for not consulting health care., Conclusions: We demonstrate a high unmet need for care of individuals with STI-associated symptoms in rural South Africa that requires urgent attention. A multidisciplinary approach that creates service demand through community awareness and information provision by healthcare workers combined with strengthening the quality of STI services is required to improve reproductive health and prevent complications of untreated STIs in this population., (© 2019 John Wiley & Sons Ltd.)

Disclosing to a child that s/he is living with HIV is necessary to promote adherence to treatment and improve health outcomes. Facilitating disclosure between caregivers and children remains a challenge for health workers. Understanding how health workers are involved in and perceive the disclosure process is integral to engaging with such challenges. We held group discussions with and surveyed 73 physicians, nurses, and counselors across 16 randomly selected facilities in two rural South African health districts, exploring their experiences of supporting disclosure between caregivers and children. Ninety percent of those surveyed agreed that children should be informed of their HIV status. Differences between categories of health workers regarding training, involvement in the disclosure process, and perceived responsibility for disclosure support led to inconsistent disclosure practices within facilities. Disclosure-strengthening interventions must consider the composition of the health worker team and the role that each category of health worker performs in their local settings., (Copyright © 2018 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)

Background: South Africa has implemented a community health programme delivered by community health workers (CHWs) to strengthen primary healthcare services. Provision of community Human Immunodeficiency Virus (HIV) services constitutes an important component of this programme. To support effectiveness, we assessed fidelity of HIV programme implementation by CHWs from the community's perspective in a rural South African setting., Methods: A cross-sectional study was conducted targeting 900 randomly selected households in twelve wards of two sub-districts (Greater Giyani and Greater Letaba) of Mopani District (Limpopo Province, South Africa). Questionnaires were administered to the traditionally most appropriate adult member of the household. Included were questions related to the four standard components to measure implementation fidelity against local guidelines: coverage, frequency, duration and content of HIV programme implementation., Results: Participants were enrolled at 534 households; in most other cases there was nobody or no adult member at home (n = 291). Reported coverage of 55% (141/253) and a frequency of 47% (66/140) were higher in Greater Giyani as compared to Greater Letaba (44%; 122/278 and 29%; 33/112, respectively, p = 0.007 for both comparisons). Coverage was not associated with the distance from the participant's household to the facility (p = 0.93). Duration of programme delivery was reported to be high, where all CHW visits (253/253; 100%) were conducted within the last 6 months and the content delivered was adequate (242/253; 96%). Individuals reporting a CHW visit were more likely to know their HIV status than those not visited (OR = 2.0; 95% CI 1.06-3.8; p = 0.032). Among those visited by the CHW discussion of HIV was associated with knowing the HIV status (OR = 2.2; 95% CI 1.02-4.6; p = 0.044); in particular for women (OR = 2.9; 95% CI 1.5-5.4; p = 0.001)., Conclusions: This study demonstrates promising HIV programme implementation fidelity by CHWs in rural South Africa. Programme coverage and frequency should be improved whilst maintaining the good levels of duration and content. Resource investment, strengthening of operational structure, and research to identify other facilitators of programme implementation are warranted to improve programme effectiveness and impact.