South African Family Practice <em>South African Family Practice</em>(SAFP) is a peer-reviewed scientific journal, which strives to provide primary care physicians and researchers with a broad range of scholarly work in the disciplines of Family Medicine, Primary Health Care, Rural Medicine, District Health and other related fields. SAFP publishes original research, clinical reviews, and pertinent commentary that advance the knowledge base of these disciplines. The content of SAFP is designed to reflect and support further development of the broad basis of these disciplines through original research and critical review of evidence in important clinical areas; as well as to provide practitioners with continuing professional development material.<p>(Note: In January 2003 <em>South African Family Practice</em> merged with <em>Geneeskunde – The Medical Journal</em> to form <em>South African Family Practice incorporating Geneeskunde</em>, and since January 2004 it is again only known as <strong>South African Family Practice</strong> (SAFP). As a result the numbering of the journal now begins from Volume 45 in 2003).<br /><em></em></p><p>Other websites related to this journal: <a href="" target="_blank"></a></p> Medpharm Publications Pty Ltd en-US South African Family Practice 2078-6190 By submitting manuscripts to SAFP, authors of original articles are assigning copyright to the SA Academy of Family Practice/Primary Care. Copyright of review articles are assigned to the Publisher, Medpharm Publications (Pty) Ltd, unless otherwise specified. Authors may use their own work after publication without written permission, provided they acknowledge the original source. Individuals and academic institutions may freely copy and distribute articles published in SAFP for educational and research purposes without obtaining permission. Mastering your fellowship: Part 1, 2024 <p>The series, ‘Mastering your Fellowship’, provides examples of the question formats encountered in the written and clinical examinations,&nbsp; Part A of the Fellowship of the College of Family Physicians (South Africa) (FCFP [SA]) examination. The series is aimed at helping family&nbsp; medicine registrars (and their supervisors) in preparing for this examination.</p> Klaus B. von Pressentin Mergan Naidoo Frederick Mayanja Selvandran C. Rangiah Ramprakash Kaswa Copyright (c) 2024 2024-01-25 2024-01-25 66 1 Mental illness attitudes, service provision interest and further training preferences of clinical associates <p><strong>Background</strong>: Non-specialist health professionals are required to provide mental health services given the burden of disease due to&nbsp; mental illness. The study aimed to explore the attitudes of clinical associates towards those with mental illness as well as their interest in mental health work and additional mental health training.</p> <p><strong>Methods</strong>: A cross-sectional study design was utilised. The study population&nbsp; consisted of clinical associates based in South Africa. An electronic questionnaire was developed that incorporated the 16-item Mental&nbsp; Illness Clinicians’ Attitudes version 4 scale (MICA-4), which is scored out of 96 with higher scores indicating more stigmatising attitudes.&nbsp; Multivariate linear regression was used to determine factors associated with the MICA-4 score.</p> <p><strong>Results</strong>: The mean MICA-4 score for the&nbsp; 166 participants who completed all 16 questions was 37.55 (standard deviation 7.33). In multivariate analysis, the factors associated with&nbsp; significantly lower MICA-4 scores were falling in the 25- to 29-year-old age category and indicating that a mental health rotation formed&nbsp; part of the undergraduate degree. More than 80% of the participants (140/167, 83.8%) indicated an interest in mental health work. Two- thirds of the participants (111/167, 66.5%) indicated an interest in a specialisation in mental health.</p> <p><strong>Conclusion</strong>: The mean MICA-4 score&nbsp; recorded for clinical associates indicates low stigma levels towards those with mental illness. Additionally, there is significant interest in&nbsp; working and training in mental health.</p> <p><strong>Contribution</strong>: Training programmes should take note of the contribution of a mental health rotation to a positive attitude to mental health patients. Clinical associates’ attitudes towards mental illness together with their interest in&nbsp; working and training in mental health suggest that they could be more widely utilised in mental health service provision.&nbsp;</p> Saiendhra V. Moodley Jacqueline Wolvaardt Christoffel Grobler Copyright (c) 2024 2024-01-25 2024-01-25 66 1 Brain drain in South Africa is affecting health care <p>No Abstract</p> Indiran Govender Copyright (c) 2024 2024-01-25 2024-01-25 66 1 Enhancing sexual health in primary care: Guidance for practitioners <p>Sexual health is an integral aspect of overall health and well-being and is fundamental to the sustainable development of societies&nbsp; worldwide. The World Health Organization (WHO) defines sexual health as ‘a state of physical, emotional, mental, and social well-being in&nbsp; relation to sexuality’. However, addressing sexual health has been afforded low priority in primary healthcare systems. Primary care&nbsp; practitioners (PCPs), who play a crucial role in providing comprehensive care to communities, receive little training on screening and&nbsp; managing individuals with sexual health problems. The scope of services ranges from education, prevention and screening, to&nbsp; management of sexual health matters. Patients with noncommunicable diseases (NCDs), such as stroke, cancer, heart disease and&nbsp; diabetes, are at increased risk for sexual dysfunction, possibly because of common pathogenetic mechanisms, such as inflammation. This&nbsp; is of considerable importance in the sub-Saharan African context where there is a rapidly increasing prevalence of NCDs, as well as a&nbsp; high burden of HIV. Strategies to improve the quality of sexual health services in primary care include creating a safe and non- judgemental practice environment for history-taking among gender-diverse populations, utilising effective screening tools aligned with&nbsp; the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for sexual dysfunctions. In particular, the International&nbsp; Consultation on Sexual Medicine (ICSM -5) diagnostic and treatment algorithm can empower primary care providers to effectively&nbsp; address sexual dysfunctions among patients and improve the quality of care provided to communities regarding sexual and reproductive&nbsp; health.&nbsp;</p> Padaruth Ramlachan Keshena Naidoo Copyright (c) 2024 2024-01-25 2024-01-25 66 1 Assessing index CD4 and associated outcomes at 1-year in a tertiary HIV clinic, KwaZulu-Natal <p><strong>Background</strong>: Human immunodeficiency virus (HIV) management guidelines have evolved from initiating therapy at CD4 counts of ≤ 200&nbsp; cells/m<sup>3</sup> to implementing universal test and treat (UTT). This study aimed to assess whether in clinical practice, patients are presenting with higher baseline CD4 counts, describe the incidence of opportunistic infections and the proportion that achieved viral suppression.&nbsp;&nbsp;</p> <p><strong>Methods</strong>: A retrospective cohort design with convenience sampling was conducted. Cohort 1 included patients initiated on antiretroviral&nbsp; therapy (ART) between 01 January 2014 and 31 December 2014, when criteria were set at CD4 count ≤ 350 cells/mm<sup>3</sup> . Cohort 2 included patients initiated on ART between 01 January 2019 and 31 December 2019, during the UTT era.</p> <p><strong>Results</strong>: At ART initiation, the median CD4 cell was 170 cells/mm3 (interquartile range [IQR]: 85.5–287) in Cohort 1 cells/mm<sup>3</sup> and 243&nbsp; cells/mm<sup>3</sup> (IQR: 120–411) in Cohort 2. Tuberculosis was the predominant OI in the group with CD4 cell count ≤ 200 cells/m<sup>3</sup> in both&nbsp; Cohort 1 (26.8%) and Cohort 2 (27.9%), p = 0.039. At 1 year, virological suppression was achieved in only 77.7% and 84.7% of Cohorts 1 and&nbsp; 2 patients.</p> <p><strong>Conclusion</strong>: A notable portion of patients at King Edward VIII Hospital’s HIV clinic commenced ART with CD4 counts&nbsp; significantly below the recommended guideline thresholds.</p> <p><strong>Contribution</strong>: The research revealed a delay in initiating ART. A&nbsp; comprehensive reevaluation is essential to pinpoint the factors contributing to this delay and to devise customised interventions.&nbsp;</p> Zanele R. Moya Somasundram Pillay Nombulelo Magula Copyright (c) 2024 2024-01-25 2024-01-25 66 1