{"doi":"10.7189/jogh.14.05035","title":"Leadership, cohesion, and stress in primary care facilities and retention in chronic care in rural northeast South Africa before and during the COVID-19 pandemic: A longitudinal study","abstract":null,"journal":"Journal of Global Health","year":2024,"id":624454,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1614281,"name":"Morelearnings Sibanda","orcid":null,"position":1,"is_corresponding":false},{"id":277340,"name":"Kathleen Kahn","orcid":"0000-0003-3339-3931","position":2,"is_corresponding":false},{"id":1430195,"name":"Stephen M Tollman","orcid":null,"position":3,"is_corresponding":false},{"id":374307,"name":"Nkosinathi Masilela","orcid":"0000-0002-4718-9336","position":4,"is_corresponding":false},{"id":1270131,"name":"F Xavier Gómez-Olivé","orcid":null,"position":5,"is_corresponding":false},{"id":1614283,"name":"Sheri A Lippman","orcid":null,"position":6,"is_corresponding":false},{"id":1614284,"name":"Chodziwadziwa W Kabudula","orcid":null,"position":7,"is_corresponding":false},{"id":1614279,"name":"Hannah H Leslie","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Leadership, cohesion, and stress in primary care facilities and retention in chronic care in rural northeast South Africa before and during the COVID-19 pandemic: A longitudinal study","abstract":"Background: Human immunodeficiency virus (HIV) and hypertension are major contributors to morbidity and mortality in South Africa. Effective management of these conditions is critical to population health, yet patient management and retention varies by facility for reasons that are not fully understood. We assessed whether measures of clinic leadership, cohesion, and stress were associated with retention for HIV and hypertension in a cohort of patients in northeast South Africa before and during the Coronavirus disease 2019 pandemic. Methods: We quantified nursing capacity and service readiness within primary health care facilities in the Bushbuckridge sub-district in Mpumalanga province South Africa. We administered brief scales on facility leadership, cohesion, and stress from January to March 2019, and tested scales for individual and facility-level agreement. We extracted clinical records for patients with HIV and/or hypertension from 2019 to 2021 and quantified treatment retention by quarter. We used generalised estimating equations to assess individual and clinic factors associated with retention in each treatment programme prior to (2019-first quarter 2020) and during (second quarter 2020-2021) the pandemic. Results: The nine facilities had a median of 12 nurses on staff and scored 0.83 out of 1.0 on basic service readiness. We collected responses to leadership, cohesion, and stress scales from 54 nurses and counsellors. Scales showed high inter-item agreement and moderate within-facility agreement. From 2019 to 2021, 19 445 individuals were treated for HIV and/or hypertension across seven participating facilities. Two-year retention was 91% for those with both conditions, 82% for those in treatment for HIV alone and 77% for those in treatment for hypertension alone, with 10-15% differences between facilities and high retention during the pandemic period. In addition to those with both conditions, women and adults aged 60-69 were more likely to be retained. Clinic factors were inconsistently associated with patient retention. Conclusions: While measures of clinic leadership, cohesion, and stress were generally reliable at individual and facility levels, we found limited evidence supporting a link between these factors and better retention in care. Retention was stable during the Coronavirus disease 2019 pandemic. Men, the youngest and oldest adults, and those without known multimorbidity should be prioritised for retention interventions.","is_dataset_classified":null,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"39652086","pmcid":"PMC11627195","openalex_id":"https://openalex.org/W4405186109","authors":[],"funders":[{"funder_name":"Wellcome Trust","grant_id":"085477/Z/08/Z","title":null},{"funder_name":"Wellcome Trust","grant_id":"058893/Z/99/A","title":null},{"funder_name":"Wellcome Trust","grant_id":"069683/Z/02/Z","title":null},{"funder_name":"Wellcome Trust","grant_id":"085477/B/08/Z","title":null},{"funder_name":"NIAID NIH HHS","grant_id":"P30 AI027763","title":null},{"funder_name":"Wellcome Trust","grant_id":"069683","title":"Investigating and responding to health, population and social transitions in rural Southern Africa."},{"funder_name":"National Institutes of Health","grant_id":"3P30AI027763-12S2","title":"UCSF-GIVI Center for AIDS research"},{"funder_name":"Wellcome Trust","grant_id":"085477","title":"Health, population and social transitions in rural Southern Africa: Elucidating pathways and testing interventions."},{"funder_name":"Wellcome Trust","grant_id":"058893","title":"Strengthening and stabilising a demographic and health surveillance in Agincourt: foundation for a health and population research programme in South Africa's rural northeast"},{"funder_name":"Wellcome Trust","grant_id":"","title":null},{"funder_name":"Wellcome Trust","grant_id":"","title":null}],"total_grants":11,"fwci":0.6564,"citation_percentile":0.7681838,"influential_citations":0,"citation_trend":[{"year":2025,"count":1}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://jogh.org/wp-content/uploads/2024/12/jogh-14-05035.pdf","host_type":"journal"},{"url":"https://jogh.org/wp-content/uploads/2024/12/jogh-14-05035.pdf","host_type":"publisher"},{"url":"https://jogh.org/2024/jogh-14-05035","host_type":"publisher"},{"url":"https://doi.org/10.7189/jogh.14.05035","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/39652086","host_type":"repository"},{"url":"https://escholarship.org/uc/item/3bf7c5tt","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/11627195","host_type":"repository"},{"url":"https://escholarship.org/content/qt3bf7c5tt/qt3bf7c5tt.pdf","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC11627195/pdf/jogh-14-05035.pdf","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC11627195","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC11627195?pdf=render","host_type":"Europe_PMC"},{"url":"http://dx.doi.org/10.7189/jogh.14.05035","host_type":""},{"url":"https://doi.org/https://doi.org/10.7189/jogh.14.05035","host_type":""}],"fields_of_study":["Primary Care and Health Outcomes","Global Maternal and Child Health","HIV/AIDS Research and Interventions","Humans","South Africa","COVID-19","Leadership","Female","Male","Primary Health Care","Longitudinal Studies","HIV Infections","Adult","Middle Aged","Hypertension","Retention in Care","Rural Population","SARS-CoV-2","Pandemics","Stress, Psychological"],"mesh_terms":["Retention in Care","COVID-19","SARS-CoV-2","Adult","Female","Humans","Hypertension","Leadership","Longitudinal Studies","Male","Middle Aged","Primary Health Care","Rural Population","South Africa","Stress, Psychological","HIV Infections","Pandemics"],"keywords":["Medicine","Quarter (Canadian coin)","Pandemic","Family medicine","Population","Cohort","Cohort study","Nursing","Demography","Coronavirus disease 2019 (COVID-19)","Environmental health","Disease","Internal medicine","Geography","Infectious disease (medical specialty)","Male","Adult","Rural Population","610","HIV Infections","Stress","7.3 Management and decision making","South Africa","Clinical Research","Health Services and Systems","Health Sciences","Behavioral and Social Science","Retention in Care","Humans","Longitudinal Studies","Pandemics","Public health","Primary Health Care","SARS-CoV-2","COVID-19","Articles","Health Services","Middle Aged","Leadership","Mental Health","Infectious Diseases","Good Health and Well Being","Hypertension","Public Health and Health Services","HIV/AIDS","Sexually Transmitted Infections","Women's Health","Psychological","Female","Infection","Stress, Psychological"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and 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