Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga Province
Background. In sub-Saharan Africa, ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour and is strongly associated with HIV infection. This range of ocular malignancies can be managed early to prevent large tumours requiring invasive treatment, facial disfigurement...
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South African Medical Association
2024-06-01
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| Series: | South African Medical Journal |
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| Online Access: | https://samajournals.co.za/index.php/samj/article/view/1310 |
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| author | S Mhlanga A C Turner S J Biddulph |
| author_facet | S Mhlanga A C Turner S J Biddulph |
| author_sort | S Mhlanga |
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Background. In sub-Saharan Africa, ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour and is strongly associated with HIV infection. This range of ocular malignancies can be managed early to prevent large tumours requiring invasive treatment, facial disfigurement and mortality. Primary healthcare workers (HCWs) play a critical role in the early identification of the lesion. In addition, the ocular lesion can also be the presenting sign of HIV infection in individuals who have not yet been diagnosed. The aim of the present study was to assess the management of suspicious conjunctival growths in HIV-infected patients in primary health facilities and a specialist eye clinic in South Africa.
Objectives. To assess the knowledge, attitude and current practice of HCWs working in HIV clinics regarding ocular surface lesions and to evaluate the management of patients with ocular surface lesions at a tertiary hospital.
Methods. A cross-sectional study design was used (November 2020 - May 2021), for which 149 HCWs were invited to assessments about their knowledge, attitudes and practices regarding ocular surface lesions. In addition, files of patients with ocular surface lesions who presented between January 2018 and August 2020 to the eye clinic were reviewed using a data extraction sheet.
Results. One hundred-and-three HCWs agreed to participate in the survey (response rate 69.1%). Of these participants, 84.5% were experienced professional nurses (6 - 15 years of work experience) but had minimal experience with detection and management of eye complaints and lesions. Twenty-seven (26.2%) of the participants recognised some ocular surface lesions and 86 (83.5%) reported that they would refer patients with suspicious lesions. Sixty-two files were reviewed and 51 (82.2%) of the patients had an HIV-positive diagnosis. Fifty percent had carcinoma-in situ and squamous cell carcinoma of the conjunctiva. Thirty-one (50%) of the patients were lost to follow-up.
Conclusion. OSSN is an important manifestation of HIV infection. It would be beneficial for patients to receive a basic ocular examination as part of the baseline clinical evaluation; this may contribute to early referral to an eye care facility. The health system would benefit from establishing an eye health support system with the nearby health facilities, thereby educating primary HCWs about the association between HIV and OSSN.
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| format | Article |
| id | doaj-art-e30b56dcc9e6485ba685a99265017ac2 |
| institution | Kabale University |
| issn | 0256-9574 2078-5135 |
| language | English |
| publishDate | 2024-06-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj-art-e30b56dcc9e6485ba685a99265017ac22025-02-10T12:25:56ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352024-06-011146b10.7196/SAMJ.2024.v114i16b.1310Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga ProvinceS Mhlanga0A C Turner1S J Biddulph2Breast and Endocrine surgical unit, Groote Schuur Hospital, Cape Town, South AfricaSchool of Health Systems and Public Health, University of Pretoria, South AfricaDepartment of Ophthalmology, Rob Ferreira Hospital, Nelspruit, South Africa Background. In sub-Saharan Africa, ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour and is strongly associated with HIV infection. This range of ocular malignancies can be managed early to prevent large tumours requiring invasive treatment, facial disfigurement and mortality. Primary healthcare workers (HCWs) play a critical role in the early identification of the lesion. In addition, the ocular lesion can also be the presenting sign of HIV infection in individuals who have not yet been diagnosed. The aim of the present study was to assess the management of suspicious conjunctival growths in HIV-infected patients in primary health facilities and a specialist eye clinic in South Africa. Objectives. To assess the knowledge, attitude and current practice of HCWs working in HIV clinics regarding ocular surface lesions and to evaluate the management of patients with ocular surface lesions at a tertiary hospital. Methods. A cross-sectional study design was used (November 2020 - May 2021), for which 149 HCWs were invited to assessments about their knowledge, attitudes and practices regarding ocular surface lesions. In addition, files of patients with ocular surface lesions who presented between January 2018 and August 2020 to the eye clinic were reviewed using a data extraction sheet. Results. One hundred-and-three HCWs agreed to participate in the survey (response rate 69.1%). Of these participants, 84.5% were experienced professional nurses (6 - 15 years of work experience) but had minimal experience with detection and management of eye complaints and lesions. Twenty-seven (26.2%) of the participants recognised some ocular surface lesions and 86 (83.5%) reported that they would refer patients with suspicious lesions. Sixty-two files were reviewed and 51 (82.2%) of the patients had an HIV-positive diagnosis. Fifty percent had carcinoma-in situ and squamous cell carcinoma of the conjunctiva. Thirty-one (50%) of the patients were lost to follow-up. Conclusion. OSSN is an important manifestation of HIV infection. It would be beneficial for patients to receive a basic ocular examination as part of the baseline clinical evaluation; this may contribute to early referral to an eye care facility. The health system would benefit from establishing an eye health support system with the nearby health facilities, thereby educating primary HCWs about the association between HIV and OSSN. https://samajournals.co.za/index.php/samj/article/view/1310Ocular manifestations of HIVocular surface squamous neoplasiaHIVprimary health careconjunctival growthocular surface lesion |
| spellingShingle | S Mhlanga A C Turner S J Biddulph Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga Province South African Medical Journal Ocular manifestations of HIV ocular surface squamous neoplasia HIV primary health care conjunctival growth ocular surface lesion |
| title | Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga Province |
| title_full | Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga Province |
| title_fullStr | Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga Province |
| title_full_unstemmed | Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga Province |
| title_short | Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga Province |
| title_sort | primary and tertiary management of ocular surface lesions in hiv infected patients in ehlanzeni mpumalanga province |
| topic | Ocular manifestations of HIV ocular surface squamous neoplasia HIV primary health care conjunctival growth ocular surface lesion |
| url | https://samajournals.co.za/index.php/samj/article/view/1310 |
| work_keys_str_mv | AT smhlanga primaryandtertiarymanagementofocularsurfacelesionsinhivinfectedpatientsinehlanzenimpumalangaprovince AT acturner primaryandtertiarymanagementofocularsurfacelesionsinhivinfectedpatientsinehlanzenimpumalangaprovince AT sjbiddulph primaryandtertiarymanagementofocularsurfacelesionsinhivinfectedpatientsinehlanzenimpumalangaprovince |