Breast and Endocrine surgical unit, Groote Schuur Hospital, Cape Town, South Africa.
School of Health Systems and Public Health, University of Pretoria, South Africa.
S Afr Med J. 2024 Jun 24;114(6b):e1310. doi: 10.7196/SAMJ.2024.v114i16b.1310.
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.
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.
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.
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.
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.
在撒哈拉以南非洲，眼表面鳞状上皮瘤（OSSN）是最常见的眼表面肿瘤，与 HIV 感染密切相关。这一系列眼恶性肿瘤可以早期得到治疗，以防止需要侵入性治疗、面部毁容和死亡的大型肿瘤。初级保健工作者（HCWs）在早期识别病变方面发挥着关键作用。此外，眼部病变也可能是尚未确诊的 HIV 感染者感染的首发症状。本研究旨在评估南非初级保健机构和专门眼科诊所中 HIV 感染者可疑结膜生长的处理情况。
评估在 HIV 诊所工作的 HCWs 对眼表面病变的知识、态度和当前实践，并评估在一家三级医院对眼表面病变患者的管理。
采用横断面研究设计（2020 年 11 月至 2021 年 5 月），邀请 149 名 HCWs 评估他们对眼表面病变的知识、态度和实践。此外，还使用数据提取表回顾了 2018 年 1 月至 2020 年 8 月期间在眼科诊所就诊的眼表面病变患者的病历。
103 名 HCWs 同意参与调查（应答率 69.1%）。这些参与者中，84.5%是经验丰富的专业护士（工作经验 6-15 年），但对眼部投诉和病变的检测和管理经验有限。27 名（26.2%）参与者认识一些眼表面病变，86 名（83.5%）报告他们会转诊有可疑病变的患者。共查阅了 62 份病历，其中 51 份（82.2%）患者 HIV 阳性诊断。50%为结膜原位癌和鳞状细胞癌。31 名（50%）患者失访。
OSSN 是 HIV 感染的重要表现。作为基线临床评估的一部分，让患者接受基本的眼部检查将对他们有益；这可能有助于及早转介到眼科医疗机构。通过与附近的卫生机构建立眼保健支持系统，卫生系统将受益于教育初级 HCWs 了解 HIV 和 OSSN 之间的关联。
