Behaviour Change Counselling for ARV Adherence Support Within Primary Health Care Facilities in the Western Cape, South Africa

• Published in: AIDS and behavior Vol. 16; no. 5; pp. 1286 - 1294
• Main Authors: Dewing, S., Mathews, C., Schaay, N., Cloete, A., Louw, J., Simbayi, L.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-07-2012; Springer Nature B.V
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - epidemiology; Acquired Immunodeficiency Syndrome - psychology; Acquired Immunodeficiency Syndrome - therapy; Adherence; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiviral agents; Behavioural changes; Cape Town, South Africa; Counseling; Counselling; Counsellors; Delivery of Health Care; Directive Counseling - methods; Feasibility; Feasibility Studies; Female; Follow-Up Studies; Health behavior; Health care; Health Care Services; Health Facilities - statistics & numerical data; Health Psychology; Humans; Infectious Diseases; Intervention; Interventions; Male; Medication Adherence - psychology; Medication Adherence - statistics & numerical data; Medications; Medicine; Medicine & Public Health; Motivation; Original Paper; Patient Acceptance of Health Care; Patients; Pressure; Primary care; Primary Health Care; Professional-Patient Relations; Public Health; Resistance; Risk Reduction Behavior; Risk taking; Sexual behavior; Sexual Behavior - psychology; Sexual Behavior - statistics & numerical data; South Africa; South Africa - epidemiology; South Africa; Western Cape South Africa; South Africa, Western Cape; South Africa, Western Cape, Cape Town; Behaviour change counselling; Antiretroviral adherence support; Lay health workers; Changing practice; Process evaluation
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-011-0059-z

Health care systems have been described as ideal settings for behaviour change counselling interventions. There is little research evaluating the feasibility of implementing such interventions in routine practice in primary care facilities. We implemented an intervention called
Options for Health
within routine adherence counselling practice in 20 antiretroviral facilities in Cape Town, South Africa. Lay counsellors were trained to use
Options
to help clients to optimise ARV adherence and reduce sexual risk behaviour. Counsellors delivered the intervention to 9% of eligible patients over 12 months. Interviews with counsellors revealed barriers to implementation including a lack of counselling space, time pressure and patient resistance to counselling. Counsellors felt that
Options
was not appropriate for use with all patients and adherence problems, and used parts of the intervention as it suited their needs. Findings revealed weaknesses in the current adherence counselling system that have implications for the feasibility of behaviour change counselling within this context.