“It’s Important to Take Your Medication Everyday Okay?” An Evaluation of Counselling by Lay Counsellors for ARV Adherence Support in the Western Cape, South Africa

• Published in: AIDS and behavior Vol. 17; no. 1; pp. 203 - 212
• Main Authors: Dewing, S., Mathews, C., Schaay, N., Cloete, A., Louw, J., Simbayi, L.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 2013; Springer Nature B.V
• Subjects: Acquired Immune Deficiency Syndrome; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiviral agents; Cape Town, South Africa; Content analysis; Counseling; Developed countries; Directive Counseling - methods; Drug therapy; Evidence Based Practice; Female; Health behavior; Health education; Health Psychology; HIV; HIV Infections - drug therapy; HIV Infections - psychology; Human immunodeficiency virus; Humans; Infectious Diseases; Male; Medication Adherence - psychology; Medications; Medicine; Medicine & Public Health; Motivation; Original Paper; Patient Acceptance of Health Care; Patient-Centered Care; Patients; Performance evaluation; Professional-Patient Relations; Public Health; Public Sector; South Africa; Treatment Compliance; South Africa; Antiretroviral adherence support; Standard care; Counselling; Egan’s skilled helper model
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-012-0211-4

There is growing interest in standard care programmes for antiretroviral (ARV) adherence support. In South Africa, individual counselling following ARV initiation is a main strategy for supporting adherence in the public sector. Egan’s client-centred “Skilled Helper” counselling model is the predominant model used in HIV counselling in this context. This study evaluated counselling delivered by lay ARV adherence counsellors in Cape Town in terms of adherence to Egan’s model. Thirty-eight transcripts of counselling sessions with non-adherent patients were analysed based on the methods of content analysis. These sessions were conducted by 30 counsellors. Generally counsellors’ practice adhered neither to Egan’s model nor a client-centred approach. Inconsistent with evidence-based approaches to counselling for ARV adherence support, counsellors mainly used information-giving and advice as strategies for addressing clients’ non-adherence. Recommendations for improving practice are made. The question as to how appropriate strategies from developed countries are for this setting is also raised.