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

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Abstract

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.

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Notes

  1. Lay health workers are defined as any health worker “carrying out functions related to health care delivery”; “trained in some way in the context of the intervention” and “having no formal professional or paraprofessional certificate or degree in tertiary education” [9].

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Acknowledgments

Ms. Nontobeko Mdudu is acknowledged for her role in interviewing the participants and quantitative data collection. Ms. Joanne Croome and Ms. Michelle Wanless are acknowledged for their role in intervention implementation and support. The Western Cape City and Provincial Departments of Health, ATICC, and the participating NGOs and counsellors are acknowledged for facilitating and supporting the implementation of the intervention. The implementation of the intervention was supported by Cooperative Agreement Number 5U2G/PS001137 from Centres for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

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Authors and Affiliations

  1. Health Systems Research Unit, Medical Research Council, P.O. Box 19070, Cape Town, Tygerberg, 7505, South Africa

    S. Dewing & C. Mathews

  2. School of Public Health and Family Medicine, University of Cape Town, Cape Town, 7925, South Africa

    C. Mathews

  3. School of Public Health, University of the Western Cape, Cape Town, 7535, South Africa

    N. Schaay

  4. HIV/AIDS, STIs and TB Research Programme, Human Sciences Research Council, Cape Town, 8000, South Africa

    A. Cloete & L. Simbayi

  5. Department of Psychology, University of Cape Town, Cape Town, 7701, South Africa

    J. Louw

Authors
  1. S. Dewing
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  2. C. Mathews
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  3. N. Schaay
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  4. A. Cloete
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  5. J. Louw
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  6. L. Simbayi
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Correspondence to S. Dewing.

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Dewing, S., Mathews, C., Schaay, N. et al. Behaviour Change Counselling for ARV Adherence Support Within Primary Health Care Facilities in the Western Cape, South Africa. AIDS Behav 16, 1286–1294 (2012). https://doi.org/10.1007/s10461-011-0059-z

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