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Improving the Counselling Skills of Lay Counsellors in Antiretroviral Adherence Settings: A Cluster Randomised Controlled Trial in the Western Cape, South Africa

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Abstract

Little research has investigated interventions to improve the delivery of counselling in health care settings. We determined the impact of training and supervision delivered as part of the Options: Western Cape project on lay antiretroviral adherence counsellors’ practice. Four NGOs employing 39 adherence counsellors in the Western Cape were randomly allocated to receive 53 h of training and supervision in Options for Health, an intervention based on the approach of Motivational Interviewing. Five NGOs employing 52 adherence counsellors were randomly allocated to the standard care control condition. Counselling observations were analysed for 23 intervention and 32 control counsellors. Intervention counsellors’ practice was more consistent with a client-centred approach than control counsellors’, and significantly more intervention counsellors engaged in problem-solving barriers to adherence (91 vs. 41 %). The Options: Western Cape training and supervision package enabled lay counsellors to deliver counselling for behaviour change in a manner consistent with evidence-based approaches.

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Acknowledgments

Dr. D. Cornman and colleagues for training the Options: WC implementation team in the Options intervention, and for the provision of training materials. Ms. Joanne Croome and Ms. Michelle Wanless for their assistance in coding transcripts. Ms. Nontobeko Mdudu for data collection. Katya Mauff at the Statistical Consulting Service at the University of Cape Town for assistance with data analysis. The Western Cape City and Provincial Departments of Health, NGOs and counsellors are acknowledged for their support and participation. The implementation of the intervention was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centres for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement number U2G/PS001137-04. The contents of this paper 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 of South Africa, Tygerberg, PO Box 19070, Cape Town, 7505, South Africa

    Sarah Dewing & Cathy Mathews

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

    Cathy Mathews

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

    Nikki Schaay

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

    Allanise Cloete & Leickness Simbayi

  5. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Cathy Mathews & Leickness Simbayi

  6. Department of Psychology, University of Cape Town, Cape Town, South Africa

    Johann Louw

Authors
  1. Sarah Dewing
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  2. Cathy Mathews
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  3. Nikki Schaay
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  4. Allanise Cloete
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  5. Leickness Simbayi
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  6. Johann Louw
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Correspondence to Sarah Dewing.

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Dewing, S., Mathews, C., Schaay, N. et al. Improving the Counselling Skills of Lay Counsellors in Antiretroviral Adherence Settings: A Cluster Randomised Controlled Trial in the Western Cape, South Africa. AIDS Behav 19, 157–165 (2015). https://doi.org/10.1007/s10461-014-0781-4

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  • DOI: https://doi.org/10.1007/s10461-014-0781-4

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