title: [Implementation and assessment of an HIV treatment training program (2000-2001) for patients in Casablanca (Morocco)].
abstract: An educational program to improve the management of HIV patients was introduced in the department of infectious diseases of Ibn Rochd hospital, Casablanca, Morocco in January 2000. The project, funded by the GlaxoSmithKline Foundation, began by training ward physicians as well as volunteers from the ALLOCS (Association de lutte contre le sida) in pedagogy and patient education techniques (four-day course). Other sessions reviewed HIV management and treatment. Treatment training sessions were offered to all patients receiving antiretroviral treatment when the program began. All had been taking medication for at least two months and gave their informed consent to participation in the project. Each patient's sessions took place just after his or her medical consultation, in a room set aside for this purpose in the hospital. During the first session the educator established an educational diagnosis and defined educational objectives according to the individual patient's needs. Objectives were related to patients' knowledge about HIV transmission prevention and treatment management (including problem-solving for mild adverse events, delays, forgetting, vacations etc.). Trainers used several educational tools, including therapeutic planning (planning card with self-adhesive stickers showing the treatment medication); a folder of drawings depicting HIV transmission, prevention, and natural history, as well as the aims of antiretroviral therapy; decks of cards illustrating symptoms and psycho-sociological problems. Each patient had to attend at least 3 educational sessions. The program was evaluated at the end of one year. Patients' attendance, treatment adherence, laboratory test results (CD4 count, viral load), satisfaction about patient-staff relationships and knowledge about HIV disease and treatment were assessed on an on-going basis with various questionnaires and data collection systems. In all, 96 patients attended classes, with a mean of 14 sessions per patient per year. After 6 and 12 months of training, patients' CD4 cell counts increased, and the proportion with viral loads below the detection level rose, as did adherence scores. Patients' knowledge appeared to have improved at 6 months but regressed somewhat at 12 months. This may be explained by program timing: most educational sessions take place during the first 6 months of patient enrolment in the program. Patient satisfaction about the program and their care reveals that they acquired autonomy in managing their disease and treatment. Their satisfaction at 12 months, however, was lower than it was at 6 months. One explanation may be that more educated patients are more demanding, but another is the staff turnover in the program. New staff may have required more support and training than was then available. This pilot program allowed us to draft guidelines for setting up educational programs for HIV patients in relatively poor countries.
authors.affiliation: Laboratoire de pédagogie des sciences de la santé, UFR (SMBH) (Unité Formation Recherche, Science Médecine Biologie Humaine), Université Paris 13, 74, rue Marcel Cachin, 93017 Bobigny cedex France. c.marchand@smbh.univ-paris13.fr
authors.forename: Claire
authors.initials: C
authors.lastname: Marchand
authors.forename: Hakima
authors.initials: H
authors.lastname: Himmich
authors.forename: Abderahmane
authors.initials: A
authors.lastname: Maaroufi
authors.forename: Nathalie
authors.initials: N
authors.lastname: Sohier
authors.forename: Jean François
authors.initials: JF
authors.lastname: Chambon
authors.forename: Rémi
authors.initials: R
authors.lastname: Gagnayre
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009018:Morocco; D010349:Patient Compliance; D010353:Patient Education as Topic; D011340:Problem Solving