title: An integrated approach for antiretroviral adherence and secondary HIV transmission risk-reduction support by nurses in Kenya.
abstract: Ongoing antiretroviral therapy (ART) adherence and secondary HIV transmission-risk reduction (positive prevention) support are needed in resource-limited settings. We evaluated a nurse-delivered counseling intervention in Kenya. We trained 90 nurses on a brief counseling algorithm that comprised ART and sexual-risk assessment, risk-reduction messages, and health-promotion planning. Self-reported measures were assessed before, immediately after, and 2 months post-training. Consistent ART adherence assessment was reported by 29% of nurses at baseline and 66% at 2 months post-training (p < .001). Assessment of patient sexual behaviors was 25% at baseline and 60% at 2 months post-training (p < .001). Nurse practice behaviors recommended in the counseling algorithm improved significantly at 2 months post-training compared with baseline, odds ratios 4.30-10.50. We found that training nurses in clinical counseling for ART adherence and positive prevention is feasible. Future studies should test impact of nurse counseling on patient outcomes in resource-limited settings.
authors.affiliation: University of Washington, Seattle, Washington, USA.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Kurth
authors.forename: Lauren
authors.initials: L
authors.lastname: McClelland
authors.forename: George
authors.initials: G
authors.lastname: Wanje
authors.forename: Annette E
authors.initials: AE
authors.lastname: Ghee
authors.forename: Norbert
authors.initials: N
authors.lastname: Peshu
authors.forename: Esther
authors.initials: E
authors.lastname: Mutunga
authors.forename: Walter
authors.initials: W
authors.lastname: Jaoko
authors.forename: Marta
authors.initials: M
authors.lastname: Storwick
authors.forename: King K
authors.initials: KK
authors.lastname: Holmes
authors.forename: Scott
authors.initials: S
authors.lastname: McClelland
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000451:nursing; D003376:Counseling; D019033:Delivery of Health Care, Integrated; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000451:nursing* / Q000517:prevention & control* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training; D007630:Kenya; D008297:Male; D055118:Medication Adherence; D009740:Nursing Staff / Q000193:education*; D010865:Pilot Projects; D040242:Risk Reduction Behavior; D021841:Safe Sex