title: "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.
abstract: 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.
authors.affiliation: Health Systems Research Unit, Medical Research Council, P. O. Box 19070, Tygerberg, Cape Town, 7505, South Africa. sarahdewing@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Dewing
authors.forename: C
authors.initials: C
authors.lastname: Mathews
authors.forename: N
authors.initials: N
authors.lastname: Schaay
authors.forename: A
authors.initials: A
authors.lastname: Cloete
authors.forename: J
authors.initials: J
authors.lastname: Louw
authors.forename: L
authors.initials: L
authors.lastname: Simbayi
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D037001:Directive Counseling / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D009042:Motivation; D010342:Patient Acceptance of Health Care; D018802:Patient-Centered Care; D011369:Professional-Patient Relations; D013019:South Africa
chemical_list: D019380:Anti-HIV Agents