title: From research to practice: lay adherence counsellors' fidelity to an evidence-based intervention for promoting adherence to antiretroviral treatment in the Western cape, South Africa.
abstract: In the Western Cape, lay counsellors are tasked with supporting antiretroviral (ARV) adherence in public healthcare clinics. Thirty-nine counsellors in 21 Cape Town clinics were trained in Options for Health (Options), an evidence-based intervention based on motivational interviewing (MI). We evaluated counsellors' ability to deliver Options for addressing poor adherence following 5 days training. Audio-recordings of counselling sessions collected following training were transcribed and translated into English. Thirty-five transcripts of sessions conducted by 35 counsellors were analysed for fidelity to the Options protocol, and using the Motivational Interviewing Treatment and Integrity (MITI) code. Counsellors struggled with some of the strategies associated with MI, such as assessing readiness-to-change and facilitating change talk. Overall, counsellors failed to achieve proficiency in the approach of MI according to the MITI. Counsellors were able to negotiate realistic plans for addressing patients' barriers to adherence. Further efforts aimed at strengthening the ARV adherence counselling programme are needed.
authors.affiliation: Health Systems Research Unit, Medical Research Council of South Africa, PO Box 19070, Tygerberg, 7505, South Africa, sarahdewing@gmail.com.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dewing
authors.forename: Cathy
authors.initials: C
authors.lastname: Mathews
authors.forename: Allanise
authors.initials: A
authors.lastname: Cloete
authors.forename: Nikki
authors.initials: N
authors.lastname: Schaay
authors.forename: Madhvi
authors.initials: M
authors.lastname: Shah
authors.forename: Leickness
authors.initials: L
authors.lastname: Simbayi
authors.forename: Johann
authors.initials: J
authors.lastname: Louw
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D019317:Evidence-Based Medicine; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D062405:Motivational Interviewing / Q000592:standards; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D015397:Program Evaluation; D013019:South Africa / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents