title: Enhancing Lay Counselor Capacity to Improve Patient Outcomes with Multimedia Technology.
abstract: Multimedia technologies offer powerful tools to increase capacity of health workers to deliver standardized, effective, and engaging antiretroviral medication adherence counseling. Masivukeni-is an innovative multimedia-based, computer-driven, lay counselor-delivered intervention designed to help people living with HIV in resource-limited settings achieve optimal adherence. This pilot study examined medication adherence and key psychosocial outcomes among 55 non-adherent South African HIV+ patients, on antiretroviral therapy (ART) for at least 6 months, who were randomized to receive either Masivukeni or standard of care (SOC) counseling for ART non-adherence. At baseline, there were no significant differences between the SOC and Masivukeni groups on any outcome variables. At post-intervention (approximately 5-6 weeks after baseline), -clinic-based pill count adherence data available for 20 participants (10 per intervention arm) showed a 10 % improvement for-participants and a decrease of 8 % for SOC participants. Masivukeni participants reported significantly more positive attitudes towards disclosure and medication social support, less social rejection, and better clinic-patient relationships than did SOC participants. Masivukeni shows promise to promote optimal adherence and provides preliminary evidence that multimedia, computer-based technology can help lay counselors offer better adherence counseling than standard approaches.
authors.affiliation: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive #15, New York, NY, 10032, USA, rnr2110@columbia.edu.
authors.forename: Reuben N
authors.initials: RN
authors.lastname: Robbins
authors.forename: Claude A
authors.initials: CA
authors.lastname: Mellins
authors.forename: Cheng-Shiun
authors.initials: CS
authors.lastname: Leu
authors.forename: Jessica
authors.initials: J
authors.lastname: Rowe
authors.forename: Patricia
authors.initials: P
authors.lastname: Warne
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
authors.forename: Susan
authors.initials: S
authors.lastname: Witte
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
authors.forename: Robert H
authors.initials: RH
authors.lastname: Remien
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003150:Community Health Workers; D003376:Counseling / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D019212:Multimedia; D010353:Patient Education as Topic; D010865:Pilot Projects; D015397:Program Evaluation; D012944:Social Support; D013019:South Africa; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents