title: Implementation and Operational Research: A Time-Motion Analysis of HIV Transmission Prevention Counseling and Antiretroviral Adherence Messages in Western Kenya.
abstract: BACKGROUND
  Shortages of health workers and large number of HIV-infected persons in Africa mean that time to provide antiretroviral therapy (ART) adherence and other messages to patients is limited.
  
  
  METHODS
  Using time-motion methodology, we documented the intensity and nature of counseling delivered to patients. The study was conducted at a rural and an urban HIV clinic in western Kenya. We recorded all activities of 190 adult patients on ART during their return clinic visits to assess type, frequency, and duration of counseling messages.
  
  
  RESULTS
  Mean visit length for patients at the rural clinic was 44.5 (SD = 27.9) minutes and at urban clinic was 78.2 (SD = 42.1) minutes. Median time spent receiving any counseling during a visit was 4.07 minutes [interquartile range (IQR), 1.57-7.33] at rural and 3.99 (IQR, 2.87-6.25) minutes at urban, representing 11% and 8% of total mean visit time, respectively. Median time patients received ART adherence counseling was 1.29 (IQR, 0.77-2.83) minutes at rural and 1.76 (IQR, 1.23-2.83) minutes at urban (P = 0.001 for difference). Patients received a median time of 0.18 (0-0.72) minutes at rural and 0.28 (IQR, 0-0.67) minutes at urban clinic of counseling regarding contraception and pregnancy. Most patients in the study did not receive any counseling regarding alcohol/substance use, emerging risks for ongoing HIV transmission.
  
  
  CONCLUSIONS
  Although ART adherence was discussed with most patients, time was limited. Reproductive counseling was provided to only half of the patients, and "positive prevention" messaging was minimal. There are strategic opportunities to enhance counseling and information received by clients within HIV programs in resource-limited settings.
authors.affiliation: *Department of Internal Medicine, School of Medicine, Indiana University, Indianapolis, IN; †Regenstrief Institute Inc., Indianapolis, IN; ‡Department of Population Health, School of Medicine, New York University, New York, NY; §Moi Teaching and Referral Hospital, Eldoret, Kenya; ‖College of Nursing, New York University, New York, NY; ¶Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya; #Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; and **New York University College of Global Public Health, College of Nursing, New York University, New York, NY.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Were
authors.forename: Jason
authors.initials: J
authors.lastname: Kessler
authors.forename: Changyu
authors.initials: C
authors.lastname: Shen
authors.forename: John
authors.initials: J
authors.lastname: Sidle
authors.forename: Stephen
authors.initials: S
authors.lastname: Macharia
authors.forename: John
authors.initials: J
authors.lastname: Lizcano
authors.forename: Abraham
authors.initials: A
authors.lastname: Siika
authors.forename: Kara
authors.initials: K
authors.lastname: Wools-Kaloustian
authors.forename: Ann
authors.initials: A
authors.lastname: Kurth
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D003151:Community Health Centers / Q000706:statistics & numerical data / Q000600:supply & distribution; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006282:Health Personnel; D006280:Health Workforce; D006801:Humans; D055118:Medication Adherence; D013996:Time and Motion Studies
chemical_list: D019380:Anti-HIV Agents