title: Shortcomings of adherence counselling provided to caregivers of children receiving antiretroviral therapy in rural South Africa.
abstract: In order to achieve optimal benefits of antiretroviral therapy (ART), caregivers of children receiving ART are required to attend routine clinic visits monthly and administer medication to the child as prescribed. Yet, the level of adherence to these behaviours varies considerably in many settings. As a way to achieve optimal adherence in rural KwaZulu-Natal, caregivers are required to attend routine counselling sessions at HIV treatment clinics that are centred on imparting information, motivation, and behavioural skills related to medication administration. According to the information-motivation-behavioural skills model, information related to adherence, motivation, and behavioural skills are necessary and fundamental determinants of adherence to ART. The purpose of the study was to observe and document the content of adherence counselling sessions that caregivers attending rural clinics in KwaZulu Natal receive. We observed 25 adherence counselling sessions, which lasted on average 8.1 minutes. Counselling typically consisted of counsellors recording patient attendance, reporting CD4 count and viral load results to caregivers, emphasising dose times, and asking caregivers to name their medications and dosage amounts. Patients were seldom asked to demonstrate how they measure the medication. They were also not probed for problems regarding treatment, even when an unsuppressed VL was reported to a caregiver. This paper calls attention to the sub-optimal level of counselling provided to patients on ART and the urgent need to standardise and improve the training, support, and debriefing provided to counsellors.
authors.affiliation: a Department of Psychology , Stellenbosch University , Stellenbosch , South Africa.
authors.forename: Bronwyne
authors.initials: B
authors.lastname: Coetzee
authors.affiliation: a Department of Psychology , Stellenbosch University , Stellenbosch , South Africa.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Kagee
authors.affiliation: b Africa Centre for Population Health , KwaZulu-Natal , South Africa.|c Institute of Health and Wellbeing and Royal Hospital for Sick Children , University of Glasgow , Glasgow , UK.|d School of Public Health, Faculty of Health Sciences , University of Witwatersrand , Johannesburg , South Africa.
authors.forename: Ruth
authors.initials: R
authors.lastname: Bland
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D017028:Caregivers / Q000523:psychology*; D002675:Child, Preschool; D003376:Counseling / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D009042:Motivation; D011361:Professional Competence; D012424:Rural Population / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral therapy; adherence; counselling; paediatric