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

摘要

In the Western Cape, lay counsellors are taskedwith supporting antiretroviral (ARV) adherence in publichealthcare clinics. Thirty-nine counsellors in 21 CapeTown clinics were trained in Options for Health (Options),an evidence-based intervention based on motivationalinterviewing (MI). We evaluated counsellors’ ability todeliver Options for addressing poor adherence following5 days training. Audio-recordings of counselling sessionscollected following training were transcribed and translatedinto English. Thirty-five transcripts of sessions conductedby 35 counsellors were analysed for fidelity to the Optionsprotocol, and using the Motivational InterviewingTreatment and Integrity (MITI) code. Counsellors struggledwith some of the strategies associated with MI, such asassessing readiness-to-change and facilitating change talk.Overall, counsellors failed to achieve proficiency in theapproach of MI according to the MITI. Counsellors wereable to negotiate realistic plans for addressing patients’barriers to adherence. Further efforts aimed at strengtheningthe ARV adherence counselling programme areneeded.