Cultural adaptation of a cognitive-behavioural intervention to improve adherence to antiretroviral therapy among people living with HIV/AIDS in Zimbabwe: Nzira Itsva

Abstract

Few evidence-based interventions to improve adherence to antiretroviral therapy have been adapted for use in Africa. We selected, culturally adapted and tested the feasibility of a cognitive-behavioural intervention for adherence and for delivery in a clinic setting in Harare, Zimbabwe. The intervention consisted of a single, 50-minute problem-solving cognitive-behavioural intervention session with four skill-based booster sessions, delivered by four lay adherence counsellors in the context of HIV care. Adaptation followed a theoretically driven approach to intervention adaptation, Assessment-Decision-Administration-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT), and included modifications to language, session length, tailoring content for delivery by lay counsellors and inclusion of culturally competent probes. The feasibility of the intervention was evaluated using a mixed-methods assessment, including ratings of provider fidelity of intervention delivery, and qualitative assessments of feasibility using individual semi-structured interviews with counsellors (n = 4) and patients (n = 15). The intervention was feasible and acceptable when administered to 42 patients and resulted in improved self-reported adherence in a subset of 15 patients who were followed up after 6 months. Next steps from this study include conducting a randomised control trial to evaluate the adapted intervention compared to standard of care in a larger sample over a long-term follow-up.

Cognitive behavioral therapy improves adherence to antiretroviral therapy in HIV-infected patients: a prospective randomized controlled trial from eastern India

“…The study showed a significantly better mean adherence level and Beck's depression score in patients of the intervention group. The beneficial effect of CBT observed in our study actually reflected the outcome of various international studies undertaken so far [28,29,[31][32][33]. But CD4 count did not show any significant difference between 2 groups after CBT sessions as opposed to the finding in some of the recent studies [32,33].…”

“…Recently several studies have looked at the effectiveness of CBT in the improvement of adherence in HIV patients, with or without concomitant depression. Recently published studies from Africa reported better maintenance of adherence with the use of the cognitive behavioral intervention [28,29]. A study even highlighted the role of CBT in reducing the intensity of troublesome side effects (fatigue and nausea), noted in patients on ART for a long duration, thus indicating towards a possible role of CBT in potentiation of individual's ability to be able to continue with ART [30].…”

Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations

“…CBT uses a collaborative process in which a provider acts as coach and educator in helping patients identify thoughts, feelings, and behavior cycles that influence adherence [56,57]. Although more common in upper-and middleincome countries, the use of CBT to promote ART adherence is growing in RLS with promising impact on adherence [20,22,58,59]. While expertise to train and supervise CBT counsellors is limited, software and computer-assisted approaches may expand capacity (discussed below).…”

A group-based mental health intervention for young people living with HIV in Tanzania: results of a pilot individually randomized group treatment trial

“…Across two sites in Moshi, Tanzania, 25-45% of YPLWH self-reported significant difficulties with depression, post-traumatic stress, and/or emotional/behavioral challenges [9,13]. Prior studies have demonstrated that mental health interventions can effectively improve ART adherence in high income countries [14,15] and proof of concept has been demonstrated for adults in low resource settings [16][17][18]. However, evidence-based interventions designed to address the unique mental health challenges faced by YPLWH in low resource settings are lacking [19,20].…”