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

Abstract

In the Western Cape, lay counsellors are tasked with supporting antiretroviral (ARV) adherence in public healthcare clinics. Thirty-nine counsellors in 21 Cape Town clinics were trained in Options for Health (Options), an evidence-based intervention based on motivational interviewing (MI). We evaluated counsellors' ability to deliver Options for addressing poor adherence following 5 days training. Audio-recordings of counselling sessions collected following training were transcribed and translated into English. Thirtyfive transcripts of sessions conducted by 35 counsellors were analysed for fidelity to the Options protocol, and using the Motivational Interviewing Treatment and Integrity (MITI) code. Counsellors struggled with some of the strategies associated with MI, such as assessing readiness-to-change and facilitating change talk. Overall, counsellors failed to achieve proficiency in the approach of MI according to the MITI. Counsellors were able to negotiate realistic plans for addressing patients' barriers to adherence. Further efforts aimed at strengthening the ARV adherence counselling programme are needed.

Efficacy of brief motivational interviewing on smoking cessation at tuberculosis clinics in Tshwane, South Africa: a randomized controlled trial

“…We were unable to monitor intervention fidelity by video‐taping actual MI sessions with real patients, as it is considered invasive to patients within the context of standard clinical care. It is therefore possible that LHCWs, although intensively trained, did not deliver MI adequately . However, the outcomes were similar or even better than would have been expected with MI.…”

Screening and Brief Interventions for Alcohol and Other Drug Use Among Pregnant Women Attending Midwife Obstetric Units in Cape Town, South Africa: A Qualitative Study of the Views of Health Care Professionals

“…Despite these barriers, participants generally felt positive and displayed a supportive attitude toward the possible implementation of an intervention. Although health care providers, including lay counselors, have supportive attitudes, some research shows that lay workers do not necessarily have the required skill to implement such interventions . However, others show that lay health workers can successfully implement interventions with sufficient training and supervision …”

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

“…MI may be brief (even a single session) or may be used in combination with other models, like CBT [64][65][66]. It can be delivered by workshop-trained clinicians and does not require highlytrained therapists [62]; however, optimal implementation requires ongoing support, which has been shown to be feasible in South Africa [64,67]. Adoption can be facilitated through publicly available and culturally adaptable training manuals and supervision tools [68], and is consistent with the skilled-helper model already used in some LMIC.…”