Marseille 2007
| Abstract #335 - Implementing a four-stage approach to adherence counselling for antiretroviral treatment using the Egan counselling model | ||||
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Session: 26.74: Posters B (Poster) on Tuesday in Chaired by Authors: Presenting Author: Mr Robin Hamilton - Aurum Institute for Health Research, South Africa |
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| Additional Authors: Ms Thobeka Dwadwa, Dr Salome Charalambous, Ms Jeanette Mtshaki, Prof Gavin Churchyard, | ||||
| Aim: To provide a conceptual framework for adherence counselling for antiretroviral treatment which addresses patient concerns, assesses readiness and supports patients to take ART. | ||||
| Method / Issue: Adherence to antiretroviral treatment (ART) is a key concern in ensuring long-term benefit for people living with HIV/AIDS. Adherence counselling is an important tool, when properly applied, to support adherence. However, health-care workers beginning HIV care often lack a conceptual framework to maximise the benefit of counselling by addressing patients concerns, determining readiness, and preparing patients for ART. | ||||
| Results / Comments: Our organisation has assisted a group of companies to implement a workplace antiretroviral treatment (ART) programme throughout South Africa since November 2002. In addition, we provide support for ART provision in community settings in six South African provinces. As of December 2006, in the workplace and community arms 19 270 patients were enrolled into HIV wellness management programmes and 8 513 patients received ART. Patients have scheduled visits pre-ART and after ART initiation. At each visit, adherence is measured through self-report. Patients receive adherence counselling at each visit from trained lay counsellors or nurses. Since 2004, nurses and lay counsellors have been trained to use a four-stage model for ART adherence, within an Egan counselling model framework. The four stages are: preparation initiation treatment maintenance, and re-motivation or treatment change. The stages approach creates a framework for health-care workers to understand the steps of ART preparedness and barriers to adherence, and to address the psychological challenges at each stage. Counsellors and nurses are thus equipped to match the content of counselling to the demands of each stage, and address the particular patient issues that emerge. | ||||
| Discussion: Health-care workers have reported that through the four-stage counselling framework they achieve better insight into the psychological challenges that patients on ART face, and they feel better equipped to adapt their counselling interventions to match patients changing needs. Patients have also provided positive feedback, expressing greater feelings of self-empowerment and self-efficacy following counselling. We believe that training counsellors and nurses in a structured approach to counselling with a framework for understanding and individualising patient needs has been an important development for our programme, and that it should be part of training for all ART counsellors and nurses. | ||||
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