Browsing by Author "Dewing, Sarah"

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    The Feasibility of implementing a sexual risk reduction intervention in routine clinical practice at an ARV clinic in Cape Town: a case study
    (Springer, 2011) Dewing, Sarah; Mathews, Catherine; Schaay, Nikki; Cloete, Allanise; Simbayi, Leickness; Chopra, Mickey
    This case study with one lay adherence counsellor assessed the implementation of Options for Health, a sexual risk-reduction intervention based on Motivational Interviewing (MI), in an antiretroviral clinic in Cape Town, South Africa. In most cases Options was not delivered with fidelity and less than one-third of intended recipients received it; the counsellor often forgot to do Options, was unsure how to deal with particular cases and felt that there was not always time to do Options. Options was not implemented in a way that was consistent with MI. Revisions to the implementation plan and training programme are required.
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    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
    (Springer Verlag, 2013) Dewing, Sarah; Mathews, Catherine; Cloete, Allanise; Schaay, Nikki; Shah, Madhvi; Simbayi, Leickness; Louw, Johann
    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. Thirty-five 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.
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    "It's important to take your medication everyday okay?" An evaluation of counselling by lay counsellors for ARV adherence support in the Western Cape, South Africa
    (Springer, 2013) Dewing, Sarah; Mathews, Catherine; Schaay, Nikki; Cloete, Allanise; Simbayi, Leickness; Louw, Johann
    There is growing interest in standard care programmes for antiretroviral (ARV) adherence support. In South Africa, individual counselling following ARV initiation is a main strategy for supporting adherence in the public sector. Egan’s client-centred ‘‘Skilled Helper’’ counselling model is the predominant model used in HIV counselling in this context. This study evaluated counselling delivered by lay ARV adherence counsellors in Cape Town in terms of adherence to Egan’s model. Thirty-eight transcripts of counselling sessions with non-adherent patients were analysed based on the methods of content analysis. These sessions were conducted by 30 counsellors. Generally counsellors’ practice adhered neither to Egan’s model nor a client-centred approach. Inconsistent with evidence-based approaches to counselling for ARV adherence support, counsellors mainly used informationgiving and advice as strategies for addressing clients’ nonadherence. Recommendations for improving practice are made. The question as to how appropriate strategies from developed countries are for this setting is also raised.