NIMH R34 MH82654“A Multimedia Social Support Intervention: Adherence to HIV Care In South Africa”

A Theoretically Framed Counselor-Driven Adherence Intervention

Utilizing Laptop Multimedia• Collaborating Partners:– HIV Center for Clinical and Behavioral Studies; NYSPI and

Columbia University; New York, NY– University of Cape Town, Departments of Psychiatry and

Public Health– Columbia Center for New Media Teaching and Learning– Hout Bay Main Road Clinic; Department of Health, City of

Cape TownFunded by the National Institute of Mental Health, USA

Background

• South Africa has one of the worst HIV/AIDS epidemics in the world with 5.7 million infected individuals (UNAIDS) and approx 13.6% of the general population affected (SA National Household Survey)

• Defaulting AND non-adherence to HIV treatment is now

recognized as a major barrier to actualizing the full potential of antiretroviral therapy (ART) in all regions of the world

• Mental health problems, including substance use problems are central barriers to optimal adherence

You Tube “Demo”http://www.youtube.com/watch?v=MOGlicrnko0

Theoretical Framework for Enhancement of Adherence

• Social Action Theory (Ewart), focusing on the following content:– Information / Knowledge– Self Regulatory Processes: mood, motivation– Social Context: stigma & disclosure– Interpersonal Processes: social support, provider

communication & behaviors– Behavior: self-efficacy, skills, problem solving &

maintenance of good adherence

Intervention Content

• Mental health screening• Program overview and choosing a buddy• HIV 101; importance of adherence• Pill regimen• Problem solving to overcome barriers to adherence• Social support and disclosure• HIV prevention• Reasons for staying healthy

Mental Health Screening

Alcohol Use

Adherence Barriers

Problem Solving Video

Two friends, Nomhle and Chantal, demonstrate the steps of effective problem solving

Problem Solving Applied to Patient’s Personal Barriers

• The counselor helps the patient + support partner apply problem solving to the specific barriers identified by the patient

Ask – What is the problem?Aim – What is the goal?Alternatives – What are the options?Action – What can we try (before next meeting)

Problem Solving Example

Benefits of Masivukeni• Standardizes delivery of information by counselors who have varying degrees of

expertise & skill• Provides a guided framework (“scaffold”) for the counselors; empowers them• Facilitates standardized mental health screening with scripts for referral• Visually engaging; useful for low literacy• Interactive; facilitates delivery of cognitive-behavioral interventions and allows

counselors to personalize intervention delivery• Facilitates data collection• Highly acceptable to patients, buddies, counselors, and clinic staff• Preliminary evidence for “promise” of adherence behavior change

Masivukeni shows promise to enhance counseling and to improve patients’ adherence to care and treatment