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1.
Artículo en Inglés | MEDLINE | ID: mdl-38397656

RESUMEN

Adolescents continue to face challenges to their sexual and reproductive health (SRH) both locally and internationally. Digital technologies such as the Internet, text messaging, and social media are often viewed as valuable tools for disseminating information on SRH. Mobile health, also known as mHealth, is a medical and public health practise that uses these digital technologies to communicate information. The literature has revealed that mHealth interventions have a positive outcome in delivering SRH information to adolescents. This review aimed to synthesise empirical studies that evaluate mHealth interventions and assess the extent to which these mHealth interventions promote sexual and reproductive health outcomes among young people. This scoping review reviewed the literature across four databases, including EBSCOhost, Scopus, Proquest, and Cochrane, and included 12 articles. The findings have shown that mHealth interventions are effective in enhancing sexual and reproductive health (SRH) knowledge and attitudes among young people in both low-middle and high-income countries. However, comprehensive longitudinal studies are necessary to measure the sustainability and long-term influence of mHealth interventions on behaviour. It is recommended that with artificial intelligence (AI) improvements, there is a possible path to bolstering mHealth interventions.


Asunto(s)
Teléfono Celular , Servicios de Salud Reproductiva , Telemedicina , Humanos , Adolescente , Inteligencia Artificial , Conducta Sexual , Salud Reproductiva
2.
BMC Public Health ; 23(1): 990, 2023 05 29.
Artículo en Inglés | MEDLINE | ID: mdl-37248495

RESUMEN

The Botshelo Ba Trans study was the first HIV bio-behavioral survey conducted with transgender women in South Africa. Engaging research with marginalized communities requires clear points of entry, reference points for understanding the internal culture, and establishing trust and understanding. The community-based participatory research approach guided the development and implementation of this study. We conducted a rapid qualitative and pre-surveillance formative assessment between August 2017 to January 2018 and a bio-behavioral survey between July 2018 and March 2019. At the start, a Steering Committee, comprising primarily of transgender women, was established and subsequently provided substantial input into the mixed methods study conducted in Buffalo City, Cape Town, and Johannesburg. Key to the study's success was building trust and establishing ownership of the survey by transgender women recognized as expert knowledge holders. Thus, a community-based participatory research-informed approach enhanced the validity of the data and ensured that we addressed relevant issues.


Asunto(s)
Infecciones por VIH , Personas Transgénero , Humanos , Femenino , Infecciones por VIH/prevención & control , Sudáfrica/epidemiología , Investigación Participativa Basada en la Comunidad/métodos , Encuestas y Cuestionarios
3.
Lancet HIV ; 10(6): e375-e384, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-37119825

RESUMEN

BACKGROUND: Despite high HIV prevalence in transgender women in sub-Saharan Africa, to our knowledge no study presents data across the HIV care continuum for this population in the region. The aim of this study was to estimate HIV prevalence and present data to develop the HIV care continuum indicators for transgender women in three South African metropolitan municipalities. METHODS: Biobehavioural survey data were collected among sexually active transgender women in the metropolitan municipalities of Johannesburg, Buffalo City, and Cape Town, South Africa. Transgender women (aged ≥18 years, self-reporting consensual sex with a man in the 6 months before the survey) were recruited using respondent-driven sampling (RDS). An interviewer-administered questionnaire was used to determine awareness of HIV status; blood specimens were collected on dried blood spots to test for HIV antibodies, antiretroviral treatment (ART) exposure, and viral load suppression. Population-based estimates of HIV 95-95-95 cascade indicators were derived by use of individualised RDS weights with RDS Analyst software. Multivariate stepwise backward logistic regression modelling was used to determine factors associated with each cascade indicator. All eligible participants were included in the final analysis. FINDINGS: Between July 26, 2018, and March 15, 2019, we enrolled 887 sexually active transgender women: 323 in Johannesburg, 305 in Buffalo City, and 259 in Cape Town. HIV prevalence was highest in Johannesburg where 229 (74·1%) of 309 tests were positive (weighted prevalence estimate 63·3%, 95% CI 55·5-70·5), followed by Buffalo City where 121 (43·7%) of 277 were positive (46·1%, 38·7-53·6), and then Cape Town where 122 (48·4%) of 252 were positive (45·6%, 36·7-54·7). In Johannesburg, an estimated 54·2% (95% CI 45·8-62·4) of transgender women with HIV knew their positive status, in Cape Town this was 24·2% (15·4-35·8), and in Buffalo City this was 39·5% (27·1-53·4). Among those who knew their status, 82·1% (73·3-88·5) in Johannesburg, 78·2% (57·9-90·3) in Cape Town, and 64·7% (45·2-80·2) in Buffalo City were on ART. Of those on ART, 34·4% (27·2-42·4) in Johannesburg, 41·2% (30·7-52·6) in Cape Town, and 55·0% (40·7-68·4) in Buffalo City were virally suppressed. INTERPRETATION: Innovative strategies are needed to inform efforts to diagnose and to treat transgender women living with HIV promptly to achieve viral load suppression. Differentiated HIV services tailored to transgender women of race groups other than Black South African, and those with low education attainment and low outreach exposure, innovative testing, and adherence strategies should be developed to improve the HIV cascade for South African transgender women. FUNDING: The US President's Emergency Plan For AIDS Relief and US Centers for Disease Control and Prevention.


Asunto(s)
Infecciones por VIH , VIH-1 , Personas Transgénero , Humanos , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Sudáfrica/epidemiología , Ciudades/epidemiología , Encuestas y Cuestionarios , Antirretrovirales/uso terapéutico , Continuidad de la Atención al Paciente
4.
SAHARA J ; 20(1): 2187446, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-36942771

RESUMEN

ABSTRACTIn this paper, we explored how vulnerable, immunocompromised groups and caregivers of the elderly experienced and perceived the onset of the Covid-19 pandemic in South Africa. Semi-structured interviews were conducted remotely between the 5th andthe 18th of April 2020 in the three South African provinces hardest hit by Covid-19, namely Gauteng, KwaZulu-Natal and the Western Cape. In total, 60 qualitative key informant interviews and one focus group discussion were conducted. Study participants expressed concerns for elderly people and people with underlying health conditions because of their increased vulnerability to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). People living with HIV expressed an increased fear of infection following the advent of the Covid-19 pandemic in South Africa. The sidelining of healthcare services and stock-outs of medication proved to be an added concern in particular for vulnerable and immunocompromised groups. Overall, the data suggest that the fear of infection is ubiquitous for people who live in unstable environments such as overcrowded townships and informal settlements. Given the increased fears of infection brought on by the Covid-19 pandemic, the mental health of vulnerable communities and those caring for them becomes an added burden for people living in unstable environments.


Asunto(s)
COVID-19 , Infecciones por VIH , Humanos , Anciano , Cuidadores/psicología , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Sudáfrica/epidemiología , Pandemias , SARS-CoV-2
5.
Psychol Health Med ; 28(1): 260-278, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-35549779

RESUMEN

Social distancing behaviour is a primary preventive measure for reducing COVID-19 transmission. Improved understanding of factors associated with adherence to social distancing is vital for mitigating the impact of COVID-19 in South Africa. The study assessed adherence to social distancing and its associated factors during the state-implemented lockdown in South Africa. Data was analysed from a large-scale public survey conducted in South Africa from 8 to 29 April 2020, which was administered online and telephonically. Invitations to participate were distributed widely on local websites and social media networks, including on a data-free platform. Adherence to social distancing was measured by self-report of having engaged in close physical contact with someone outside the home. Simple and multiple logistic regression models examined the association between social distancing and potential explanatory variables. Of the 17,586 participants, 9.2% came into close physical contact with a person outside their home by hugging, kissing, or shaking hands during the past 7 days. The odds of coming into close physical contact with other people were significantly higher for males, students, and those with incorrect knowledge on physical distancing, angry attitudes about the lockdown, lack of confidence in the government response, high-risk perception, movement out of the local area, travelling to shops using public transport, households with communal water facilities and higher household size. The 25-59-year olds compared to 18-24-year olds, and the White and Indian/Asian compared to the African population groups had significantly lower odds of close physical contact with others outside the home. The study identifies subgroups of individuals for whom public health interventions to improve adherence to social distancing should be prioritised and tailored. Interventions and policies should take cognisance of the social determinants of health as well as culturally accepted greeting practices like hand shaking.


Asunto(s)
COVID-19 , Distanciamiento Físico , Humanos , Masculino , Control de Enfermedades Transmisibles , COVID-19/epidemiología , COVID-19/prevención & control , SARS-CoV-2 , Sudáfrica , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad
8.
Soc Sci Humanit Open ; 4(1): 100167, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34927060

RESUMEN

We examined how different sectors of society experienced the first 21 days of the stay-at-home lockdown following the onset of the coronavirus disease 2019 (COVID-19) pandemic in South Africa. This rapid qualitative assessment was conducted remotely with 60 key and community informants from different socio-cultural and economic backgrounds in Gauteng, KwaZulu-Natal and the Western Cape provinces of South Africa. Atlas.ti.8 was used to facilitate qualitative data analysis. Data revealed how the lockdown exacerbated social inequalities for the poor and marginalised. Fear of infection, and food and income insecurity were common concerns mentioned in key and community informant interviews. Despite the social and economic distress, the data also point to a narrative of social responsibility, resilience and social cohesion. The social responsibility and cohesion demonstrated by South African communities should be drawn upon to invoke community resilience, even in the absence of physical proximity.

10.
PLoS One ; 15(12): e0244420, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33351852

RESUMEN

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new strain of virus in the Coronavirus family that has not been previously identified. Since SARS-CoV-2 is a new virus, everyone is at risk of catching the Coronavirus disease 2019 (Covid-19). No one has immunity to the virus. Despite this, misconceptions about specific groups of people who are immune to Covid-19 emerged with the onset of the pandemic. This paper explores South African communities' misconceptions about who is most vulnerable to Covid-19. A rapid qualitative assessment was conducted remotely in Gauteng, KwaZulu-Natal and the Western Cape provinces of South Africa. Recruitment of study participants took place through established relationships with civil society organizations and contacts made by researchers. In total, 60 key informant interviews and one focus group discussion was conducted. Atlas.ti.8 Windows was used to facilitate qualitative data analysis. The qualitative data was coded, and thematic analysis used to identify themes. The results show a high level of awareness and knowledge of the transmission and prevention of SARS-CoV-2. Qualitative data revealed that there is awareness of elderly people and those with immunocompromised conditions being more vulnerable to catching Covid-19. However, misconceptions of being protected against the virus or having low or no risk were also evident in the data. We found that false information circulated on social media not only instigated confusion, fear and panic, but also contributed to the construction of misconceptions, othering and stigmatizing responses to Covid-19. The study findings bring attention to the importance of developing communication materials adapted to specific communities to help reduce misconceptions, othering and stigmatization around Covid-19.


Asunto(s)
COVID-19/epidemiología , Conocimientos, Actitudes y Práctica en Salud , SARS-CoV-2/patogenicidad , Adaptación Fisiológica , Adulto , Anciano , COVID-19/psicología , COVID-19/virología , Agentes Comunitarios de Salud/psicología , Diabetes Mellitus/epidemiología , Diabetes Mellitus/psicología , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Trabajadores Sexuales/psicología , Minorías Sexuales y de Género/psicología , Sudáfrica/epidemiología , Estereotipo
11.
Lancet HIV ; 7(12): e825-e834, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-32622370

RESUMEN

BACKGROUND: The South African national HIV plan recommends pre-exposure prophylaxis (PrEP) for transgender women, whose HIV prevalence estimates are as high as 25% in sub-Saharan Africa. The aim of this study was to explore PrEP awareness, uptake, and willingness, as well as associated barriers and facilitators, in order to inform PrEP implementation efforts with transgender women in South Africa. METHODS: Using a community-engaged, convergent parallel mixed methods design, trained local transgender women data collectors recruited 213 transgender women participants (aged >18 years, assigned male sex at birth, and identifying as a gender different from male), via network referral and word-of-mouth in Cape Town, East London, and Johannesburg. A subset of 36 transgender women also participated in qualitative in-depth interviews. Quantitative analyses included descriptive statistics and negative binomial regression models to assess correlates of PrEP willingness. Qualitative interviews were audio-recorded, transcribed verbatim, and coded. Thematic content analysis was used to identify key themes. Quantitative and qualitative data were integrated for interpretation. FINDINGS: Participants were recruited between June 1 and Nov 30, 2018. 57 (45%) of 127 HIV-negative participants were PrEP-aware and only 14 (11%) of 129 were currently taking PrEP. HIV-negative participants experiencing social (eg, violence, poverty) and interpersonal (eg, discrimination, low transgender women community connectedness) hardship reported PrEP awareness more frequently than HIV-negative transgender women who did not. Willingness to take PrEP was low, at 56 (55%) of 102, among HIV-negative participants who were not currently taking PrEP, and negatively associated with transgender women community connectedness (multivariable prevalence ratio 0·87; 95% CI 0·77-0·99). Barriers to PrEP included taking a daily pill, side-effects, and cost. Participants urged greater education and engagement of transgender women in PrEP implementation. INTERPRETATION: South Africa is poised to scale up PrEP services for transgender women. Dedicated transgender clinics are planned to provide comprehensive care, including PrEP, for transgender women. It is critical to ensure transgender women are aware of and have accurate information about PrEP, and that health-care sites are prepared to provide quality care for transgender women. FUNDING: Gilead Sciences.


Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Profilaxis Pre-Exposición , Personas Transgénero , Adulto , Estudios Transversales , Femenino , Identidad de Género , Infecciones por VIH/virología , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Profilaxis Pre-Exposición/métodos , Vigilancia en Salud Pública , Asunción de Riesgos , Estigma Social , Sudáfrica/epidemiología , Adulto Joven
12.
J Assoc Nurses AIDS Care ; 29(6): 887-901, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29743146

RESUMEN

Condom use has remained low in South Africa despite efforts by the government to make condoms accessible to all. We assessed condom availability, procurement/distribution, and education practices, and explored perceptions of and interest in an expanded array of condom options, including fitted male condoms in Cape Town, South Africa. We conducted 11 key informant interviews with staff members from two sexual health organizations and four state-owned clinics. Key informants (a) were interested in their organizations offering an expanded variety of male condom options including different sizes, colors, and flavors; and (b) substantiated the capacity that their organizations had to integrate alternative condom options into existing procurement, distribution, and education programs. Challenges discussed included securing funding, educating clients, and addressing logistical issues of stocking and distributing new condom types. Further research should explore whether providing condoms with a greater array of characteristics could improve condom use in South Africa.


Asunto(s)
Condones/provisión & distribución , Infecciones por VIH/prevención & control , Salud Sexual , Adulto , Condones/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Personal de Salud , Humanos , Entrevistas como Asunto , Masculino , Investigación Cualitativa , Sexo Seguro , Sudáfrica
13.
Drug Alcohol Depend ; 167: 103-11, 2016 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-27567968

RESUMEN

OBJECTIVE: Using daily diary methods, we aimed to test the hypothesis that at the event-level consuming alcohol increases the likelihood that antiretrovirals (ARV) will be missed on a particular day. METHODS: This prospective cohort study of 74 (52 female, 22 male) people living with HIV (PLHIV) in South Africa collected event-level data on ARV adherence and alcohol consumption using structured daily phone interviews over a period of 42days generating 2718 data points. We used generalized estimating equations (GEE) analyses to assess univariate and multivariate associations between alcohol and adherence, controlling for sociodemographics and testing for effect modification. RESULTS: Controlling for sociodemographics, each alcohol measure was a statistically significant predictor of non-adherence on a particular day; any drinking compared to no drinking (daytime: AOR=3.18, 95% CI=2.25-4.49; evening: AOR=3.43, 95% CI=2.12-5.53), consuming more alcohol than one normally consumes (daytime: AOR=1.06, 95% CI=1.02-1.11; evening: AOR=1.10, 95% CI=1.05-1.15), and drinking at low to moderate risk level (daytime: 4.29, 95% CI=2.81-6.56; evening: AOR=4.24, 95% CI=2.38-7.54) and high to very high risk levels (daytime: AOR=2.31, 95% CI=1.56-3.42; evening: AOR=3.08, 95% CI=1.91-4.98) were all significantly related to missing ARVs in the daytime and evening. CONCLUSIONS: These data provide support for an event-level relationship between alcohol and non-adherence. Interventions that mitigate alcohol use among people on ARVs or provide strategies to maintain optimal adherence among those who drink are needed.


Asunto(s)
Consumo de Bebidas Alcohólicas/psicología , Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Cumplimiento de la Medicación/psicología , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sudáfrica , Adulto Joven
14.
Open AIDS J ; 10: 49-64, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27347271

RESUMEN

BACKGROUND: The HIV epidemic in South Africa is characterized mainly by heterosexual transmission. Recently, the importance of targeting key populations and marginalized groups, including men who have sex with men (MSM) and transgender people, has been added to the national agenda. OBJECTIVES: This mini-review explores the current state of empirical research on HIV risk and MSM, women who have sex with women (WSW), lesbian, gay, bisexual and transgender (LGBT) populations in South Africa in order to assess the current state of research and identify gaps in the literature. METHOD: Peer-reviewed empirical social and behavioral articles on HIV prevalence and risk focusing on MSM, WSW, and LGBT populations published since 2006 were included in this mini-review. RESULTS: In total 35 articles were included: 30 on MSM, gay, and/or bisexual male-identified populations, three on WSW, lesbian, and/or bisexual female-identified populations, two on LGB youth, and none on transgender populations. CONCLUSION: Despite South Africa being the country with the largest number of people living with HIV in the world, there is a limited amount of research in South Africa on HIV and non-normative gender identities and sexualities, especially WSW, lesbian, and/or bisexual female-identified populations, transgender populations, and LGB youth. Research with MSM, WSW, and LGBT populations should be prioritized in South Africa in order to appropriately inform HIV prevention strategies that meet the specific needs of these marginalized groups.

15.
AIDS Behav ; 20 Suppl 1: S60-73, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26280530

RESUMEN

Literature from sub-Saharan Africa and elsewhere supports a global association between alcohol and HIV risk. However, more rigorous studies using multiple event-level methods find mixed support for this association, suggesting the importance of examining potential moderators of this relationship. The present study explores the assumptions of alcohol expectancy theory and alcohol myopia theory as possible moderators that help elucidate the circumstances under which alcohol may affect individuals' ability to use a condom. Participants were 82 individuals (58 women, 24 men) living with HIV who completed daily phone interviews for 42 days which assessed daily sexual behavior and alcohol consumption. Logistic generalized estimating equation models were used to examine the potential moderating effects of inhibition conflict and sex-related alcohol outcome expectancies. The data provided some support for both theories and in some cases the moderation effects were stronger when both partners consumed alcohol.


Asunto(s)
Consumo de Bebidas Alcohólicas/psicología , Infecciones por VIH/epidemiología , Inhibición Psicológica , Asunción de Riesgos , Conducta Sexual/efectos de los fármacos , Parejas Sexuales , Sexo Inseguro/estadística & datos numéricos , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Intoxicación Alcohólica/psicología , Condones/estadística & datos numéricos , Femenino , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Encuestas Epidemiológicas , Humanos , Entrevistas como Asunto , Modelos Logísticos , Masculino , Persona de Mediana Edad , Medio Social , Sudáfrica/epidemiología , Sexo Inseguro/psicología
16.
SAHARA J ; 12: 10-7, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25778765

RESUMEN

In HIV-discordant relationships, the HIV-negative partner also carries the burden of a stigmatised disease. For this reason, couples often hide their HIV-discordant status from family, friends and community members. This perpetuates the silence around HIV-discordant relationships and impacts on targeted HIV prevention, treatment and counselling efforts. This article reports on experiences of stigma and discrimination among HIV-discordant couples in South Africa, Tanzania and Ukraine. During 2008, HIV-discordant couples who had been in a relationship for at least one year were recruited purposively through health-care providers and civil society organisations in the three countries. Participants completed a brief self-administered questionnaire, while semi-structured interviews were conducted with each partner separately and with both partners together. Interviews were analysed using thematic content analysis. Fifty-one couples were recruited: 26 from South Africa, 10 from Tanzania, and 15 from Ukraine. Although most participants had disclosed their HIV status to someone other than their partner, few were living openly with HIV discordance. Experiences of stigma were common and included being subjected to gossip, rumours and name-calling, and HIV-negative partners being labelled as HIV-positive. Perpetrators of discrimination included family members and health workers. Stigma and discrimination present unique and complex challenges to couples in HIV sero-discordant relationships in these three diverse countries. Addressing stigmatisation of HIV-discordant couples requires a holistic human rights approach and specific programme efforts to address discrimination in the health system.


Asunto(s)
Composición Familiar , Seropositividad para VIH/psicología , Relaciones Interpersonales , Percepción Social , Estigma Social , Adulto , Actitud del Personal de Salud , Comparación Transcultural , Femenino , Seronegatividad para VIH , Educación en Salud , Humanos , Masculino , Investigación Cualitativa , Sudáfrica/epidemiología , Encuestas y Cuestionarios , Tanzanía/epidemiología , Ucrania/epidemiología
17.
AIDS Behav ; 19(1): 157-65, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24770948

RESUMEN

Little research has investigated interventions to improve the delivery of counselling in health care settings. We determined the impact of training and supervision delivered as part of the Options: Western Cape project on lay antiretroviral adherence counsellors' practice. Four NGOs employing 39 adherence counsellors in the Western Cape were randomly allocated to receive 53 h of training and supervision in Options for Health, an intervention based on the approach of Motivational Interviewing. Five NGOs employing 52 adherence counsellors were randomly allocated to the standard care control condition. Counselling observations were analysed for 23 intervention and 32 control counsellors. Intervention counsellors' practice was more consistent with a client-centred approach than control counsellors', and significantly more intervention counsellors engaged in problem-solving barriers to adherence (91 vs. 41 %). The Options: Western Cape training and supervision package enabled lay counsellors to deliver counselling for behaviour change in a manner consistent with evidence-based approaches.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Consejo/educación , Infecciones por VIH/terapia , Cumplimiento de la Medicación/psicología , Competencia Profesional/normas , Medicina Basada en la Evidencia , Necesidades y Demandas de Servicios de Salud , Humanos , Relaciones Profesional-Paciente , Evaluación de Programas y Proyectos de Salud , Sudáfrica
18.
J Consult Clin Psychol ; 82(1): 19-29, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24099433

RESUMEN

OBJECTIVE: Options for Health is an evidence-based sexual risk reduction intervention based on motivational interviewing (MI). Thirty-nine antiretroviral adherence lay counselors were trained to deliver Options for Health to help their patients to optimize their antiretroviral treatment adherence. An evaluation of counselors' ability to deliver the intervention after 35 hr of training revealed that counselors struggled with elements of the 8-step Options protocol and failed to achieve proficiency in MI. The current study aimed to determine the impact of refresher training and supervision on counselors' proficiency in the intervention. METHOD: Audio-recordings of counseling sessions were collected for 22 of 39 counselors after 18 hr of refresher training and supervision had been delivered over a 12-month period. Recordings were transcribed, translated, and analyzed for fidelity to the Options protocol and the MI approach. Analysis was conducted using the Motivational Interviewing Treatment Integrity Tool and an instrument developed by the researchers. Results were compared to findings from an evaluation of counselors' performance immediately following the initial 35-hr training. RESULTS: Counselors improved their delivery of some intervention steps, but not others; their use of micro-counseling skills and therapeutic approach improved to such an extent that they closely approximated the MI approach. CONCLUSIONS: This study contributes evidence for the positive impact of ongoing training and supervision on lay health worker practice. Although counselors did not achieve complete proficiency in the Options protocol, refresher training and supervision improved counselors' basic counseling communication skills and therapeutic approach, enabling them to deliver better quality counseling for behavior change.


Asunto(s)
Consejo/métodos , Entrevista Motivacional , Competencia Profesional , Salud Reproductiva , Conducta de Reducción del Riesgo , Adulto , Femenino , Humanos , Masculino
19.
AIDS Behav ; 17(9): 2935-45, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23666183

RESUMEN

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.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación/psicología , Entrevista Motivacional , Aceptación de la Atención de Salud/psicología , Adulto , Medicina Basada en la Evidencia , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Entrevista Motivacional/normas , Aceptación de la Atención de Salud/estadística & datos numéricos , Relaciones Profesional-Paciente , Evaluación de Programas y Proyectos de Salud , Sudáfrica/epidemiología
20.
Cult Health Sex ; 14(3): 257-68, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22077668

RESUMEN

In many sub-Saharan African countries, a high proportion of people living with HIV are in long-term serodiscordant relationships. This paper explores how HIV serodiscordance shapes communication among couples in long-term HIV-serodiscordant relationships. A total of 36 couples were purposively recruited through healthcare providers and civil society organisations in South Africa (26) and Tanzania (10). We explored couples' portrayal of living in a serodiscordant relationship by conducting semi-structured interviews with each partner separately, followed by a joint interview with both partners. Using an adaptation of Persson's model on sero-silence and sero-sharing, we categorised coping style as 'sero-silent' if partners reported that they did not talk much with each other about issues related to their serodiscordant status or as 'sero-sharing' if they portrayed HIV as being an issue which they dealt with together. Some couples exhibited features of both coping styles and, at times, partners differed in their ways of coping.


Asunto(s)
Actitud Frente a la Salud , Comunicación , Composición Familiar , Infecciones por VIH/psicología , Seropositividad para VIH/psicología , Heterosexualidad/psicología , Parejas Sexuales/psicología , Adulto , Coito/psicología , Femenino , Humanos , Relaciones Interpersonales , Masculino , Autorrevelación , Percepción Social , Factores Socioeconómicos , Sudáfrica , Tanzanía , Adulto Joven
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