The Options for Health: Western Cape Project

Behaviour Change Counselling for ARV Adherence and Sexual Risk Reduction among People on ART

The Options for Health Intervention
Options for Health is an evidence-based, sexual risk reduction intervention based on the Information, Motivation and Behavioural (IMB) Skills model of behaviour change, and using Motivational Interviewing (MI) techniques to deliver HIV risk reduction information, motivation and behavioural skills content (Abstract). In response to findings from our pilot study (Abstract) we included ARV adherence as a focus of the intervention (WC Intervention Manual, pdf format, 849 kb).

Background
In response to a recent finding that 44.7% of people initiating ARV treatment in public health clinics in Cape Town had had unprotected sex at last sex (Abstract), we collaborated with the Provincial and City of Cape Town Departments of Health to train lay ARV adherence counsellors from 4 NGOs in the Cape Town metropolitan area to implement Options for Health as a part of routine adherence counselling practice.

The Implementation of Options for Health: Western Cape
Thirty-nine counsellors from 21 ARV clinics (and 4 NGOs) took part in an initial 5-Day training programme in June 2009 (WC Facilitators Guide, pdf format, 650 kb and Report on Options Training, pdf format, 1503 kb) and a 2-Day follow-up training programme in October 2009 (Follow-up training report, pdf format, 1435 kb). Monthly supervision sessions were implemented from March 2010 until the end of implementation in June 2010.

Evaluation of the Options for Health: Western Cape Programme
We conducted a process evaluation in preparation for a controlled trial in which patient outcomes were to be assessed, however our findings regarding implementation were such that we doubted an impact on adherence would be observed, and so this outcome assessment was never conducted (Abstract). In addition, weaknesses in the current Provincial adherence counselling system were identified (Abstract, PHASA poster, pdf format, 6968 kb), and an evaluation of current adherence counselling practice was conducted (Abstract). Following 12 months of implementation we compared the counselling skills of counsellors having been trained in Options with a comparison group of lay ARV adherence counsellors in order to determine the impact of our training and supervision on counselling performance (Abstract).

The Basic Counselling Skills Tool (BCoST)
The BCoST (pdf format, 688 kb) was developed as a part of this project in order to assess lay counsellor performance in basic counselling skills associated with a problem-management approach to counselling - specifically the Egan’s (2002) Skilled Helper and Options for Health (Fisher et al., 2006) models. The BCoST is an instrument in development; while it has undergone a number of revisions, inter-rater agreement has been consistently low and the tool remains un-validated. The tool is being made available in its current form in the event that it could be of use in the training or supervision of lay counsellors.

The Options Implementation and Research Team

• Ms Sarah Dewing (MRC)
• Assoc Prof Cathy Mathews (MRC, UCT)
• Ms Nontobeko Mdudu (MRC)
• Ms Nikki Schaay (UWC)
• Ms Allanise Cloete (HSRC)
• Prof Leickness Simbayi (HSRC)
• Ms Joanne Croome
• Ms Michelle Wanless

Contact the project manager (sarah.dewing@mrc.ac.za) for further information.

Acknowledgements
The Western Cape City and Provincial Departments of Health, ATICC, participating NGOs, counsellors and ARV clinics are acknowledged for facilitating and supporting the implementation of the intervention.

The implementation of the intervention was supported by Cooperative Agreement Number 5U2G/PS001137 from Centres for Disease Control and Prevention. The contents of this webpage are solely the responsibility of the authors and do not necessarily represent the official views of CDC.