AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #221 - Diversity of strategies for preparation of patients initiating highly active antiretroviral treatment in Western Cape, South Africa
Authors: Presenting Author: Ms Rose Zulliger - University of Cape Town
Additional Authors: Dr. Landon Myer, Dr. David Pienaar,
Aim: Patient preparation for the initiation of Highly Active Antiretroviral Treatment (HAART) is a central component of HAART rollout around the world. Despite its importance, there is little evidence from the African context on patient preparation for HAART. This study sought to fill this gap by comprehensively determining the current training and patient requirements at the HAART clinics within one province of South Africa.
Method / Issue: Semi-structured telephonic and in-person interviews were conducted with all governmental and non-governmental institutions involved in patient preparation for HAART in Western Cape, South Africa. Institutions were identified using an existent list of organizations trained by the provincial government to prepare patients for HAART initiation. The list was augmented using snowball sampling to ensure that all relevant institutions were included. Interviews were conducted with eleven nongovernmental organizations and with seven members of the provincial and municipal Department of Health.
Results / Comments: Almost all patient preparation is conducted by lay counselors who are educated by a central training center within the Department of Health. Counselors train patients on a breadth of HIV-related subjects in a series of two to three sessions in order to ensure patient HAART adherence. Despite this shared counselor training and a unified provincial policy, the implementation of patient preparation and initiation requirements varies substantially in the clinics within the province. This is particularly apparent in the average duration from when patients become HAART-eligible to when they complete their training and initiate treatment. Patients in some clinics average two weeks of training whereas those in other clinics average six weeks. The diversity is more pronounced in patients eligible for fast-tracked initiation with the duration ranging from immediate initiation to three weeks. Additionally, HAART adherence facilitators and barriers are managed differently in the various clinics around the province. Some patients are required to have treatment supporters and to disclose their HIV-status whereas patients in other clinics are not. There are also substantial differences in patient sobriety and mental health requirements.
Discussion: This survey identified substantial diversity in patient preparation and requirements prior to the initiation of HAART, despite the central goal of ensuring patient adherence. This is indicative of a clear need to generate further evidence in an African context on the facilitators and barriers to adherence. This evidence must then be used to identify best practices and to regulate patient training timelines and eligibility. Additionally, patient preparation and requirements must be monitored at the clinic level to ensure standardized implementation.
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