Adherence to Antiretroviral Therapy in Adults

This training manual was developed for the Antiretroviral Therapy Program in Mombasa, Kenya by the Horizons Program of the Population Council, the International Centre for Reproductive Health and the Coast Province General Hospital, Mombasa.

It aims to provide trainees with a basic understanding of the challenges of Highly Active Anti-Retroviral Therapy (HAART) and adherence to antiretroviral therapy. The Adherence Training Manual has been designed for health workers including physicians, clinical officers and adherence nurse counsellors in antiretroviral (ARV) programmes. The manual consists of four modules to be conducted over four sessions of approximately two hours each. These sessions can be conducted as a part of a comprehensive ART training programme.

The first module provides a background on adherence to ART and is relevant for all health workers involved in ART service delivery. Modules 2, 3 and 4 provide detailed adherence management of a patient on ART designed for adherence nurse counsellors. Physicians would benefit from attending the session on Module 2. The objective for each session is given at the beginning. The methodology, the materials required, the expected duration and the handouts are given in the margin at the beginning of each exercise. Handouts for the training use actual patient literacy materials, counselling checklists, pill charts and medication demonstration charts being used in the Mombasa ART programme.

Topics include:

• Preparatory Adherence Counselling;
• Patient Preparation for Adherence;
• The Multidisciplinary Adherence Team;
• HIV Infection and Antiretroviral Treatment; and
• Strategies and Tools to Enhance Adherence.

The manual uses different techniques in these modules: brainstorming, small group discussion, Power Point presentations, case studies and role-play. Brainstorming, small group discussions and interactive sessions provide an opportunity for a large number of participants to share their views. Power Point presentations are useful in providing participants with the theory and background on the topics being discussed. Case studies help participants discuss and understand the issues in a practical way. Role-play provides practical training in developing adherence-counselling skills.