“It’s Important to Take Your Medication Everyday Okay?” An Evaluation of Counselling by Lay Counsellors for ARV Adherence Support in the Western Cape, South Africa

There is growing interest in standard care programmes for antiretroviral (ARV) adherence support. In South Africa, individual
counselling following ARV initiation is a main strategy for supporting adherence in the public sector. Egan’s client-centred
“Skilled Helper” counselling model is the predominant model used in HIV counselling in this context. This study evaluated
counselling delivered by lay ARV adherence counsellors in Cape Town in terms of adherence to Egan’s model. Thirty-eight transcripts
of counselling sessions with non-adherent patients were analysed based on the methods of content analysis. These sessions
were conducted by 30 counsellors. Generally counsellors’ practice adhered neither to Egan’s model nor a client-centred approach.
Inconsistent with evidence-based approaches to counselling for ARV adherence support, counsellors mainly used information-giving
and advice as strategies for addressing clients’ non-adherence. Recommendations for improving practice are made. The question
as to how appropriate strategies from developed countries are for this setting is also raised.