Enhancing Lay Counselor Capacity to Improve Patient Outcomes with Multimedia Technology

Abstract

Multimedia technologies offer powerful tools to increase capacity of health workers to deliver standardized, effective, and engaging antiretroviral medication adherence counseling. Masivukeni is an innovative multimedia-based, computer-driven, lay counselor-delivered intervention designed to help people living with HIV in resource-limited settings achieve optimal adherence. This pilot study examined medication adherence and key psychosocial outcomes among 55 non-adherent South African HIV+ patients, on ART for at least 6 months, who were randomized to receive either Masivukeni or standard of care (SOC) counseling for ART non-adherence. At baseline, there were no significant differences between the SOC and Masivukeni groups on any outcome variables. At post-intervention (approximately 5–6 weeks after baseline), clinic-based pill count adherence data available for 20 participants (10 per intervention arm) showed a 10% improvement for Masivukeni participants and a decrease of 8% for SOC participants. Masivukeni participants reported significantly more positive attitudes towards disclosure and medication social support, less social rejection, and better clinic-patient relationships than did SOC participants. Masivukeni shows promise to promote optimal adherence and provides preliminary evidence that multimedia, computer-based technology can help lay counselors offer better adherence counseling than standard approaches.

Optimizing ART Adherence: Update for HIV Treatment and Prevention

“…In a pilot RCT among clinic identified non-adherent adult HIV patients, Masivukeni participants’ pharmacy pill count adherence rates improved by 10%, while standard care (SOC) patients’ adherence declined by 8% at post-intervention, though the difference was not significant [54]. Masivukeni participants also reported significantly more positive attitudes towards disclosure and medication social support, less social rejection, and better clinic-patient relationships than did SOC participants at post-intervention [54]. The six-session Masivukeni intervention uses videos and interactive activities to convey complex information about HIV and HIV treatment, as well as to systematically guide counselors through intervention content.…”

Community-Based Interventions to Improve and Sustain Antiretroviral Therapy Adherence, Retention in HIV Care and Clinical Outcomes in Low- and Middle-Income Countries for Achieving the UNAIDS 90-90-90 Targets

“…Such community-based interventions are likely to have more impact since they tend to involve trained community health workers, peers, volunteers, or patient’s own social network members (e.g., family and friends) who assist with ART adherence counseling and support. In addition, there is evidence that they may provide material, instrumental, and emotional support, as well as promote other healthy behaviors, such as decreased alcohol and drug use, leading to better health outcomes—including survival [14, 24, 29, 32]. Furthermore, enhancing certain aspects of the patient–supporter relationships—such as trust, supporter availability, communication, reciprocity of support, and medication assistance—in a manner consistent with patients’ expectations may help to optimize the relationship and its positive impact on patient health [14, 24, 70].…”

“…Community-based programs to promote retention in HIV care and/or ART adherence are now increasingly being recognized as an important and sustainable approach that could contribute significantly toward the UNAIDS 90-90-90 target and ultimately an AIDS-free generation [20–27, 28•, 29–32]. Such approaches are also seen as an essential mechanism of service delivery, including dispensing of ART, and a means of decongesting traditional health services, rather than being purely an adherence adjunct.…”

Adaptive Learning Mode of a Multimedia-based "English Literature" Learning System

“…With the development of information technology, multimedia technology has been widely applied to various fields since its rise in the 1990s [1]. Gradually, multimediaaided teaching, especially multimedia-aided foreign language teaching, has received extensive attention.…”