“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

Quality of HIV Counselling in South Africa

“…The manner in which clients are encouraged into taking the HIV test and receive their HIV test results plays a key role in their future HIV prevention behaviour for both HIV positive and HIV negative clients. However, counsellors do not seem to be consistently applying a standard counselling approach (Setswe 2009;Dewing et al 2012;Mpiima et al 2013). Counsellors at various set-tings have been observed and reported to be prone to giving information and advice instead of exploring personalised alternatives to managing client situations (Dewing et al 2013).…”

“…The current pre-dominant counselling models such as the Egan model in South Africa and the TASO model in Uganda are seen as less structured to effect any behavioural change compared to the risk reduction model used in many other parts of the world (Van Rooyen et al 2010). The Egan model, for example, is described as client-centred and is used by skilled helpers, is collaborative and its main task is to assist the client to explore personalised alternatives to their situation (Van Rooyen et al 2010;Dewing et al 2012). In a study evaluating the standard of care during ART adherence counselling in the Western Cape, South Africa, it was established that while counsellors described their counselling approach as having the Egan's client-centred principle, the actual observations of the counselling sessions did not evidence the practice (Dewing et al 2012).…”

“…The Egan model, for example, is described as client-centred and is used by skilled helpers, is collaborative and its main task is to assist the client to explore personalised alternatives to their situation (Van Rooyen et al 2010;Dewing et al 2012). In a study evaluating the standard of care during ART adherence counselling in the Western Cape, South Africa, it was established that while counsellors described their counselling approach as having the Egan's client-centred principle, the actual observations of the counselling sessions did not evidence the practice (Dewing et al 2012). Both the Egan and the TASO models are problem solving oriented with a focus on helping the client state why they have come in for HIV testing and consider their options regarding testing as well as helping them come up with a plan regarding the HIV test.…”

The emotional wellbeing of lay HIV counselling and testing counsellors

“…A few studies evaluated the ability of lay counsellors to implement counselling. Dewing et al (2013) raised concern about the quality of counselling delivered by lay counsellors, because they mainly provide information and advice and not counselling and support (Haffejee et al, 2010;Van Rooyen, 2013). A systematic review of 29 studies showed that lay counsellors in the South African context can be effective if they are appropriately trained and supervised (Peterson et al, 2014).…”

“…The dilemma is that the lay HCT counsellors are not qualified to deal with the clients' emotional distress. They do not receive adequate training and supervision for the work they have to do (Daniels et al, 2010;Dewing et al, 2013). This therefore results in the counsellors' high levels of emotional exhaustion and depression which could negatively affect the quality of the counselling they provide.…”