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In LifeLine/Childline Western Cape, we have an
extensive adherence counselling programme within
our HIV and AIDS lay counselling programme. This
integral service is offered to those on anti-retroviral
treatment programmes, and is aimed at ensuring
adherence to the treatment programme.
Antiretrovirals (ARVs) are publicly available,
however not all HIV positive people will need
to be on ARV treatment. ARV therapy helps people
living with HIV to live a longer and healthier
life by lowering the amount of virus in the body
(viral load) thereby enabling the immune system
to get strong again. In South Africa about 5 million
people have already been infected with the HI
virus (1 in every 9 people) but only about 500
000 people need to take ARV's because the rest
are still healthy. The only time HIV positive
people will need to go onto ARV's is if they have
a CD4 count below 200 (CD4 count is the test that
shows how strong the immune system is) or an AIDS
defining illness (e.g. extreme weight loss, meningitis,
pneumonia, dementia, extrapulmony TB, cancers,
fungal and parasitic infections). Therefore you
would need to have met one of these two criteria
before you would qualify for ARV therapy.
The Western Cape planned to have 19 sites for
the ARV roll out by April 2004 and a further 14
sites starting later in the year, which gives
a total of 33 sites where one could become part
of the ARV programme.
- Clients will be referred to the programme
when their CD4 counts are below 200 or if they
are diagnosed with an AIDS defining illness.
- The client must be committed to taking
ARV triple therapy
(combination of 3 drugs taken) for life.
- Disclosing to someone who will be a treatment
"buddy' or assistant for the client
to ensure adherence. This is important,
as having to take many drugs at the same
time of day, every day of for the rest of
your life is not easy to accomplish without
help. The client needs to be adherent to
ensure that they have enough of the drug
in their body to make sure they do not become
drug resistant.
- Making sure that the client does not
abuse substances, especially alcohol. The
reason for this is to ensure that the person
does not suffer from liver toxicity. In
addition to which it will be very difficult
to be compliant to treatment when under
the influence of a substance. The client
is also encouraged to follow a healthy lifestyle
and is made aware of the dangers of drug
interactions.
- Ensuring that the person will be able
to attend 3 information sessions and 2 individual
counselling sessions. This process will
take about 6 to 8 weeks to complete. The
purpose of this will be to educate the client
on various things including, information
on what ARVs are, how they work, the side
effects, the importance of adherence and
drug resistance. The counsellors would also
need to do a social and psychological assessment
of the client in order for the medical team
to decide if the client will qualify for
ARV treatment. If the client does qualify
then ongoing counselling and clinic visits
will be needed. If the client does not yet
qualify then the counsellor and the client
will work together on the problem so that
the client will be able to qualify.
The client has to agree to take responsibility
for their own health and treatment. This means
taking ownership around pill taking, attending
all sessions and ensuring that they comply with
the conditions of the programme.
In conclusion, HIV positive people will be able
to receive free ARV therapy when their immune
system is weak and needs to be strengthened (CD4
below 200) and when they have been able to show
that they are ready for a life-long commitment
to the therapy. Therefore you will need to go
to your nearest clinic to be assessed as to whether
you qualify for the programme.
www.capegateway.gov.za
I chatted to our adherence counsellors at LifeLine/Childline
Western Cape to find out about their day-to-day
challenges in the work that they do:
“You have to appeal to them to disclose. Sometimes
you ask them to bring a person with them if they
are not happy to disclose alone. Some disclose
to their partners, and then they split up.”
“Sometimes you have to refer clients to the social
workers, or to other organisations such as SANCA,
or social workers at the clinics, because there
are other issues that they need to deal with before
they can begin to focus on their treatment programmes.”
“It is very difficult for us when a client is
not taking treatment correctly. If they are defaulting
on Regimen 1, then how will they deal with Regimen
2? We have to encourage them to keep on taking
their ARVs, emphasising adherence. We cannot be
on the clients’ shoes, so we have to continue
with the education and help them to understand
the importance of sticking to the Regimen.”
“Work issues often stop people being compliant,
as does alcohol abuse.”
“Some of our clients are homeless, and they start
on treatment but do not have anywhere to stay.
It is vital to take the treatment at the same
time every day, and this is very difficult when
clients do not have anywhere to stay.”
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