1. Module 6: Using the Child and Adolescent Flipcharts
This talk will review how to interpret viral load results and provide adherence counseling using the Viral Load Monitoring and Enhanced Adherence Counseling Flipchart

2. Learning Objectives
Use the Child and Adolescent Viral Load Monitoring and Enhanced Adherence Counseling Flipcharts in order to:
Interpret and explain the meaning of a viral load result <1,000 copies/ml
Interpret and explain the meaning of a viral load result >1,000 copies/ml
Assess adherence among those with viral load >1,000 copies/ml
Develop targeted interventions to improve adherence support
Manage steps based on repeat viral load results
The learning objectives are outlined here

3. Outline
Child Viral Load Monitoring and Enhanced Adherence Counseling Flipchart
Adolescent Viral Load Monitoring and Enhanced Adherence Counseling Flipchart
We will cover these topics

4. Child Flipchart
The format is the same as the adult flipchart.

5. About the Flipchart Purpose:
Provide information about viral load and promote adherence for those starting and already receiving ARVs.
Explain the meaning of viral load results and improve adherence assessment counseling for those with elevated viral load.
Intended Users: Health care workers (adherence counselors, doctors, nurses, community health workers, lay counselors, expert clients).
The child flipchart is intended for the parents of children who are on ARVs and will need viral load monitoring. The flipchart will help the provider explain the meaning of viral load results and will coach parents with receiving ARVs to work with them to improve adherence.

6. Using the Child Flipchart
Many of the cards are very similar to the adult flipchart, but with some small differences.
Differences to highlight:
Different artwork.
Language in key messages, let’s review, and talking points sections have been changed to highlight your child.

7. New Slides in the Child Flipchart
Talking to your child about ARVs
Child-specific Enhanced Adherence Counseling interventions
These cards are unique to the child flipchart.

8. Talking to Your Child About ARVs
Use this card to help parents think about how to best to talk to their children about taking ARVs during their first appointment with you. It is important to give children truthful information, but what parents say will depend on the child’s age and how well they can understand.

9. Child- and Parent-Specific Enhanced Adherence Counseling Interventions
It is an adult job to give ARVs, but adults face many of their own challenges as well as taking care of their children. It is important as their health care provider to understand all the challenges that they are facing and to help find solutions to make giving ARVs better.
Enhanced adherence counseling intervention cards for children and their parents are different than the adult flipchart. Card 10 prompts the provider to have more in-depth conversations about the following topics:
Sharing your child’s status with others
Remembering to give ARVs
Understanding your child’s ARVs
Child doesn’t want to take ARVs
Tips for giving small children medicine
Pill swallowing tips

10. Sharing Your Child’s Status With Others
Use this card for parents who are concerned about sharing their child’s status or have not yet told anyone. Sharing their child’s status and identifying possible treatment supporters can make it much easier to take care of their child every day.

11. Remembering to Give ARVs
It is extremely important that children are given their ARVs every day, but it can be a lot of work. This card provides tips for parents who have trouble remembering to give their child ARVs every day.

12. Understanding Your Child’s ARVs
To be successful with ARVs it is important that patients learn how they work and how best to give them to their children daily. Use this card for patients who may not understand how ARVs work, why they are important, or have other questions related to knowledge or health beliefs.

13. Child Doesn’t Want To Take Medication
Some children dislike taking ARVs. Use this card for parents who are having a difficult time getting their children to take ARVs.

14. Tips for Helping Your Child Take Medication
There are several ways you can help small children take medication (review examples). Review these tips with the parent.

15. Pill Swallowing Tips
Older children may need help learning how to swallow pills on their own. Review these tips with the parent.

16. Adolescent Flipchart

17. New Slides in the Adolescent Flipchart
Keeping your virus low
Adolescent-specific Enhanced Adherence Counseling interventions
Taking charge of your ARVs
These cards are unique to the adolescent flipchart.

18. Keeping Your Virus Low
Use this card for adolescents who have a low viral load result after their first test.

19. Adolescent-Specific Enhanced Adherence Counseling Interventions
Taking ARVs is an adult job, and adolescents are still growing up. It is important as their health care provider to understand all the challenges that they are facing and to help find solutions to make taking ARVs better.
Enhanced adherence counseling intervention cards for adolescents are different than the adult and child flipcharts. Card 14 prompts the provider to have more in-depth conversations about the following topics:
Remembering to take ARVs
Understanding your ARVs
Making it easier
Tips for pill swallowing
Who and why to tell
Taking Charge of your ARVs

20. Remembering to Take ARVs
Always remembering to take ARVs can be difficult, so it’s important to help adolescents find solutions to make taking ARVs easier for them and to create good habits. Use this card for adolescents who have a hard time remembering to take their ARVs.

21. Understanding Your ARVs
Use this card if the patient is having trouble understanding how their ARVs work (including names and frequency off medications, how medications work, or other health beliefs).

22. Making it Easier
Taking ARVs is not easy. Use Talking Points to discuss a few different issues the patient may be having, such as managing side effect, managing emotions around taking ARVs, or taking pills.

23. Tips for Pill Swallowing
Review how to swallow pills with the patient.

24. Who and Why to Tell
Use this card for patients who are concerned about disclosing their status. Encourage the patient to share their status with someone they trust. Feeling supported can help them take their ARVs every day.

25. Taking Charge of your ARVs
Make sure to review this card with every adolescent patient after completing individualized enhanced adherence counseling

26. Questions?