1. NIMH R34 MH82654 “A Multimedia Social Support Intervention: Adherence to HIV Care In South Africa”

2. A Theoretically Framed Counselor- Driven Adherence Intervention Utilizing Laptop Multimedia Collaborating Partners: – HIV Center for Clinical and Behavioral Studies; NYSPI and Columbia University; New York, NY – University of Cape Town, Departments of Psychiatry and Public Health – Columbia Center for New Media Teaching and Learning – Hout Bay Main Road Clinic; Department of Health, City of Cape Town Funded by the National Institute of Mental Health, USA

3. Background South Africa has one of the worst HIV/AIDS epidemics in the world with 5.7 million infected individuals (UNAIDS) and approx 13.6% of the general population affected (SA National Household Survey) Defaulting AND non-adherence to HIV treatment is now recognized as a major barrier to actualizing the full potential of antiretroviral therapy (ART) in all regions of the world Mental health problems, including substance use problems are central barriers to optimal adherence

4. You Tube “Demo” http://www.youtube.com/watch?v=MOGlicrnko0

5. Theoretical Framework for Enhancement of Adherence Social Action Theory (Ewart), focusing on the following content: – Information / Knowledge – Self Regulatory Processes: mood, motivation – Social Context: stigma & disclosure – Interpersonal Processes: social support, provider communication & behaviors – Behavior: self-efficacy, skills, problem solving & maintenance of good adherence

6. Intervention Content Mental health screening Program overview and choosing a buddy HIV 101; importance of adherence Pill regimen Problem solving to overcome barriers to adherence Social support and disclosure HIV prevention Reasons for staying healthy

7. Mental Health Screening

8. Alcohol Use

9. Adherence Barriers

10. Problem Solving Video Two friends, Nomhle and Chantal, demonstrate the steps of effective problem solving

11. Problem Solving Applied to Patient’s Personal Barriers The counselor helps the patient + support partner apply problem solving to the specific barriers identified by the patient Ask – What is the problem? Aim – What is the goal? Alternatives – What are the options? Action – What can we try (before next meeting)

12. Problem Solving Example

13. Benefits of Masivukeni Standardizes delivery of information by counselors who have varying degrees of expertise & skill Provides a guided framework (“scaffold”) for the counselors; empowers them Facilitates standardized mental health screening with scripts for referral Visually engaging; useful for low literacy Interactive; facilitates delivery of cognitive-behavioral interventions and allows counselors to personalize intervention delivery Facilitates data collection Highly acceptable to patients, buddies, counselors, and clinic staff Preliminary evidence for “promise” of adherence behavior change Masivukeni shows promise to enhance counseling and to improve patients’ adherence to care and treatment