An integrated approach for antiretroviral adherence and secondary HIV transmission risk-reduction support by nurses in Kenya

Abstract

Ongoing antiretroviral therapy (ART) adherence and secondary HIV transmission-risk reduction (positive prevention) support are needed in resource-limited settings. We evaluated a nurse-delivered counseling intervention in Kenya. We trained 90 nurses on a brief counseling algorithm that comprised ART and sexual-risk assessment, risk-reduction messages, and health-promotion planning. Self-reported measures were assessed before, immediately after, and 2 months post-training. Consistent ART adherence assessment was reported by 29% of nurses at baseline and 66% at 2 months post-training (p < .001). Assessment of patient sexual behaviors was 25% at baseline and 60% at 2 months post-training (p < .001). Nurse practice behaviors recommended in the counseling algorithm improved significantly at 2 months post-training compared with baseline, odds ratios 4.30-10.50. We found that training nurses in clinical counseling for ART adherence and positive prevention is feasible. Future studies should test impact of nurse counseling on patient outcomes in resource-limited settings.

Figure 1. HIV provider counseling algorithm

Note. STI = sexually transmitted infection; Mgmt = Management; Patient education (in English and Kiswahili), provider counseling algorithm, and clinic milieu materials available for download at www.pambazuko.org

Figure 2. HIV nurse counseling practices over time

Note. ART = antiretroviral therapy; STI = sexually transmitted infection; mos = months