Population Council Research that makes a difference

A situation analysis conducted soon after the national antiretroviral therapy (ART) program had begun in Thailand indicated a high drop-out rate among patients, gaps in providers’ abilities and confidence to manage patients, and barriers to adherence.

In response, this study is evaluating the use of practical treatment guidelines for providers and a strengthened clinic-counseling intervention to reduce dropouts and to promote short- and long-term treatment adherence. The research also examined the added value of a peer component: Some of the health services are offering monthly peer group education sessions at the clinic, peer outreach education, and follow-up in the community. Study partners included the AIDS, STD and TB Bureau of the Thai Ministry of Health; the Department of Psychiatry, Faculty of Medicine, Chiang Mai University; and the Research Institute for Health Sciences, Chiang Mai University.

The counseling intervention was divided into three phases. The preparation phase was conducted before people living with HIV/AIDS begin taking medication; the initial phase included weekly counseling during the first month; and the maintenance phase included counseling integrated into the clinic’s routine work. Family involvement was integrated throughout the counseling process. Furthermore, modules, training, and tool kits to promote adherence to HIV treatment were developed.
The study took place in one provincial and 44 district hospitals in northern Thailand. Each of the three arms of the study was randomly assigned 15 hospitals. The arms included:

• Arm I: practical guidelines and the adherence-counseling program
• Arm II: same as Arm I but with a peer-based intervention added
• Arm III: standard care (control)
  
  

Three waves of data collection were undertaken, and quantitative and qualitative data from respondents in the three arms are being compared to determine the impact of the interventions.