BACKGROUND

The adherence counseling activity is an integral part of patient care in IHVN-ACTION program.  Adherence is a process that involves both patients and care providers which ensures consistent and correct taking of medication as well as ensuring patient retention in care. The Institute of Human Virology, Nigeria has the responsibility of providing treatment and care in Nigeria for optimum adherence; the need for adherence counselors to provide these services became vital in the ACTION program.

In 2005, IHVN was working with six tertiary facilities namely: Aminu Kano Teaching Hospital (AKTH) in Kano, Nnamdi Azikiwe University Teaching Hospital (NAUTH) in Nnewi, National Hospital Abuja (NHA) in Abuja, University of Abuja Teaching Hospital (UATH) in Gwagwalada, University of Benin Teaching Hospital (UBTH) in Benin and University of Calabar Teaching Hospital (UCTH) in Calabar.

Today, we have over 32 sites providing adherence services in 23 states across the federation. There is a growing increase in service demand across these sites and thus the continuous improved strategies to address the increasing demand to ensure standard & qualitative care.

There are five regions of the IHVN office currently implementing the ACTION program: Kano, Lagos, Jos, Benin and FCT regions. Each thematic program area has regional program officers who oversee the specific activities.

Adherence counseling unit has program officers in each region that supervises across 3 to 5 states each having over 11-15 sites to oversee. They are the link between the central office and sites. At the site levels, adherence counselors are identified, trained and provided patient adherence counseling services on a daily basis.

ADHERENCE ACTIVITIES

Capacity building is a priority of the adherence team.  Therefore, on-the-job trainings are conducted centrally, regionally and at the site level in order to develop care providers’ capacities. Expert training manuals have been developed and a team of master trainers have  come on board to help in providing step-down trainings at sites.

Mentoring & supervision: Regular supervision and periodic mentoring has been our best tool in achieving the optimal goal of medication adherence in the IHVN project sites. Various supervisory tools have been developed to support adherence counselors during site visits.

Patient counseling and education: This is the primary responsibility of the adherence counseling unit. Appropriate counseling ensures that each patient benefits from the provision of basic, factual and regular education on a group and/or individual basis. During these sessions, appropriate tools are utilized to communicate consistent information to patients.

Implementation strategy: The adherence unit recently implemented a reviewed standard operational procedure across all project sites. This emphasized on the importance of treatment preparation and readiness before commencing ARV, regular monitoring and recording of patients’ weight, CD4 count monitoring, and appropriate linking of patient with community support network. The provision of basic care package is ensured as well as maintaining adherence continuity throughout the continuum of care.

STAFFING

The adherence unit is a seven-man team. There is one staff member at each of the regions, with two staff members at the central level.