Caution: Piglet Crossing!
While the past few weeks have consisted mainly of presenting our work before countless organizations, we had quite a change of pace yesterday. We finally had the chance to go out to some of the more rural ART (antiretroviral therapy) clinics and see how things are done there. On our way out to the sites, we came to a halt on one of the rural roads where three little piglets were following their mother across the road!
I spent my time yesterday at Mankayane Government Hospital with a representative from ICAP. We were able to train about six expert clients on how to use the tablet adherence charts that we have been working on during our time here. At the end of the day (which happens around lunch time), I asked for feedback on the charts and was surprised to see how receptive the expert clients were to using them. They did not seem to feel that the charts were too complicated and they wanted to have some made for 60-day and 90-day visits as well.
I have to admit that while we were working on the charts from the Baylor clinic, I was a bit skeptical about how much of a difference they would actually make on calculating adherence in rural facilities. But actually seeing them used in clinics (where adherence monitoring was not consistently done before), I realized what a powerful tool these charts can be – if providers are properly trained on how to use them and they are used consistently – in improving the quality of care given to patients.
Using the feedback we were given from the facilities, we created extended charts which could be used for 60 days and 90 days as well. We were able to present these charts to the director of SNAP (Swaziland National AIDS Program) just this afternoon and should have them on their way to the Ministry of Health (Forms Committee) soon, even though this is likely to happen only after we leave the country.
One very interesting thing about adherence that I did not previously think about was the support structure needed in order for a patient to have good adherence to ARVs. Many of the patients we saw had much better adherence to their morning tablets than their evening tablets because they would often fall asleep before the time designated to take them. Living alone, these patients did not have anyone to wake them or remind them to take their pills before falling asleep, exhausted from a full day at work. There was even one patient who broke down in the clinic because she felt so alone, without any real friend with whom she could even share the fact that she was HIV positive. This comes back to the barrier of having such a large stigma against HIV in the country, an issue that requires some creative thought indeed.
Finally, at the very end of our hectic day, we had our first opportunity to try some authentic Swazi food. From the cornbread-type cakes to the colorful wild vegetables to the stewed oxtail, the food was incredible, a welcome break from cooking our own meals!
Below are some of the expert clients being trained on how to use the adherence charts:
