We, at the SHM Foundation, invite you to share your thoughts on the complexities of medical adherence for the population you're working with.

The question of medical adherence is central to our mental health innovation - Project Khuluma. Khuluma is a pioneering support group model run by the SHM Foundation that provides psychosocial support to closed groups of 10-15 adolescents living with HIV/AIDS (ALWHA) via text-message. One of the biggest challenges for ALWHA is adherence to medication. There is strong evidence that various social, emotional and psychological factors can have a significant impact on adherence but it remains difficult to accurately assess for what works improving adherence rates.

Although participants reported at enrolment that medical adherence was not a major issue for them, during their time in Khuluma they admitted that they missed taking their medication for a range of practical and emotional reasons, including disrupted routine, a lack of social support, feelings of anger, fear of stigma and trouble managing side-effects. Participants encouraged one another to take their medication and discussed the underlying reasons, such as stigma, that had a negative impact on their medical adherence. Overall, there has been a 17.4% self-reported increase in adherence levels amongst in the number of participants who self reported that they take their antiretroviral medication.

We'll be presenting these findings at the International HIV/AIDS Conference in Durban, July 18th-22nd. Follow us on Twitter during the conference and beyond, @SHMFoundation, to keep up to date our findings and insights. You learn more by visiting our website - www.shmfoundation.org

We hope you share your own insights on the complexities of adherence during the week of the conference.


adherence hiv mental health stigma

  • erzseagnes Agnes Erzse 21 Jul 2016

    Hi Nikita! Thank you for your post. I think innovations like Khuluma highlights very well the power of peer-based programmes and should be a high priority in the HIV response. Building on the resources that friends spontaneously offer one another, have a significant power in supporting adherence.

    While it is critical that HIV patients receives and understands information about HIV disease e.g. the prescribed regimen, information alone is not sufficient to assure adherence. From the perspective of a HIV positive adolescent, non-adherence is often a consequence of psychosocial barriers e.g., depression, low levels of social support, stressful life events, and stigma. Therefore, patients must also be positively motivated to maintain therapy.

    Can you explain what role do Khuluma facilitators play over the course of a discussions about adherence?

  • nikitasimpson1 Nikita Simpson 25 Jul 2016

    Hi Agnes,

    We ensure that our facilitation is bespoke to each group. This means that there will always be a split between the amount of time the facilitators spend actively educating their group - giving them info on their condition, pointing them to appropriate resources etc - and the amount of time they spend simply allowing natural conversation to play out. We find the latter particularly important when it comes to adherence, as we consider our participants to be experts themselves. We don't know much about the mental health complexities surrounding adherence, so we have to let the issues arise from our participants themselves.

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