June 30, 2008
Options for Health: Western Cape
I know there's been a rather large delay between the first entry and this one which means that I'm not hovering over a computer all the time :). The primary reason I'm in Cape Town in the first place is because I'm doing a research internship with University of Cape Town Department of Public Health and the Medical Research Council. I'm working with Dr. Catherine Mathews, who's really nice and fantastic in giving me perspective on all these projects and enough work to do. I'll give a brief summary about each project I'm working on and also the limitations of all the research. Working in the public health sector is completely new to me as I'm so used to research on a much smaller scale. Here, even during experimentation, there are real problems to deal with that can't be fixed with another trial. Sometimes the problems affect entire groups of people and so, before even considering experimentation, everything must be thought through.
PROJECT 1: Options for Health - Western Cape
This is the primary project I am working on with Dr. Mathews. Options for Health is an intervention that is going to be implemented throughout the Western Cape. The intervention is aiming to reduce the levels of risky sexual behavior of HIV/AIDS patients who are on ARVs through motivational interviewing and education. The intervention will be implemented for 9 months in 15 clinics and compared to 15 other control clinics. Assessment will occur through a final interview after the 9 month period. While the intervention is being implemented, patients will be routinely interviewed and their medication adherence will be quantified. Other issues that will be addressed during this study are pregnancy intention (what should a counselor advise when a patient who is HIV+ wants to have a child?), gender-based violence, and medication adherence importance. First, we are going to be running a pilot study at one clinic in Kraafontein in order to see if this intervention can be implemented. 40 patients who have been on ARVs for more than 6 months will be selected this Thursday and the intervention will be implemented for 4 months. In order to make sure that the intervention doesn't disrupt the clinic's usual work, observations will be taken for a week prior to and after the intervention is implemented. Counselors, doctors, and nurses will all be interviewed to make sure they understand the intervention and agree to it. For all of this, we had to meet with various staff from the clinic and Department of Health to ask permission to carry this out. There's a lot of red tape surrounding healthcare in South Africa to the point where the number of doctors are regulated to clinics. In many townships, no doctors are available or sent there from the Department of Health. There is not a lack of doctors in South Africa but many choose to work overseas due to poor pay and facilities. Many NGOs instead try to take the brunt of this decision by financing doctors (such as through Doctors Without Borders), counselors, and nurses. However, none of this is permanent and is contract-based. I have met many counselors who are in fear that they will lose their job once their NGO ends their contract with a particular clinic. Looking at past papers regarding similar interventions in the US is misleading at times as there is so much more red tape in South Africa both politically and socially. In fact, the main concern the doctor at Kraafontein had about the intervention was the effect it would have on the community which is valid as the topics such as safer sex and disclosure about one's status are very touchy.
One thing that has struck me though about this intervention is whether or not it will work outside a research perspective. To be able to assess this study, patients are selected and given "incentives" through either Shop-Rite vouchers or free transportation to and from the clinic. When the study ends and it's written that it works, will it actually still work without any incentives and without researchers tracking down the original 40 patients they selected?
There's one counselor here named Samuel in Kraafontein who's been trained in the Options intervention. He has a holiday for 2 months but cut it short for the study to only 3 weeks and will lose his holiday pay because he wants to help the clinic out more than just relaxing at home. Because of him, we can pilot the study even earlier now. People who work in the community as counselors and peer educators do really want to help in any way possible to reduce levels of re-infection or spreading of the disease. They rather not waste any time, which I found amazing and very unlike the health officials who know all the statistics surrounding this matter.
Posted by Reshma Ramachandran at June 30, 2008 06:43 AM