Adherence to HIV treatment: its about appreciation & listening and not teaching

I am a counselor for children and teenagers/adolescents and work on Elma project in Kisubi Hospital, Entebbe. The goal is to identify HIV positive children and teenagers/adolescents and link them to HIV care and retain them on treatment.

We had many children with high viral load and others with adherence to treatment challenges. My role was to support the children and improve their adherence to reduce their viral load. Health workers were doing tests like blood pressure, HIV status, gave medicine and how are you going to take it but still children were not adhering to treatment and many not suppressed their viral load.  We had to do something different from the daily routine.

 I realized that I could not do it with children alone and had to involve their parents and care takers as they were the ones living with the children.  Together with other health workers we organized psycho social seminar meeting with children and their parents and care takers how to improve the current situation.  For the first time I brought SALT approach. Usually in such meetings health workers teach you what to do. But this time we had to listen to the children and their guardians on the challenges they had. We appreciated the work they are doing and stimulating them to share with us. They opened up and freely told us some of the challenges they faced. One parent said that truthfully for me, school van comes at 6:30 am and in the end I don’t give my daughter the medicine. And we asked them what do you think you can do to address this situation. She said that she would take the daughter herself to the school instead of the school van. That created a change for six months viral load of the child had suppressed.

Care takers  were always busy working and had two children 8 years old and 4 yearsold who were HIV positive. They left the 8 year old child to give medicine to the 4 year old and to herself. They acknowledged that sometimes these children don’t take the medicine without adult’s supervision.  After this conversation, the care taker took help of another older child who is 16 year old  who could monitor the children to take the medicine regularly.

Similarly, we listened to the children without judging them. Children did not know that why they were taking medicine though they were not sick.  We had to disclose their condition with age appropriate information.

 What can we see is that when we engage the caretakers and the children, there is a positive change in adherence as they were taking responsibility and were making own decisions how they could improve on current situation and implement on their own and not what health workers tell them. Appreciation of what they are doing works and not teaching and just providing awareness. 

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