Triangle Initiative at CCNMTL

Masivukeni

Partner(s): Robert Remien
Department of Psychiatry

Access: Private
Released: March 2009

Masivukeni is a counselor support tool for delivering an HIV-treatment adherence intervention in clinics in South Africa. It is a collaboration between Dr. Robert Remien, a research scientist at the HIV Center for Clinical and Behavioral Studies, and CCNMTL. Masivukeni was developed with the help of counselors, nurses, and volunteers at Hout Bay clinic where it is currently piloting. It provides a detailed protocol for counselors to follow when helping non-adherent patients, and provides patients with interactive activities and videos that help explain the importance of adherence, how HIV and HIV-treatment regiments affect the body, and how treatment resistance can develop.

Project Details

CCNMTL and Dr. Robert Remien, a research scientist at the HIV Center for Clinical and Behavioral Studies and associate professor of clinical psychology (in psychiatry), received a grant from the National Institute of Mental Health (NIMH) to create and pilot Masivukeni, a multimedia version of an HIV-treatment adherence program, SMART Couples, that has been effective in New York City HIV care clinics. The grant allows the program to extend its reach to South Africa, which has one of the highest rates of HIV in the world. Originally named SMART +SA, Masivukeni also aims to enrich Columbia courses at the Mailman School of Public Health and other programs focused on health disparities.

  Masivukeni, which loosely translates to "let's wake up" in Xhosa, is a computer-assisted program that supports counselors at health clinics in Cape Town, South Africa in assisting HIV-positive adults to adhere to their antiretroviral drug regimens through a combination of education and support. The program uses enhanced text, imagery, animations, audio, and video to teach the basics of how HIV and antiretrovirals affect health, and to build problem solving and social support skills that patients use to overcome barriers to treatment adherence. Research partners and community stakeholders from Cape Town provided guidance on Masivukeni's design, language, and skill-building activities to ensure that the program incorporated culturally relevant themes. A central component of Masivukeni is the Island Activity, an interactive tool that depicts the improvement or decline of a patient's health using an animation of a person on an island surrounded by rising or lowering water.

Currently, South Africa uses a 'buddy system' for new patients beginning antiretroviral treatment. A patient finds a support person to go through several sessions of counseling with them before the first drugs are dispensed. Masivukeni follows up on this system, helping the patient to identify appropriate supports in their social network and asking the patient to choose a partner to bring to the Masivukeni sessions. Five of the six sessions are delivered to the patient and his or her treatment partner.

In March 2009, a team from CCNMTL and the HIV Center for Clinical and Behavioral Studies trained two adherence counselors at an HIV clinic in Cape Town to deliver Masivukeni to 30 patients who are experiencing challenges adhering to their HIV treatment. Based on results from this pilot project, CCNMTL and the HIV Center will explore ways to implement a broader study of Masivukeni.