Triangle Initiative at CCNMTL

Masivukeni

Partner(s): Robert Remien
HIV Center for Clinical and Behavioral Studies

Access: Private
Revised: December 2012
Released: March 2009

VIEW PROJECT

Masivukeni, which translates to 'Let's wake up!' in the Xhosa language, is a computer-supported curriculum designed to help patients in South Africa stay on their antiretroviral medication. Masivukeni provides lay counselors with an intervention roadmap and scripts that help them communicate to their patients the importance of adherence to treatment plans. In addition, the Masivukeni tool features interactive activities to help patients build their support network, develop problem-solving skills, visualize their pill regimen, and learn how HIV affects the body as viral resistance develops.

Masivukeni is a collaboration between Dr. Robert Remien, a research scientist at the HIV Center for Clinical and Behavioral Studies; researchers at the University of Cape Town; and CCNMTL. It was developed with assistance from counselors, nurses, and volunteers at the Hout Bay clinic outside of Cape Town, South Africa. The project is supported by a five-year, $3 million grant from the National Institute of Mental Health (NIMH) and builds on a 2007 NIMH grant that facilitated developing and piloting Masivukeni. Masivukeni is now being tested in a randomized control trial at two clinics outside Cape Town, South Africa.

Project Details

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.

In 2007 CCNMTL, Dr. Robert Remien, a research scientist at the HIV Center for Clinical and Behavioral Studies and associate professor of clinical psychology (in psychiatry), and researchers at the University of Cape Town (UCT) 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 allowed the program to extend its reach to South Africa, which has one of the highest rates of HIV in the world.

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, a metaphor which was developed with partners at the pilot clinic. Masivukeni also follows South Africa's 'buddy system' for new patients beginning antiretroviral treatment, in which a patient is asked to find a support partner who can attend counseling with the patient before the first drugs are dispensed. During the first session of Masivukeni, a counselor helps the patient identify appropriate supports in their social network and asks the patient to choose a partner to bring to the Masivukeni sessions.

After a successful pilot in 2009, CCNMTL, Dr. Remien and UCT received further funding from the NIMH to enhance Masivukeni based on pilot feedback and to conduct a randomized control trial at clinics around Cape Town. This trial is currently underway. Masivukeni also aims to enrich Columbia courses at the Mailman School of Public Health and other programs focused on health disparities. It is currently used in courses at the Mailman School of Public Health and at the Columbia University School of Social Work to give students a real example of evidence based practice and research at work in the field.