Using Intervention Mapping to Develop a Motivational Interviewing Training and Support Program for HIV Lay Counsellors to Improve ART Uptake in The Primary Health Care Setting in Gauteng, South Africa

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Abstract Background Worldwide, countries are striving to achieve universal antiretroviral treatment (ART) coverage. In South Africa, given the shortage of specialist health care professionals in the public sector, lay HIV counsellors are at the forefront of many HIV related behavioural interventions. They have limited formal counselling training and little ongoing in-service support, leading to considerable variability in skills, knowledge, and approaches to counselling. We aimed to use the Intervention Mapping approach to develop a motivational interviewing counselling training and support program for lay HIV counsellors practising in primary health care (PHC) clinics in Gauteng, South Africa. Methods We applied the steps of Intervention Mapping. This included the analysis of key informant data collected among clinic managers and counsellors (target group), in-depth literature reviews on determinants of critical elements of target behaviours and approaches for influencing these. Extensive consultations with an expert team led to two program objectives: 1) improved general HIV counselling skills among lay HIV counsellors; and 2) sustained motivational interviewing skills for ART and HIV care demand creation. Matrices of change objectives were produced specifying performance and change objectives as well as evidence and theory-based training methods to achieve these. Result We developed a motivational interviewing counselling training and support program titled “Thusa-Thuso - helping you help”. For objective one, we partnered with a seasoned psychologist and counselling trainers to recap and strengthen essential counselling skills and resilience. For objective two, we adapted the Boston University Brief Negotiated Interviewing motivational interviewing counselling training. Adaptations include adjusting the English readability level of training materials; translating materials to spoken Zulu and Sotho; anchoring the training around interactive sessions; producing contextually-relevant modelling videos, in-training role plays and on-site (clinic) mentoring using the Motivational Interviewing Treatment Integrity coding system (MITI) as a training and self-correction tool. The planned support component comprises of quarterly support and mentoring sessions over 12-months. Conclusion The “Thusa-Thuso” motivational interviewing counselling training and support program is a contextually relevant, locally-produced, scalable training and support program designed to impart sustained motivational interviewing counselling skills in lay HIV counsellors for improved ART uptake in the UTT era.

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