Date of Award


Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Gerald Friedland MD


ISSUES: The widening availability of antiretroviral therapy but dearth of medication taking experience among rural South Africans has raised concerns about adequate adherence to these medications. Interventions to improve adherence have been limited in development and evaluation and are often not culturally appropriate to patients in resource poor settings. It is hypothesized that a culturally-sensitive audio-visual patient education program may be of significant use in increasing patient understanding of concepts of resistance and medication taking skills, particularly in areas with low literacy rates. METHODS: After focus groups with health care providers and HIV-positive adherence counselors, a 15 minute educational video was created in which basic drug-taking concepts, as well as practical advice on how to improve adherence, were presented. After taking a 24-point Likert-style baseline survey of drug-taking knowledge, 34 HIV-positive patients (including 11 ARV naïve patients and 23 ARV experienced patients) were shown the completed educational video. Immediately post-video, they were given a second questionnaire to assess their knowledge. RESULTS: Overall, patients showed a statistically improvement in their baseline knowledge score, with an average improvement of 2.2 points out of 24 (p=0.028). ARV naïve patients had an average improvement of 3.0 points, with most significant gains in understanding of medication taking strategies and side effects. CONCLUSIONS: With the help of focus groups with providers and HIV positive individuals, complex information and concepts can be reduced to comprehensible and learnable messages using creative film techniques and culturally-specific metaphors. A key element of the videos success was the utilization of a three-pronged approach including 1) a mock doctor-patient encounter, 2) a narrative sketch (in which actors depict correct and incorrect medication taking procedures), and 3) a documentary portion including practical advice from adherence counselors. This video file Adherence to ARVs is hereby released for distribution for educational use with the following restrictions: 1. The video must be used exclusively for non-proprietary use in the non-profit sector (no money or services may be exchanged for the privilege of viewing the video) 2. The full list of credits must be included 3. Acknowledgement must be made of the copyright, belonging to Ilene Wong and Nick Lawrence 4. Acknowledgement must be made of the role of Yale University School of Medicine in the production of the video.

Adherence-to-ARVs.mpg (173752 kB)
See Abstract for details.