Community Views of Antiretroviral Therapy: Strengthening Stakeholder Information Systems in Southern Africa, 2007

In 2004, the Department of Health of South Africa’s Free State province began to provide ART to people infected with HIV. A special concern was that high value commodities would be available at the periphery of the health system and that system leakage could undermine th eprogramme. CIET implemented a baseline household survey just as the roll out of the ART programme was initiated.

Such were the precautions against system leakage that the emerging theme over the following years was access to ART. In order not to raise expectations it could not meet, the provincial government did not disseminate information about ART — essentially limiting the supply of ARVs to those nearest the ART centres. For the rest, ignorance and disinformation about ART provided a very unfavourable environment for rollout.

A communication campaign based on the findings of the baseline study was agreed with the Free State government (Click here to download a description of some of the materials prepared.). As it turned out, the government of Free State did not implement the planned communication campaign. CIET then examined testing their effectiveness in a randomised controlled trial in a selection of baseline survey sites.

Three different communication strategies were evaluated: 
– In three communities we invited community members involved in service provision related to HIV and AIDS to attend a community forum to discuss the results of the 2004 baseline study and formulate plans for a way forward. 
– In three communities we presented the audio drama to community groups and facilitated discussions around the content. 
– In three communities we combined the two above strategies by holding community forums and presenting Episode 9 of the BVV audio series. 
– A further 30 sites from the baseline provided a control group.

The 2007 follow-up household survey found an encouragingly high level of acceptance of ART in all the communities.The most effective of the three strategies was the combination of interventions, while the individual interventions on their own showed unimpressive improvements over the control communities. Significantly more people in the combined intervention communities had heard of ART and more of them knew the appropriate time of its use. More members of the combined intervention communities believed ART can help someone with AIDS and more said they would take ARTs if they needed them in future.

This project was supported by Canada’s International Development Research Centre (IDRC).