Although antiretroviral treatment (ART) is becoming more widely accessible in South Africa and other parts of the developing world, more than a decade of intensive research in the developed world has demonstrated that the availability of ART alone is not enough. Patients must also carefully adhere to often complex medication regimens or risk declines in their own health and the development of drug-resistant strains of HIV, which they can transmit to others. Yet with health systems already overtaxed, medical personnel in South Africa rarely have the time to provide intensive counseling about the importance of adhering to medication regimens or to help patients overcome specific barriers to adherence.

To help ensure that the roll-out and scale-up of ART programs in South Africa have optimal effect, HIV Center investigator Robert Remien, Ph.D., is leading a multimedia intervention study called Masivukeni to improve and sustain adherence in clinics in Cape Town. The multimedia dimensions of Masivukeni were developed in collaboration with the Columbia Center for New Media Teaching and Learning (CCNMTL), the University-based organization dedicated to enhancing teaching and learning through the purposeful use of new media and digital technologies.

“Through the use of technology, we can develop user-friendly and visually engaging tools to strengthen and enhance the delivery of adherence counseling by lay counselors,” noted Dr. Remien. “Through our partnerships with communities and in-country colleagues, we are also able to tailor graphics and language to particular settings and populations.”

Masivukeni draws upon Dr, Remien’s earlier SMART Couples intervention, which showed significant efficacy and demonstrated that a social support intervention (patient + support partner) resulted in higher levels of adherence to ART compared to standard of care. In New York, SMART Couples was led by nurse practitioners; however, in resource-constrained settings in the developing world, there are often far too few personnel with medical training relative to large patient populations. For this reason, Masivukeni employs computer-assisted multimedia technology to provide an interactive intervention that can be delivered by lay counselors who do not have extensive training.

Masivukeni, which loosely translates to "let's wake up" in the Xhosa language, assists 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, to enhance motivation, and to build problem solving and social support skills that patients can 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 and practices. A central component of Masivukeni is the Island Activity (pictured above), 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. Another image involves creating a tree with branches with the names of sources of social support (pictured at left) These images, and many others, were tailored in collaboration with the local populations in South Africa in order to make them culturally and linguistically appropriate.

In developing Masivukeni, Dr. Remien collaborated with HIV Center investigator Claude Ann Mellins, Ph.D., Elaine Abrams, M.D., of the Columbia Mailman School of Public Health, and colleagues at the Columbia University School of Social Work (CUSSW) including Susan Witte, Ph.D. and Nabila El-Bassel, Ph.D., while at CCNMTL, efforts were led by Frank Moretti, Ph.D., Ryan Kelsey, Ed.D., and Jessica Rowe. M.Des.

In the box below, you can view a demonstration of Masivukeni. If you have a problem accessing the demonstration on this page, you can watch it on YouTube by clicking here.

You can read more about about CCNMTL's work on Masivukeni by clicking here.