[Implementation of therapeutic education programmes for patients living with HIV in four low-income countries: an evaluative approach]. / Implantation de programmes d'éducation thérapeutique de patients vivant avec le VIH dans quatre pays à ressources limitées. Approche évaluative.

This study focuses on the evaluation of conditions for implementation of therapeutic education (TE) programmes for patients living with HIV in seven health care structures located in four low and middle income countries (Morocco, Senegal, Congo and Cambodia). The objectives were the following: to identify how TE was integrated in health care practice within the various contexts, to assess the quality of educational process and to identify the contributing factors which favour the sustainability of TE programmes. The evaluation methodology is based on quality criteria and indicators for TE programmes. The evaluation demonstrates that TE is truly integrated in each structure that was assessed; however, levels of integration vary according to the contextual elements of care, the health care providers, and the level of institutional recognition and awareness regarding TE. At the time of the study, the sustainability of the TE programmes was enabled and ensured by the coordinators' support of the programme, management of the trained team of educators and by the progressive integration of TE within the national policies and regional health plans.

[Implementation and assessment of an HIV treatment training program (2000-2001) for patients in Casablanca (Morocco)]. / Mise en oeuvre et évaluation d'un programme d'éducation thérapeutique (2000-2001) pour les patients atteints du VIH à Casablanca (Maroc).

An educational program to improve the management of HIV patients was introduced in the department of infectious diseases of Ibn Rochd hospital, Casablanca, Morocco in January 2000. The project, funded by the GlaxoSmithKline Foundation, began by training ward physicians as well as volunteers from the ALLOCS (Association de lutte contre le sida) in pedagogy and patient education techniques (four-day course). Other sessions reviewed HIV management and treatment. Treatment training sessions were offered to all patients receiving antiretroviral treatment when the program began. All had been taking medication for at least two months and gave their informed consent to participation in the project. Each patient's sessions took place just after his or her medical consultation, in a room set aside for this purpose in the hospital. During the first session the educator established an educational diagnosis and defined educational objectives according to the individual patient's needs. Objectives were related to patients' knowledge about HIV transmission prevention and treatment management (including problem-solving for mild adverse events, delays, forgetting, vacations etc.). Trainers used several educational tools, including therapeutic planning (planning card with self-adhesive stickers showing the treatment medication); a folder of drawings depicting HIV transmission, prevention, and natural history, as well as the aims of antiretroviral therapy; decks of cards illustrating symptoms and psycho-sociological problems. Each patient had to attend at least 3 educational sessions. The program was evaluated at the end of one year. Patients' attendance, treatment adherence, laboratory test results (CD4 count, viral load), satisfaction about patient-staff relationships and knowledge about HIV disease and treatment were assessed on an on-going basis with various questionnaires and data collection systems. In all, 96 patients attended classes, with a mean of 14 sessions per patient per year. After 6 and 12 months of training, patients' CD4 cell counts increased, and the proportion with viral loads below the detection level rose, as did adherence scores. Patients' knowledge appeared to have improved at 6 months but regressed somewhat at 12 months. This may be explained by program timing: most educational sessions take place during the first 6 months of patient enrolment in the program. Patient satisfaction about the program and their care reveals that they acquired autonomy in managing their disease and treatment. Their satisfaction at 12 months, however, was lower than it was at 6 months. One explanation may be that more educated patients are more demanding, but another is the staff turnover in the program. New staff may have required more support and training than was then available. This pilot program allowed us to draft guidelines for setting up educational programs for HIV patients in relatively poor countries.