Self-Assessment Questions (SAQs) for Study Session 23

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the questions below. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 23.1 (tests Learning Outcomes 23.1 and 23.4)

Explain what poor adherence to ART means, and why it results in drug resistance and poor health in PLHIV.


Poor adherence to ART means not taking drugs as prescribed by the health workers. It results in low levels of drugs in the blood so that multiplication of HIV is not completely suppressed, thereby inducing resistance to drugs. As a result of increased multiplication of the virus, CD4 lymphocytes will be destroyed, which results in various opportunistic infections that damage the patient’s health.

SAQ 23.2 (tests Learning Outcomes 23.2 and 23.6)

A female patient who is on ART comes to your health post and tells you that she takes her drugs in hiding from her family, as she does not want them to know about her HIV status. She says she has missed three tablets in the last two weeks, as she could not take them in front of her relatives. How can you help her?


One of the barriers of adherence is stigma and discrimination resulting from patients not disclosing their HIV status to people around them. In this patient’s case, counselling about disclosure is essential, and you should try to find someone in the family or the community who will support the patient in taking ART. Otherwise, refer the patient to the health centre for further support.

SAQ 23.3 (tests Learning Outcomes 23.3 and 23.5)

For the patient in SAQ 23.2, ART involves taking one tablet twice per day. Based on the total number of missed tablets in a month, calculate her adherence percentage. Is her adherence percentage optimal?


If she is taking two tablets per day, then a total of 28 doses are expected in 14 days. If she misses three tablets, then she has taken 25 out of 28 tablets. Therefore, her adherence level is 25 × 100/28 = 89%. Her adherence is not 100%; therefore you need to counsel her about strict adherence.

SAQ 23.4 (tests Learning Outcome 23.6)

Explain what it means to form a partnership between you, as the Health Extension Practitioner, and your patient in adherence counselling.


In adherence counselling, a partnership between the patient and the healthcare team is vital. It means you should treat your patients as an active agent of their own health. Your relationship with them shouldn’t be like a boss who tries to control their behaviour. An equal partnership greatly helps in building trust with your patients.

Summary of Study Session 23