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Initial Outcomes of a Brief Motivational Interviewing-Based Intervention During
Provider-Initiated HIV Testing and Counseling in Rural Uganda
Susan M. Kiene1,2 Haruna Lule3, Moses H. Bateganya4, Harriet
Nantaba3, Rhoda K. Wanyenze2
1 University of Connecticut School of Medicine, USA, 2 Makerere University School of Public Health, Uganda, 3 Gombe Hospital, Uganda,
4 CDC, Atlanta, USA
Funded by NIMH, K01MH083536
23 July, 2014
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Background
Majority of those who are HIV positive are unaware of their status (WHO, 2013)
HIV testing and behavior change (e.g., Kamb et al., 1998; Marks et al., 2005)
Provider-initiated HIV testing Counseling
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Intervention
Information-Motivation-Behavior Skills model (Fisher & Fisher, 1992, 2000)
Motivational Interviewing (Miller & Rollnick, 1991) Client-centered Identify patient’s risk behaviors Choose a behavior to change Discuss barriers to change Develop a risk reduction plan
Brief (<10 min.)
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Hypothesis
MI-based client-centered counseling during provider-initiated HIV testing will be more effective than the standard-of-care counseling at reducing sexual risk behavior and related outcomes.
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Gombe
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RecruitmentBaseline Interview
Control n = 160 Intervention n = 173
3 and 6-month follow-up
HIV testStandard-of-care counseling
HIV testClient-centered
motivational interviewing counseling
RecruitmentBaseline Interview
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Measures Number of sex events in prior 3-months with 3
most recent partners Condom use Partner type and knowledge of HIV status
Tested w/in prior 12 months “Risky” sexual events
Participants
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Control n=160 Intervention n=173
% Female 51.9% 49.9%
Average age 33.5 (SD 9.5) 33.6 (SD 10.4)
Married 87.5% 86.1%
Education• Primary or <• Secondary (O level)• Adv. secondary (A level) and >
59.5%28.1%12.4%
67.6%24.3%8.1%
Employment• Never• Once in a while• Part of the year• Throughout the year
12.5%30.6%15.0%41.9%
10.4%24.9%28.3%36.4%
First time HIV testers 16.9% 17.4%
Retained through 6mo FU 90.2% 91.4%
Groups differed on employment
Baseline Descriptive Statistics
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Control n=160 Intervention n=173
HIV positive 10.6% 8.7 %
Knows all partner(s)’ HIV status
20.0% 22.5%
Sex events M 20.79, SD 14.59 M 21.87, SD 17.56
Risky sex events M 14.91, SD 14.33 M 15.99, SD 16.41
Percent of sex events that were risky
73.7% 72.8%
Groups were not significantly different at baseline.
Percentage knowing their partner(s)' HIV status
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Controlling for sociodemographics and HIV results
Time main effect: 3mo: χ2 20.09, OR 3.19 CI (1.92-5.26), p<0.001, 6mo: χ2 43.13, OR 6.76 CI (3.82-11.95),
p<0.001Time x Gender: 3mo: χ2 9.45, OR 0.44, CI (0.26-0.74), p=0.002
6mo: χ2 9.75, OR 0.39, CI (0.22-0.71), p=0.002
GEE regression model, autoregressive correlation structure, binomial distribution, logit link
11Time x study condition: 3mo: χ2 0.20 OR 0.85 CI (0.41-1.74) p=0.65, 6mo: 6mo: χ2 5.87 OR 0.42 CI (0.21-0.85) p=0.015GEE regression model, autoregressive correlation structure, binomial distribution (events w/in trials), logit link
12Time x study condition: 3mo: χ2 0.34 OR 0.90 CI (0.64-1.27) p=0.56, 6mo: 6mo: χ2 9.16 OR 0.59 CI (0.41-0.83) p=0.002GEE regression model, autoregressive correlation structure, Poisson distribution, log link
How did risk decrease?
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Controlling for knowledge of partner(s)’ status: Time x study condition: χ2 9.22, df =2, p=0.01Time x study condition x knows partner status x gender: χ2 7.24, df=2, p=0.027
Risky sex events with serodiscordant vs. unknown status partners
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Discussion and Conclusion
Women’s difficulty in getting their partners tested Intervention effectiveness
For both HIV negative and HIV positive Limitations
Study design Follow-up Self-report
Behavior change is possible!
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AcknowledgementsParticipants
CollaboratorsRhoda WanyenzeMoses BateganyaHaruna Lule
FundingNIMH, K01MH083536
Research Assistants and StudentsRuth SessangaHarriet NantabaHajara Kagulire Farouk KimbowaRuth NamulemeNalongo KijjeKia JayaratneJoe JasperseRebecca SternKaty Sileo
Contact: [email protected]
Extra Slides
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Changes in condom use
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