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Initial Outcomes of a Brief Motivational Interviewing-Based Intervention During Provider-Initiated HIV Testing and Counseling in Rural Uganda.

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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

background
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
intervention
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.)
hypothesis
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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Control n = 160

Intervention n = 173

Recruitment

Baseline Interview

Recruitment

Baseline Interview

HIV test

Standard-of-care counseling

HIV test

Client-centered

motivational interviewing counseling

3 and 6-month follow-up

measures
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
Participants

Groups differed on employment

baseline descriptive statistics
Baseline Descriptive Statistics

Groups were not significantly different at baseline.

percentage knowing their partner s hiv status
Percentage knowing their partner(s)\' HIV status

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<0.001

Time 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

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Time 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=0.015

GEE regression model, autoregressive correlation structure, binomial distribution (events w/in trials), logit link

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Time 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=0.002

GEE regression model, autoregressive correlation structure, Poisson distribution, log link

how did risk decrease
How did risk decrease?

Risky sex events with serodiscordant vs. unknown status partners

Controlling for knowledge of partner(s)’ status: Time x study condition: χ2 9.22, df =2, p=0.01

Time x study condition x knows partner status x gender: χ2 7.24, df=2, p=0.027

discussion and conclusion
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!
acknowledgements
Participants

Collaborators

Rhoda Wanyenze

Moses Bateganya

Haruna Lule

Funding

NIMH, K01MH083536

Research Assistants and Students

Ruth Sessanga

Harriet Nantaba

Hajara Kagulire

Farouk Kimbowa

Ruth Namuleme

Nalongo Kijje

Kia Jayaratne

Joe Jasperse

Rebecca Stern

Katy Sileo

Contact: [email protected]

Acknowledgements
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