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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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23 July, 2014

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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

  • 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

  • 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

    • 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.


    Gombe


    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

    • 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

    Groups differed on employment


    Baseline Descriptive Statistics

    Groups were not significantly different at baseline.


    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


    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


    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?

    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

    • 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!


    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


    Extra Slides


    Changes in condom use


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