23 July, 2014

1. 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

2. 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

3. 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.)

4. 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.

5. Gombe

6. 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

7. 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

8. Participants Groups differed on employment

9. Baseline Descriptive Statistics Groups were not significantly different at baseline.

10. 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

11. 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

12. 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

13. 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

14. 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!

15. 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: susankiene@gmail.com Acknowledgements

16. Extra Slides

17. Changes in condom use