Adaptation and delivery of a motivational interviewing-based counseling program for persons acutely infected with HIV in Malawi: Implementation and lessons learned

Grodensky, Catherine A.; Golin, Carol E.; Pack, Allison; Pettifor, Audrey; Demers, Michele; Massa, Cecelia; Kamanga, Gift; McKenna, Kevin; Corneli, Amy

doi:10.1016/j.pec.2018.02.004

Cited by 5 publications

(7 citation statements)

References 31 publications

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“…In addition, it was encouraging to observe the significant improvement in lay counsellors’ MI relational skills, particularly in “Empathy and Partnerships”, which are key components of MI counselling (23, 26). In our pilot study cohort, MI global ratings were higher than previous MI-based counselling interventions implemented in similar settings (32, 49–51). Although our sample size was smaller than other studies, most previous cohorts consisted of shorter training sessions with limited ongoing support.…”

Section: Discussioncontrasting

confidence: 63%

Improving patient-centred counselling skills among lay healthcare workers in South Africa using the Thusa-Thuso motivational interviewing training and support program

Mokhele,

Sineke,

Vujovic

et al. 2023

Preprint

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Background We developed a motivational Interviewing (MI) training and support program for lay counsellors in South Africa – branded "Thusa-Thuso - helping you help", commonly referred to as Thusa-Thuso. We present the results of a pilot study to determine the program's impact on MI technical skills and qualitatively assess the feasibility of a training-of-trainers (TOT) scale-up strategy among counselling staff of non-governmental (NGO) partners of the human immunodeficiency virus (HIV) treatment program in South Africa. Methods We enrolled adult (≥ 18 years) lay counsellors from ten primary healthcare clinics in Johannesburg (South Africa) selected to participate in the Thusa-Thuso training and support program. Counsellors attended the ten-day baseline and quarterly refresher training over 12 months (October 2018-October 2019). Each counsellor submitted two audio recordings of mock counselling sessions held during the ten-day baseline training and two additional recordings of sessions with consenting patients after each quarterly contact session. We reviewed the recordings using MI treatment integrity (MITI) coding to determine MI technical (cultivating change talk and softening sustain talk) and relational (empathy and partnership) competency scores before and after training. After 12 months of support with pilot site counsellors, we were asked to scale up the training to NGO partner team trainers in a once-off five-day Training of trainers (TOT) format (n = 127 trainees from November 2020 to January 2021). We report TOT training experiences from focus group discussions (n = 42) conducted six months after the TOT sessions. Results Of the 25 enrolled lay counsellors from participating facilities, 10 completed the 12-month Thusa-Thuso program. Attrition over the 12 months was caused by death (n = 3), site exclusion/resignations (n = 10), and absence (n = 2). MI competencies improved as follows: the technical skills score increased from a mean of 2.5 (standard deviation (SD): 0.8) to 3.1 (SD: 0.5), with a mean difference of 0.6 (95% confidence interval (CI): 0.04, 0.9). The MI relational skills score improved from a mean of 3.20 (SD: 0.7) to 3.5 (SD: 0.6), with a mean difference of 0.3 (95% CI: -0.3, 8.5). End-point qualitative data from the counsellors highlighted the value of identifying and addressing specific skill deficiencies and the importance of counsellors being able to self-monitor skill development using the MITI. Participants appreciated the ongoing support to clarify practical MI applications. The TOT program tools were valuable for ongoing on-the-job development and monitoring of quality counselling skills. However, the MITI review process was perceived to be too involved for large-scale application and was adapted into a scoring form to document sit-in mentoring sessions. Conclusion The Thusa-Thuso MI intervention can improve counsellor motivation and skills over time. In addition, the program can be scaled up using an adapted TOT process supplemented with fidelity assessment tools, which are valuable for skills development and ongoing maintenance. However, further studies are needed to determine the effect of the Thusa-Thuso program on patient ART adherence and retention in care.

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Section: Discussioncontrasting

confidence: 63%

Improving patient-centred counselling skills among lay healthcare workers in South Africa using the Thusa-Thuso motivational interviewing training and support program

Mokhele,

Sineke,

Vujovic

et al. 2023

Preprint

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“…Most of those who disclosed after the first day but within the first 1–2 weeks were randomized to the intervention arm of the study, which delivered a counseling session focused on partner disclosure at about 1 week after diagnosis that may have supported their disclosure. [ 9 ] Those who did not disclose within the first month were more likely to be men and in casual relationships, and to anticipate negative reactions from their partners. Additional support such as assisted partner notification may be needed for this type of patient to manage the interpersonal and logistical barriers to disclosure.…”

Section: Discussionmentioning

confidence: 99%

“…Details of the MP3 study have been described elsewhere; briefly, participants were randomly assigned into a standard of care, motivational interviewing (MI), or MI plus 12-week antiretroviral therapy group. [ 9 ] The MI sessions focused on topics including knowledge of AHI, the importance of safer sex and partner notification, and disclosure. [ 9 ] The Biomedical Institutional Review Board of the University of North Carolina at Chapel Hill and the National Health Sciences Research Committee of Malawi approved this study, and informed consent was obtained from all participants.…”

Section: Methodsmentioning

confidence: 99%

HIV status disclosure during acute HIV infection in Malawi

Hino

Grodensky

Rutstein³

et al. 2018

PLoS ONE

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Diagnosis of acute HIV infection (AHI) presents an opportunity to prevent HIV transmission during a highly infectious period. Disclosure is important during AHI as a means to facilitate safer sex practices and notify partners, particularly as those with AHI may be better able to identify the source of their infection because of the recency of HIV acquisition. However, little is known about disclosure during AHI. We conducted 40 semi-structured interviews with Malawians diagnosed with AHI (24 men; 21 married). Most participants reported disclosing to a sexual partner within a month of diagnosis, and knew or had a strong suspicion about the source of their infection. Participants often assumed their source had knowingly infected them, contributing to anger and feeling that disclosure is futile if the source already knew their HIV status. Assisted partner notification, individual and couples counseling, and couples HIV testing may facilitate disclosure during AHI.Clinical trial registration number: NCT01450189.

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“…Four studies recruited men who have sex with men (MSM), one recruited only women, and two recruited young people (16-26 years) (Table 1). Four articles were from the HPTN 062 study (Malawi) [17][18][19][20]; three were from the NIMH Acute HIV Infection Study (USA) [21][22][23].…”

Section: Characteristics Of Included Articlesmentioning

confidence: 99%

“…One article reported research informing the development of prevention strategies during AHI [32]; interventions were viewed favourably by participants and thought to be best initiated within a week of diagnosis [32]. Four articles reported results from HPTN 062, a motivational interviewing (MI) intervention study in Malawi [17][18][19][20]. MI starting on or soon after AHI diagnosis was reported to be feasible and acceptable [17].…”

Section: Interventions To Prevent Onward Transmissionmentioning

confidence: 99%

A systematic review of qualitative research on recently acquired HIV

Nicholls,

Policek,

Volny-Anne

et al. 2023

Aids

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Objective(s): Recently-acquired HIV is a critical time when people may experience debilitating symptoms and is when they are most likely to pass HIV on. Qualitative research offers insights into lived experiences and a deeper understanding of the contextual factors underlying HIV acquisition. We aimed to synthesize qualitative literature on recently-acquired HIV. Design: Systematic review and textual narrative synthesis. Methods: We searched MEDLINE, CINAHL Plus, PsycINFO and Sociology Database. Articles were screened, and two authors completed full text review and data extraction. Quality appraisal was conducted (Critical Appraisal Skills Programme Qualitative Studies Checklist) and certainty of findings graded (GRADE-CERQual). Results: We reviewed 1890 articles (1554 following de-duplication), excluding 1539. Fifteen articles were included and an additional article was included after updating the search. We identified 15 themes, three of which we have high confidence in: recent acquisition of HIV facilitates understanding of circumstances of HIV acquisition; indeterminate HIV tests generate uncertainty and anxiety; and people with recently-acquired HIV are motivated to reduce risk of onward transmission. Conclusions: Our findings highlight the importance of continued research into recently-acquired HIV, as well as the need for support to manage the emotional impact of indeterminate test results and negotiate risk reduction. We found no studies exploring sexual risk in the context of recently-acquired HIV, or use of PrEP or treatment as prevention. The literature is primarily focused on HIV acquisition from an individual and behavioral perspective, neglecting important aspects of lived experience such as immediate ART, stigma, and health and wellbeing.

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Adaptation and delivery of a motivational interviewing-based counseling program for persons acutely infected with HIV in Malawi: Implementation and lessons learned

Abstract: MI techniques of topic selection and goal setting may enhance prevention education and counseling for Malawians with AHI.

Cited by 5 publications

References 31 publications

Improving patient-centred counselling skills among lay healthcare workers in South Africa using the Thusa-Thuso motivational interviewing training and support program

Improving patient-centred counselling skills among lay healthcare workers in South Africa using the Thusa-Thuso motivational interviewing training and support program

HIV status disclosure during acute HIV infection in Malawi

A systematic review of qualitative research on recently acquired HIV

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