Does the quality of safetalk motivational interviewing counseling predict sexual behavior outcomes among people living with HIV?

Abstract

Objective Although past research has demonstrated a link between the quality of motivational interviewing (MI) counseling and client behavior change, this relationship has not been examined in the context of sexual risk behavior among people living with HIV/AIDS. We studied MI quality and unprotected anal/vaginal intercourse (UAVI) in the context of SafeTalk, an evidence-based secondary HIV prevention intervention. Methods We used a structured instrument (the MISC 2.0 coding system) as well as a client-reported instrument to rate intervention sessions on aspects of MI quality. Then we correlated client-reported UAVI with specific counseling behaviors and the proportion of interactions that achieved MI quality benchmarks. Results/Conclusion Higher MISC-2.0 global ratings and a higher ratio of reflections to questions both significantly predicted fewer UAVI acts at 8-month follow-up. Analysis of client ratings, which was more exploratory, showed that clients who rated their sessions higher in counselor acceptance, client disclosure, and relevance reported higher numbers of UAVIs, whereas clients who selected higher ratings for perceived benefit were more likely to have fewer UAVI episodes. Practice Implications Further research is needed to determine the best methods of translating information about MI quality into dissemination of effective MI interventions with people living with HIV.

Mechanisms of Motivational Interviewing for Antiretroviral Medication Adherence in People with HIV

“…There was no evidence found in support of the relational pathway of MI within the context of improving ART adherence levels; namely change talk (or sustain talk) was not found to mediate the relationship between MI spirit and ART adherence. This result is consistent with findings reported in a meta-analysis [25], although an association between MI spirit and fewer instances of unprotected anal/vaginal intercourse has been reported in people with HIV [27]. Baseline rates were not controlled for in this study, however.…”

“…Pre-session MI adherence levels were measured and were used in the mediational models as either a covariate or to create a difference score. The sample size was larger than other published MI process research studies within the context of HIV-related behaviour change [26,27]. The sample size was also large enough to make it unlikely that null findings (often associated with small effects) were due to a lack of statistical power.…”

“…Client language -a key aspect of the MI model -and the influence of pre-MI session adherence data was not considered in the analysis. A second study examined if the quality of MI was related to risky sexual behaviour [27]. Participants (n = 32) were mostly male (52%), non-white (84%), with a mean age of 42 years.…”

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

“…Previous research suggests that MI quality is often a significant predictor of behavior change; in the SafeTalk intervention, participants whose counselors received higher MI quality ratings were less likely to report unprotected sex at 8-month follow-up. [36] In the sub-Saharan African setting, Evangeli et al found that counselors trained for 12 hours in MI for a range of HIV-related health behaviors reported high levels of confidence in providing MI, but had not achieved beginning proficiency by the end of the training[27] or one year later. [28] The importance of MI quality and the number of counselors failing to achieve proficiency in Evangeli's studies suggest that further research is needed on the ability of counselors to achieve MI proficiency in sub-Saharan African settings.…”

Is fidelity to motivational interviewing associated with alcohol outcomes in treatment-seeking 60+ year-old citizens?

“…If MI works as hypothesized, by conveying a relational and technical component (Miller and Rose, 2009), there should be clear associations between the fidelity of these elements and client outcomes. Although MI therapist behaviors are commonly linked to outcomes in studies of MI (Borsari et al, 2015;Gaume et al, 2014;Gaume, Heather, Tober, and McCambridge, 2018;Grodensky et al, 2017), meta-analyses of this hypothesized association have not detected direct associations between MI elements and outcome (Magill et al, 2018;Pace et al, 2017). Indications were found, T however, for indirect pathways of associations between MI-elements and outcome; that is, through measures of client change talk or client sustain talk leading to change outcomes.…”