Motivational Interviewing to Support Antiretroviral Therapy Adherence: The Role of Quality Counselin

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Motivational Interviewing to Support
Antiretroviral Therapy Adherence The Role of
Quality Counseling

• Angela D. Thrasher, MPH1,2 Research Assistant
• Carol E. Golin, MD1,2,3 Principal Investigator
• Jo Anne L. Earp, ScD1 Co-Principal Investigator
• Hsiao Tien, PhD4 Statistician
• Carol Porter, BS2 Data Manager
• Lynn Howie, MS2 Project Manager
• 1Dept. of Health Behavior Health Education
  2Cecil G. Sheps Center for Health Services
  Research 3Dept. of Medicine 4Dept. of
  Biostatistics
• University of North Carolina at Chapel Hill

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Antiretroviral Therapy (ART) Adherence

• Health benefits require near-perfect adherence1,
  which the majority of patients do not achieve.2,3
• Those with suboptimal adherence1
• Have greater morbidity
• Are more likely to experience treatment failure
  and
• May develop drug resistance.

1Guidelines, 2001 2Chesney et al, 2001 3Turner,
2002
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Motivational Interviewing as a Potential
Intervention Strategy

• A directive, client-centered counseling style
  for eliciting behavior change by helping clients
  to explore and resolve ambivalence.4
• Evolved from experience in treating problem
  drinkers
• Shown to be highly effective5
• Adapted to wide range of health behaviors6

4 Miller Rollnick, 1991 5Emmons et al,
2001 6Resnicow et al, 2001
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Motivational Interviewing

• Empirically-derived, but adapted to incorporate
  health behavior theories
• Enhances motivation and self-efficacy
• Counselor helps patients to
• Identify problems
• Recognize motivations and
• Develop solutions.

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The Role of Quality Counseling

• Although most MI interventions are successful,
  not all studies report significant results.
• One reason may be poor treatment fidelity or
  interviewer skill.7,8
• Motivational Interviewing Skill Code (MISC) is an
  instrument to assess MI quality.9
• Few studies report MI quality or investigate
  possible associations with patient behavior.

7Carroll et al, 2002 8Dunn et al, 2001 9Miller,
2003
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Study Aims

• To evaluate the quality of audiotaped MI sessions
• To explore the extent to which MI quality is
  associated with antiretroviral therapy adherence

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Methods

• Secondary data analysis of the Participating and
  Communicating Together Study
• Theory-based intervention to improve ART
  adherence
• HIV patients of tertiary care clinic
• MI sessions lasted 30 minutes

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Qualitative Analysis

• MISC 1.0
• Two passes
• Globally assessment of client-counselor
  interaction
• Count of specific, defined counselor behaviors
• 89 reliability
• Quality benchmarks adjusted down 0.5

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Quantitative Analysis

• Correlation (r) between MI quality measures and
  ART adherence

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Measures and Data Sources
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10Liu et al, 2001
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Participant Characteristics

• N 48
• 70 male
• 90 minority
• Mean age 40
• 65 less than high school education
• 67 less than 15,000 annual income
• Mean adherence at exit 85 (5-100)

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Global Assessment of Interviewers Skill
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Interviewer Behaviors
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() Desirable, (0) Neutral, (-) Undesirable
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Achievement of Quality Benchmarks
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Association with Antiretroviral Therapy Adherence

• All participants (n48)
• Facilitating comments (r.42, p.03)
• Paraphrases (r.35, p.07)
• Ratio of reflections to questions (r.32, p.07)
• Open-ended questions (r -.34, p.08)
• Chose medication-taking as topic (n23)
• Facilitating comments (r.41, p.06)
• Paraphrases (r.35, p.10)

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Summary

• Interviewers achieved most MI quality benchmarks.
• A few MI quality benchmarks may be associated
  with ART adherence.

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Limitations

• Small sample size
• Limited generalizability

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Strengths

• One of the few studies that explores and
  describes MI processes and variations in use.
• The first study to suggest that measures of MI
  quality may be related to antiretroviral therapy
  adherence.

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Implications for Research and Practice

• High quality MI can be conducted within a
  randomized control trial.
• Analysis using MISC was labor-intensive and may
  be too difficult for evaluation in practice.

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Acknowledgements

• Denise Ernst, Univ. of New Mexico
• Society for General Internal Medicine
• Agency for Healthcare Research and Quality/Cecil
  G. Sheps Center for Health Services Research
  (Training grant T32 HS00032)

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