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The Effect of Motivational Interviewing-Based Counseling During Outpatient Provider Initiated HIV Testing on High-Risk Sexual Behavior in Rural Uganda

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Abstract

Provider-initiated HIV testing and counseling (PITC) has rapidly expanded in many countries including Uganda. However, because it provides HIV prevention information without individualized risk assessment and risk reduction counseling it may create missed opportunities for effective HIV prevention counseling. Our objective was to assess the effect of a brief motivational interviewing-based intervention during outpatient PITC in rural Uganda compared to Uganda’s standard-of-care PITC at reducing HIV transmission-relevant sexual risk behavior. We enrolled 333 (160 control, 173 intervention) participants in a historical control trial to test the intervention vs. standard-of-care. Participants received PITC and standard-of-care or the intervention counseling and we assessed sexual risk behavior at baseline and 3 and 6 months follow-up. The intervention condition showed 1.5–2.4 times greater decreases in high risk sexual behavior over time compared to standard-of-care (p = 0.015 and p = 0.004). These data suggest that motivational interviewing based counseling during PITC may be a promising intervention to reduce high-risk sexual behavior and potentially reduce risk of HIV infection.

Resumen

Los servicios de pruebas y asesoramiento del VIH iniciadas por proveedores de cuidado de salud (PITC) se han expandido rápidamente en muchos países, entre ellos Uganda. Sin embargo, debido a que se proporciona información sobre la prevención del VIH sin evaluación del riesgo individual o asesoramiento para reducir el riesgo, esto puede crear oportunidades perdidas para el asesoramiento eficaz de prevención del VIH. Nuestro objetivo fue evaluar el efecto de una breve intervención de entrevista motivacional durante PITC para pacientes ambulatorios en la zona rural de Uganda en comparación con el estándar de atención durante PITC en Uganda para reducir comportamientos sexuales de riesgo para la transmisión del VIH. Incluimos a 333 (160 en el grupo de control y 173 en el grupo de intervención) participantes en un ensayo de control histórico para poner a prueba la intervención vs. estándar de atención. Los participantes recibieron PITC y el estándar de atención o el asesoramiento de intervención y se evaluó el comportamiento sexual de riesgo al inicio del estudio, 3 y 6 meses de seguimiento. La condición de intervención mostró 1.5 a 2.4 veces mayores disminuciones en el comportamiento sexual de alto riesgo sobre el tiempo en comparación con el estándar de atención (p = 0.015 y p = 0.004). Estos datos sugieren que el asesoramiento basado en entrevista motivacional durante PITC puede ser una intervención prometedora para reducir el comportamiento sexual de alto riesgo y potencialmente reducir el riesgo de infección por el VIH.

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Acknowledgments

This research was supported by the National Institute of Mental Health (K01 MH083536). The authors thank Kenneth Mayer for input into the study design, Michael Stein for providing feedback on an earlier version of this manuscript, Katelyn Sileo for editorial assistance, Harriet Nantaba and Hajara Kagulire for assistance with data collection, Joeseph Jasperse and Kia Jayaratne for assistance with the day-to-day study management, Jane Ngamita, John Bosco Nduugutse, and Kagga Twaahah for their work as laboratory technicians/HIV counselors, Clovice Nyakatura for logistics assistance, and all of the Gombe Hospital staff for their support.

Funding

Supported by the National Institute of Mental Health (K01 MH083536).

Author information

Authors and Affiliations

  1. Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA

    Susan M. Kiene

  2. Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA

    Susan M. Kiene

  3. Department of Global Health, University of Washington, Seattle, WA, USA

    Moses H. Bateganya

  4. Gombe General Hospital, Gombe, Uganda

    Haruna Lule

  5. Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda

    Rhoda K. Wanyenze

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  1. Susan M. Kiene
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  2. Moses H. Bateganya
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  3. Haruna Lule
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  4. Rhoda K. Wanyenze
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Correspondence to Susan M. Kiene.

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Kiene, S.M., Bateganya, M.H., Lule, H. et al. The Effect of Motivational Interviewing-Based Counseling During Outpatient Provider Initiated HIV Testing on High-Risk Sexual Behavior in Rural Uganda. AIDS Behav 20, 1928–1936 (2016). https://doi.org/10.1007/s10461-016-1377-y

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