HealthCall: technology-based extension of motivational interviewing to reduce non-injection drug use in HIV primary care patients - a pilot study

Abstract

To reduce non-injection drug use (NIDU) among HIV primary care patients, more than a single brief intervention may be needed, but clinic resources are often too limited for extended interventions. To extend brief motivational interviewing (MI) to reduce NIDU, we designed and conducted a pilot study of "HealthCall," consisting of brief (1-3 minutes) daily patient calls reporting NIDU and health behaviors to a telephone-based interactive voice response (IVR) system, which provided data for subsequent personalized feedback. Urban HIV adult clinic patients reporting ≥4 days of NIDU in the previous month were randomized to two groups: MI-only (n=20) and MI+HealthCall (n=20). At 30 and 60 days, patients were assessed and briefly discussed their NIDU behaviors with their counselors. The outcome was the number of days patients used their primary drug in the prior 30 days. Medical marijuana issues precluded HealthCall with patients whose primary substance was marijuana (n=7); excluding these, 33 remained, of whom 28 patients (MI-only n=17; MI+HealthCall n=11) provided post-treatment data for analysis. Time significantly predicted reduction in "days used" in both groups (p<0.0001). At 60 days, between-group differences approached trend level, with an effect size of 0.62 favoring the MI+HealthCall arm. This pilot study suggests that HealthCall is feasible and acceptable to patients in resource-limited HIV primary care settings and can extend patient involvement in brief intervention with little additional staff time. A larger efficacy trial of HealthCall for NIDU-reduction in such settings is warranted.

Figure 1

Flow of study participants in study of HealthCall enhancement of Motivational Interviewing: New York City HIV primary care patients who were non-injection drug users

Figure 2

Sample patient feedback form: graph and summary statistics based on prior 30 days of IVR calls ^{1 1} Study of HealthCall enhancement of Motivational Interviewing: New York City HIV primary care patients who were non-injection drug users; data collected August 2008–February 2009; “primary amount” in figure legend refers to amount (in dollars) of use of primary substance reported on the call to HealthCall on each day that the patient called HealthCall.

Figure 3

Days used primary substance (log-transformed), by treatment group and time point: New York City HIV primary care patients who were non-injection drug users