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Meta-Analysis
. 2012 Sep 12;2012(9):CD009748.
doi: 10.1002/14651858.CD009748.pub2.

Motivational interviewing for improving outcomes in youth living with HIV

Lawrence Mbuagbaw  1 , Chenglin Ye, Lehana Thabane
Affiliations
Meta-Analysis

Motivational interviewing for improving outcomes in youth living with HIV

Lawrence Mbuagbaw et al. Cochrane Database Syst Rev. .

Abstract

Background: Almost half of all the new HIV infections occur in youth. Motivational interviewing (MI) is a counselling technique that is effective in bringing about positive behavior changes in the general population. It is unclear whether it can be used to improve outcomes in youth living with HIV.

Objectives: To determine whether MI is effective in improving outcomes in youth living with HIV.

Search methods: We used a comprehensive and exhaustive strategy in an attempt to identify all relevant studies, regardless of language or publication status, in electronic databases (PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, LILACS, CINAHL, PsycINFO), conference proceedings and specialised databases from January 1980 to March 2012.

Selection criteria: Randomised controlled trials (RCTs) in which youth (aged 10 to 24) living with HIV received MI, singly or in combination with another intervention compared to any other intervention, and reporting on the outcomes of interest (adherence to medication, mortality, quality of life, viral load, CD4-positive-T-lymphocyte count, progression to AIDS, retention in care, substance abuse and condom use). All settings were considered.

Data collection and analysis: We identified 863 references.Two authors independently examined the titles and abstracts of all identified trials, of which 28 full-text articles were closely screened for eligibility based on criteria established a-priori. The included studies were appraised for quality in duplicate. Data were extracted using a pre-tested and standardised form. No meta-analyses were performed.

Main results: Two trials located in the United States, reported in four papers met our inclusion criteria. They enrolled a total of 237 participants and compared motivational interviewing singly to standard of care. None of these trials reported on adherence to HIV medication, mortality or quality of life. Both trials reported reductions in viral load (in the short term) and unprotected sexual acts. A reduction in alcohol use was identified only in one of two studies that reported on this outcome. One trial reported on retention. Retention rates were not affected by the intervention.

Authors' conclusions: There is moderate quality evidence, coming from two trials which suggests that MI is effective in reducing short term viral load and unprotected sexual acts. There is moderate quality evidence from one trial that MI is effective in reducing alcohol use. There is a need for more trials which report on outcomes such as adherence to medication, mortality and quality of life in youth.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Study flow diagram.
1.1
1.1. Analysis
Comparison 1 Motivational interviewing versus control, Outcome 1 Log 10 viral load at 3 months.
1.2
1.2. Analysis
Comparison 1 Motivational interviewing versus control, Outcome 2 Log 10 Viral load at 6 months.
1.3
1.3. Analysis
Comparison 1 Motivational interviewing versus control, Outcome 3 Log 10 Viral load at 9 months.
1.4
1.4. Analysis
Comparison 1 Motivational interviewing versus control, Outcome 4 Marijuana use.
1.5
1.5. Analysis
Comparison 1 Motivational interviewing versus control, Outcome 5 Alcohol abuse.
1.6
1.6. Analysis
Comparison 1 Motivational interviewing versus control, Outcome 6 Retention in care.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD009748

References

References to studies included in this review

Healthy Choices 2009 {published data only}
    1. Chen X, Murphy DA, Naar‐King S, Parsons JT. A clinic‐based motivational intervention improves condom use among subgroups of youth living with HIV. The Journal of adolescent health : official publication of the Society for Adolescent Medicine 2011;49(2):193‐8. [PUBMED: 21783053] - PMC - PubMed
    1. Murphy DA, Chen X, Naar‐King S, Parsons JT. Alcohol and marijuana use outcomes in the healthy choices motivational interviewing intervention for HIV‐positive youth. AIDS patient care and STDs 2012;26(2):95‐100. [PUBMED: 22191456] - PMC - PubMed
    1. Naar‐King S, Parsons JT, Murphy DA, Chen X, Harris DR, Belzer ME. Improving health outcomes for youth living with the human immunodeficiency virus: a multisite randomized trial of a motivational intervention targeting multiple risk behaviors. Archives of pediatrics & adolescent medicine 2009;163(12):1092‐8. [PUBMED: 19996045] - PMC - PubMed
Naar‐King 2006 {published data only}
    1. Naar‐King S, Wright K, Parsons JT, Frey M, Templin T, Lam P, et al. Healthy choices: motivational enhancement therapy for health risk behaviors in HIV‐positive youth. AIDS education and prevention : official publication of the International Society for AIDS Education 2006;18(1):1‐11. [PUBMED: 16539572] - PubMed

References to studies excluded from this review

Holstad 2011 {published data only}
    1. Holstad MM, DiIorio C, Kelley ME, Resnicow K, Sharma S. Group motivational interviewing to promote adherence to antiretroviral medications and risk reduction behaviors in HIV infected women. AIDS and behavior 2011;15(5):885‐96. [PUBMED: 21165692] - PMC - PubMed
Jacobs 2010 {published data only}
    1. Jacobs RJ, Fernandez MI, Bowen GS. Development of an internet‐based intervention using motivational interviewing culturally tailored for young Hispanic MSM. AIDS 2010 ‐ XVIII International AIDS Conference. 2010; Vol. Abstract no. WEPE0402 .
Krummenacher 2011 {published data only}
    1. Krummenacher I, Cavassini M, Bugnon O, Schneider MP. An interdisciplinary HIV‐adherence program combining motivational interviewing and electronic antiretroviral drug monitoring. AIDS care 2011;23(5):550‐61. [PUBMED: 21271406] - PubMed
Merlo 2010 {published data only}
    1. Merlo LJ, Naar‐King S, Green‐Jones M. Computer‐based motivational intervention promotes condom use among urban youth with HIV. Comprehensive psychiatry 2010;51(6):e7.
Naar‐King 2007 {published data only}
    1. Naar‐King Sylvie, Lam Phebe, Wright Kathryn. 49: Recruitment and retention in healthy choices: A motivational intervention (MI) for HIV+ youth. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Elsevier,, 2007; Vol. 40, issue 2:S40‐. - PMC - PubMed
Naar‐King 2008 {published data only}
    1. Naar‐King S, Lam P, Wang B, Wright K, Parsons JT, Frey MA. Brief report: maintenance of effects of motivational enhancement therapy to improve risk behaviors and HIV‐related Health in a randomized controlled trial of youth living with HIV. Journal of pediatric psychology 2008;33(4):441‐5. [PUBMED: 17905800] - PubMed
Naar‐King 2009a {published data only}
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Naar‐King 2010 {published data only}
    1. Naar‐King S, Parsons JT, Murphy D, Kolmodin K, Harris DR. A multisite randomized trial of a motivational intervention targeting multiple risks in youth living with HIV: initial effects on motivation, self‐efficacy, and depression. The Journal of adolescent health : official publication of the Society for Adolescent Medicine 2010;46(5):422‐8. [PUBMED: 20413077] - PMC - PubMed
Outlaw 2010 {published data only}
    1. Outlaw AY, Naar‐King S, Parsons JT, Green‐Jones M, Janisse H, Secord E. Using motivational interviewing in HIV field outreach with young African American men who have sex with men: a randomized clinical trial. American journal of public health 2010;100 Suppl 1:S146‐51. [PUBMED: 20147689] - PMC - PubMed
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Samet 2005 {published data only}
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Velasquez 2009 {published data only}
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References to studies awaiting assessment

DiIorio 2008 {published data only}
    1. DiIorio C, McCarty F, Resnicow K, McDonnell Holstad M, Soet J, Yeager K, et al. Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study. AIDS care 2008;20(3):273‐83. [PUBMED: 18351473] - PMC - PubMed
Goggin 2010 {published data only}
    1. Goggin K, Gerkovich M, Williams K, Banderas J, Catley D, Berkley‐Patton J, Bradley‐Ewing A, Thomson N, Carruth T, Kakolewski K, Martinez D, Liston R, Pinkston‐Camp M, Clark K, Stanford J, Neville S, Kumar V, Bamberger D, Clough L. Outcomes of Project MOTIV8: A RCTof Novel Behavioral Interventions for ARTAdherence. 5th International Conference on HIV TREATMENT ADHERENCE. Journal of the International Association of Physicians in AIDS Care (JIAPAC) July;9(4):240‐67 (Abstract 62097).
Golin 2006 {published data only}
    1. Golin CE, Earp J, Tien HC, Stewart P, Porter C, Howie L. A 2‐arm, randomized, controlled trial of a motivational interviewing‐based intervention to improve adherence to antiretroviral therapy (ART) among patients failing or initiating ART. Journal of acquired immune deficiency syndromes (1999) 2006;42(1):42‐51. [PUBMED: 16763491] - PMC - PubMed
Golin 2011 {published data only}
    1. Golin CE, Earp JA, Grodensky CA, Patel SN, Suchindran C, Parikh M, et al. Longitudinal Effects of SafeTalk, a Motivational Interviewing‐Based Program to Improve Safer Sex Practices Among People Living with HIV/AIDS. AIDS and behavior 2011;16(5):1182‐1191. [PUBMED: 21964975] - PMC - PubMed
Ingersoll 2011 {published data only}
    1. Ingersoll KS, Farrell‐Carnahan L, Cohen‐Filipic J, Heckman CJ, Ceperich SD, Hettema J, et al. A pilot randomized clinical trial of two medication adherence and drug use interventions for HIV+ crack cocaine users. Drug and alcohol dependence 2011;116(1‐3):177‐87. [PUBMED: 21306837] - PMC - PubMed
Parsons 2007 {published data only}
    1. Parsons JT, Golub SA, Rosof E, Holder C. Motivational interviewing and cognitive‐behavioral intervention to improve HIV medication adherence among hazardous drinkers: a randomized controlled trial. Journal of acquired immune deficiency syndromes (1999) 2007;46(4):443‐50. [PUBMED: 18077833] - PMC - PubMed
van Loggerenberg 2010 {published data only}
    1. Loggerenberg F, Grant A, Naidoo K, Murrman M, GengiahS, Gengiah T, Karim SA. Group Counseling Achieves High Adherence to Antiretroviral Therapy: Resultsof the CAPRISA 058 Randomized Controlled Trial Comparing Group Versus Individualized Adherence Counseling Strategies in Durban,South Africa. 5th International Conference on HIV TREATMENT ADHERENCE. Journal of the International Association of Physicians in AIDS Care (JIAPAC) July;9(4):240‐67 (Abstract 62157).

References to ongoing studies

NCT00218634 {published data only}
    1. Skills Based Counseling for Adherence and Depression in HIV+ Methadone Patients ‐ 1. Ongoing study February 2005.
NCT00794391 {published data only}
    1. Effects of Motivational Interviewing on Risky Injecting Practices Among Injecting Drug Users (IDUs). Ongoing study November 2008.
NCT01122186 {published data only}
    1. Intervention Targeting Medication Adherence and Methamphetamine Use in HIV Positive Men (ACE). Ongoing study September 2007.
NCT01347437 {published data only}
    1. Improving Antiretroviral Medication Adherence Among HIV‐infected Youth. Ongoing study July 2011.
NCT01554423 {published data only}
    1. Four‐Arm Randomized Control Trial of Brief MI Versus Couples‐Based HIV/STI Prevention in South Africa (SA R01). Ongoing study July 2010.

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