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[ Recorded presentation ] Recorded presentation

Improving Antiretroviral Adherence through Motivational Interviewing: The Role of Quality Counseling

Angela D. Thrasher, MPH, School of Public Health, Dept. of Health Behavior & Health Education, University of North Carolina, CB#7440, Rosenau Hall, Chapel Hill, NC 27599-7440, 919-968-9960, angela_thrasher@unc.edu, Carol Golin, MD, Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, and Jo Anne L. Earp, ScD, Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill, CB #7440, Chapel Hill, NC 27599.

BACKGROUND: Although research explicitly linking motivational interviewing (MI) to behavior change exists, few studies report on MIís quality or examine how quality influences effectiveness. We studied the relationship between MI quality and adherence to antiretroviral therapy (ART) in the context of a randomized, controlled trial of an MI-based intervention with HIV-infected patients failing their current regimen. METHODS: We evaluated the quality of professionally-transcribed audiotaped MI sessions using a standardized coding scheme to measure the proportion of interactions that achieved established performance benchmarks. We assessed ART adherence using electronic bottle cap monitor and pill count data at 4, 8, and 12 weeks follow-up. We then correlated ART adherence with specific MI counseling behaviors. RESULTS: The sample (n=48) was predominantly male (70%) and minority (90%), with an average age of 40 years and an average adherence level at exit of 85% (range: 5-100%). On 4 of 5 performance benchmarks, the majority of MI sessions achieved the targeted quality level: 67% for global therapist rating; 88% for reflections to questions ratio; 33% percent for using open-ended questions; 96% percent for complex reflections; 100% for MI-consistent statements. Interviewer behaviors associated with ART adherence were: number of facilitative comments (r=.42, p=.026), number of paraphrases (r=.35, p=.069), number of open-ended questions (r=.34, p=.077), and ratio of reflections to questions (r=.32, p=.097). CONCLUSIONS: High quality MI can be conducted within the structure of a randomized, controlled trial and is associated with effectiveness. Further studies should clarify which specific counseling behaviors are most closely associated with behavioral change.

Learning Objectives: At the end of the session, the participant will be able to

Keywords: Adherence, Antiretroviral Combination Therapy

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

[ Recorded presentation ] Recorded presentation

HIV/AIDS Treatment Adherence

The 132nd Annual Meeting (November 6-10, 2004) of APHA