Motivational interviewing for improving outcomes in youth living with HIV

RHL summary

10 March 2014
HIV-positive adolescents sharing their experiences in a support group, Brazil
UNICEF/Claudio Versiani

Findings of the review: Motivational Interviewing is a communication strategy that helps patients self-motivate to make positive behaviour changes. First described in the 1990s for substance abuse counselling, it has since been proposed for changing other risky health behaviours as well. This review aimed to evaluate the effectiveness of motivational interviewing in improving outcomes in young people living with HIV. Two trials (237 participants) were included in this review. Both trials, of moderate quality, had compared motivational interviewing with standard care and had been conducted in the USA . Owing to insufficient reported data no meta-analysis could be done. Statistically significant reduction in viral load and reduction in unprotected intercourse were reported by both trials. One author described lower alcohol use in the intervention group. Neither of the studies reported on adherence to treatment, quality of life and mortality. However, these results must be viewed cautiously owing to limited data.

Implementation: This review suggests that motivational interviewing may help youth living with HIV to reduce short-term viral loads, unprotected intercourse and alcohol use.


Cochrane review

Citation: Mbuagbaw L, Ye C, Thabane L. Motivational interviewing for improving outcomes in youth living with HIV Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD009748. DOI: 10.1002/14651858.CD009748.pub2.

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.

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