Preliminary data revealed motivational interviewing (MI) delivered by physicians may increase the rate of antiretroviral therapy (ART) adherence among patients disengaged from HIV care. These findings were published in The Lancet Regional Health Americas.
Motivational interviewing (MI) is a physician-delivered evidence-based intervention designed to help patients with their motivation for treatment adherence. Researchers compared the effects of MI with enhanced standard of care, comprising online training on HIV treatment updates, adherence, and retention. The primary outcomes were ART adherence, HIV virologic suppression, and retention in care. (Clinicaltrials.gov, NCT02846350).
Overall, 360 patients enrolled at 6 regional clinics in Argentina were randomly assigned to receive MI or enhanced standard of care. Assessments of ART adherence, HIV RNA viral load, CD4+ cell count, and retention, were made at baseline, 6, 12, 18 and 24 months.
Among patients in the MI (n=180) and standard care (n=180) groups was 40.3 and 37.9 years, and 42% and 60% were women, respectively. Overall, 56% of the patients were employed and 65% had completed high school.
A longitudinal mixed models analysis showed that MI had no significant direct effect on the mean rate of ART adherence compared with standard care (P =.07). However, a significant indirect effect was observed among patients in the MI group in which increased satisfaction with the patient-provider relationship was associated with an increase in the mean rate of ART adherence. There also was a significant indirect effect between MI and HIV viral load (P =.027), indicating that increased patient-provider satisfaction was associated with a decrease in HIV viral load count.
No significant direct or indirect effects were observed in regard to retention among patients in the MI group.
This study was limited by its small sample size and its inclusion of only patients with detectable HIV viral loads. In addition, enrollment may have encouraged ART adherence among the patients.
According to the researchers, “continued research on re-engagement and retention of [patients with HIV infection] disengaged from HIV care is essential.”
Sued O, Cecchini D, José Rolón M, et al. A small cluster randomised clinical trial to improve health outcomes among Argentine patients disengaged from HIV care. Lancet Reg Health Am. Published online June 23, 2022. doi:10.1016/j.lana.2022.100307