Initial Outcomes of a Brief Motivational Interviewing-Based Intervention During Provider-Initiated HIV Testing and Counseling in Rural Uganda Susan M. Kiene 1,2 Haruna Lule 3, Moses H. Bateganya 4, Harriet Nantaba 3, Rhoda K. Wanyenze 2 1 University of Connecticut School of Medicine, USA, 2 Makerere University School of Public Health, Uganda, 3 Gombe Hospital, Uganda, 4 CDC, Atlanta, USA Funded by NIMH, K01MH July, 2014

2 Background  Majority of those who are HIV positive are unaware of their status (WHO, 2013)  HIV testing and behavior change (e.g., Kamb et al., 1998; Marks et al., 2005)  Provider-initiated HIV testing  Counseling

3 Intervention  Information-Motivation-Behavior Skills model (Fisher & Fisher, 1992, 2000)  Motivational Interviewing (Miller & Rollnick, 1991)  Client-centered  Identify patient’s risk behaviors  Choose a behavior to change  Discuss barriers to change  Develop a risk reduction plan  Brief (<10 min.)

4 Hypothesis  MI-based client-centered counseling during provider-initiated HIV testing will be more effective than the standard-of-care counseling at reducing sexual risk behavior and related outcomes.

5 Gombe

6 Recruitment Baseline Interview Control n = 160Intervention n = and 6-month follow-up HIV test Standard-of-care counseling HIV test Client-centered motivational interviewing counseling Recruitment Baseline Interview

7 Measures  Number of sex events in prior 3-months with 3 most recent partners  Condom use  Partner type and knowledge of HIV status  Tested w/in prior 12 months  “Risky” sexual events

Participants 8 Control n=160Intervention n=173 % Female51.9%49.9% Average age33.5 (SD 9.5)33.6 (SD 10.4) Married87.5%86.1% Education Primary or < Secondary (O level) Adv. secondary (A level) and > 59.5% 28.1% 12.4% 67.6% 24.3% 8.1% Employment Never Once in a while Part of the year Throughout the year 12.5% 30.6% 15.0% 41.9% 10.4% 24.9% 28.3% 36.4% First time HIV testers16.9%17.4% Retained through 6mo FU90.2%91.4% Groups differed on employment

Baseline Descriptive Statistics 9 Control n=160Intervention n=173 HIV positive 10.6%8.7 % Knows all partner(s)’ HIV status 20.0%22.5% Sex events M 20.79, SD 14.59M 21.87, SD Risky sex events M 14.91, SD 14.33M 15.99, SD Percent of sex events that were risky 73.7%72.8% Groups were not significantly different at baseline.

Percentage knowing their partner(s)' HIV status 10 Controlling for sociodemographics and HIV results Time main effect: 3mo: χ , OR 3.19 CI ( ), p<0.001, 6mo: χ , OR 6.76 CI ( ), p<0.001 Time x Gender: 3mo: χ2 9.45, OR 0.44, CI ( ), p= mo: χ2 9.75, OR 0.39, CI ( ), p=0.002 GEE regression model, autoregressive correlation structure, binomial distribution, logit link

11 Time x study condition: 3mo: χ OR 0.85 CI ( ) p=0.65, 6mo: 6mo: χ OR 0.42 CI ( ) p=0.015 GEE regression model, autoregressive correlation structure, binomial distribution (events w/in trials), logit link

12 Time x study condition: 3mo: χ OR 0.90 CI ( ) p=0.56, 6mo: 6mo: χ OR 0.59 CI ( ) p=0.002 GEE regression model, autoregressive correlation structure, Poisson distribution, log link

How did risk decrease? 13 Controlling for knowledge of partner(s)’ status: Time x study condition: χ2 9.22, df =2, p=0.01 Time x study condition x knows partner status x gender: χ2 7.24, df=2, p=0.027 Risky sex events with serodiscordant vs. unknown status partners

14 Discussion and Conclusion  Women’s difficulty in getting their partners tested  Intervention effectiveness  For both HIV negative and HIV positive  Limitations  Study design  Follow-up  Self-report  Behavior change is possible!

15 Acknowledgements Participants Collaborators Rhoda Wanyenze Moses Bateganya Haruna Lule Funding NIMH, K01MH Research Assistants and Students Ruth Sessanga Harriet Nantaba Hajara Kagulire Farouk Kimbowa Ruth Namuleme Nalongo Kijje Kia Jayaratne Joe Jasperse Rebecca Stern Katy Sileo Contact:

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Changes in condom use 17