Mechanisms of Motivational Interviewing for Antiretroviral Medication Adherence in People with HIV
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ORIGINAL PAPER
Mechanisms of Motivational Interviewing for Antiretroviral Medication Adherence in People with HIV Ailbhe Hogan1 · Delwyn Catley2 · Kathy Goggin3,4 · Michael Evangeli1
© The Author(s) 2020
Abstract Antiretroviral therapy (ART) for HIV requires strict regimen adherence. Motivational interviewing (MI) can improve ART adherence. MI process studies have rarely focussed on ART adherence. Such studies may facilitate MI modifications to improve outcomes. This study employed a single group pre and post-test design with 62 adults with HIV (16 female; mean age 40 years). Therapist use of MI-consistent (MICO) methods, MI spirit, and client change and sustain talk were coded from an MI session. Relationships were assessed with ART schedule adherence. MICO methods positively correlated with change and sustain talk and were negatively associated with proportion of change talk. No variables were associated with ART adherence change. Mediation analysis did not support the MI model of change. This may be due to the fact that ART adherence is determined by both motivational and non-motivational factors. It may also be that bidirectional relationships exist between therapist and client speech. Keywords HIV · Antiretroviral · Adherence · Motivational interviewing · Mechanisms
Introduction Chronic conditions have long been recognised as the leading causes of death and disability worldwide [1]. Adherence to long-term medication for chronic illnesses, however, is only approximately 50% across conditions [2]. HIV is now considered a chronic condition due to the success of antiretroviral therapy (ART). ART guidelines recommend that all people diagnosed with HIV take ART regardless of CD4 count or viral load [3]. Dose adherence rates of less than 95% are associated with the risk of drug-resistance which can lead to the evolution of drug-resistant strains, progression of the disease, and an increased risk of onward transmission [4, 5]. Schedule adherence (percentage of doses taken on time) is * Michael Evangeli [email protected] 1
Department of Psychology, Royal Holloway, University of London, Egham, Surrey TW20 0EX, UK
2
Center for Children’s Healthy Lifestyles and Nutrition, Children’s Mercy Kansas City, Kansas City, MO, USA
3
Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, MO, USA
4
School of Medicine, University of Missouri − Kansas City, Kansas City, MO, USA
also important [6] to maintain a continuous coverage of ART within the blood to minimise the risk of developing drug resistance. Non-adherence can result in drug-resistant mutations of the virus being transmitted to uninfected people who are then newly infected with a drug-resistant strain of the virus and thus have less effective treatment options available to them [7]. Consequently, adherence to ART medication has public health implications and achieving viral suppression in those receiving ART is one of the goals set out by the UNAIDS – Lancet Commission in their plan to end the AIDS epidemic by 2030
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