Effectiveness of Motivational Interviewing on HIV risk behaviors among men who have sex with men: A systematic review of the best available evidence
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Effectiveness of Motivational Interviewing on HIV risk behaviors among men who have sex with men: A systematic review of the best available evidence

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Effectiveness of Motivational Interviewing on HIV risk behaviors among men who have sex with men: A systematic review of the best available evidence Presentation Transcript

  • 1. Effectiveness of Motivational Interviewing on HIV risk behaviors among men who have sex withKunnskapsesenterets of the men: A systematic review bestnye PPT-mal available evidence Rigmor C Berg, Ph.D., CHES Michael W. Ross, Ph.D.; Ronny Tikkanen, Ph.D.
  • 2. I - BACKGROUND MSM 53% of all new HIV infections in U.S. (CDC, 2010) MSM most affected by HIV in EU/EEA (van de Laar et al., 2009) UAI principal risk behavior for HIV among MSM (CDC, 2010) UAI often in conjunction with alcohol, drugs (AOD) (e.g. Folch et al., 2010; Hirshfield et al., 2004; Stall et al., 2001) Meta-analysis: 87% increased risk of HIV (RR 1.87) when consuming alcohol prior to/the time of sexual relations (Baliunas et al., 2010) Syndemic condition of HIV and AOD use among MSM create behavioral health service challengesSeptember 15, 2011 2
  • 3. I - BACKGROUND Motivational Interviewing (MI) = "directive, client-centred counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence" (Miller and Rollnick, 2002 p25) 5 key techniques: ♦ expressing empathy ♦ developing discrepancy ♦ avoiding argumentation ♦ rolling with resistance ♦ supporting self-efficacy (Miller and Rollnick, 1991) Variable effectiveness of MI across populations, target problems, and settings (e.g. Lai et al., 2010; Lundahl et al., 2010; Smedslund et al., 2011)September 15, 2011 3
  • 4. II - OBJECTIVE Conduct a systematic review of the effectiveness of behavioral interventions adapting the principles and techniques of MI on HIV-risk behaviors for MSMSeptember 15, 2011 4
  • 5. III - METHODS Systematic review (transparent, reproducible) Search: 9 e-databases, Google Scholar, motivationalinterview.net, Motivational Interviewing Newsletter / MINT Bulletin, literature lists of 14 MI reviews, literature lists of included studies, experts Independent and paired screening, appraisal of methodological quality, data extraction Data analysis: – relative risk (RR) – mean difference (MD) – meta-analysis (pooled)September 15, 2011 5
  • 6. IV - RESULTS: 10 included studies 10 RCTs (1 cluster RCT) 6051 MSM (9 RCTs from U.S., 1 C-RCT from Netherlands), in reports published 2001-2010 Methodological quality: Adequate sequence generation? Allocation concealment? Blinding? Incomplete outcome data addressed? Free of selective reporting? Free of other bias? 0% 25% 50% 75% 100% Yes (low risk of bias) Unclear No (high risk of bias)15. september 2011 6
  • 7. IV - RESULTS (1) 114 effect estimates from 32 unique outcomes were extracted from the studies  10 were statistically significant at study levelSeptember 15, 2011 7
  • 8. IV - RESULTS (2) 1 study (Explore, 2004) biological endpoint, acquisition of HIV infection: odds ratio 0.84  15.7% lower in MI group than control group (NS)September 15, 2011 8
  • 9. IV - RESULTS (3) UAI with non-primary partner: NS Risk Ratio Risk Ratio Study or Subgroup log[Risk Ratio] SE Weight IV, Random, 95% CI IV, Random, 95% CI Picciano 2007 0.00995 0.1947 81.8% 1.01 [0.69, 1.48] van Kesteren 2007 0.157 0.413 18.2% 1.17 [0.52, 2.63] Total (95% CI) 100.0% 1.04 [0.73, 1.47] Heterogeneity: Tau² = 0.00; Chi² = 0.10, df = 1 (P = 0.75); I² = 0% 0.1 0.2 0.5 1 2 5 10 Test for overall effect: Z = 0.21 (P = 0.83) Favours MI Favours controlSeptember 15, 2011 9
  • 10. IV - RESULTS (4) UAI with primary partner: NS Risk Ratio Risk Ratio Study or Subgroup log[Risk Ratio] SE Weight IV, Random, 95% CI IV, Random, 95% CI Picciano 2007 0.5988 0.236 63.7% 1.82 [1.15, 2.89] van Kesteren 2007 -0.2357 0.496 36.3% 0.79 [0.30, 2.09] Total (95% CI) 100.0% 1.34 [0.61, 2.95] Heterogeneity: Tau² = 0.20; Chi² = 2.31, df = 1 (P = 0.13); I² = 57% 0.1 0.2 0.5 1 2 5 10 Test for overall effect: Z = 0.74 (P = 0.46) Favours MI Favours controlSeptember 15, 2011 10
  • 11. IV - RESULTS (5) UAI short-term follow-up: NS MI Control Std. Mean Difference Std. Mean Difference Study or Subgroup Mean SD Total Mean SD Total Weight IV, Random, 95% CI IV, Random, 95% CI Mausbach 2007 2.88 0.98 96 2.74 1.06 112 42.1% 0.14 [-0.14, 0.41] Picciano 2001 1.55 2.44 46 2.57 8.49 43 18.1% -0.16 [-0.58, 0.25] Velasquez 2009 3.99 6.34 82 3.91 6.11 120 39.8% 0.01 [-0.27, 0.29] Total (95% CI) 224 275 100.0% 0.03 [-0.14, 0.21] Heterogeneity: Tau² = 0.00; Chi² = 1.43, df = 2 (P = 0.49); I² = 0% -10 -5 0 5 10 Test for overall effect: Z = 0.36 (P = 0.72) Favours MI Favours controlSeptember 15, 2011 11
  • 12. IV - RESULTS (6) Drinks per day (short term): Sign. MI Control Std. Mean Difference Std. Mean Difference Study or Subgroup Mean SD Total Mean SD Total Weight IV, Random, 95% CI IV, Random, 95% CI Morgenstern 2007 2.07 2.87 42 3.52 3.95 47 31.1% -0.41 [-0.83, 0.01] Velasquez 2009 1.77 3.04 82 2.91 4.03 120 68.9% -0.31 [-0.59, -0.03] Total (95% CI) 124 167 100.0% -0.34 [-0.58, -0.11] Heterogeneity: Tau² = 0.00; Chi² = 0.16, df = 1 (P = 0.69); I² = 0% -4 -2 0 2 4 Test for overall effect: Z = 2.86 (P = 0.004) Favours MI Favours controlSeptember 15, 2011 12
  • 13. IV - RESULTS (7) Drinks per day (long term): NS MI Control Std. Mean Difference Std. Mean Difference Study or Subgroup Mean SD Total Mean SD Total Weight IV, Random, 95% CI IV, Random, 95% CI Morgenstern 2007 2.09 2.01 42 2.47 3.12 47 33.6% -0.14 [-0.56, 0.27] Velasquez 2009 1.02 1.54 77 1.29 1.83 102 66.4% -0.16 [-0.45, 0.14] Total (95% CI) 119 149 100.0% -0.15 [-0.39, 0.09] Heterogeneity: Tau² = 0.00; Chi² = 0.00, df = 1 (P = 0.95); I² = 0% -4 -2 0 2 4 Test for overall effect: Z = 1.23 (P = 0.22) Favours MI Favours controlSeptember 15, 2011 13
  • 14. V - SUMMARY Study level: Few differences between groups, but … Rate of HIV acquisition in Explore study almost 16% lower in first 18 months of follow-up in MI group  clinically important result Of 9 meta-analyses, 1 showed sign diff between groups: drinks per day (short term follow up)September 15, 2011 14
  • 15. VI - DISUSSION MI effective as intervention for excessive drinking? MI less effective in changing MSM’s sexual risk behaviors than other risk behaviors? – Sexual behavior is shared activity and decision, private – Assumption of psychosocial models of behavior change that risk behaviors largely under control of the individualSeptember 15, 2011 15
  • 16. VII - CONCLUSIONS Effectiveness of MI as an intervention strategy for unsafe sexual and substance use behaviors among MSM is uncertain MI largely equivalent to other active and minimal treatments for problem behaviors involving substance use and unsafe sex among MSM Continued work to craft more effective HIV prevention programming for MSM should be doneSeptember 15, 2011 16
  • 17. IV - ACKNOWLEDGEMENTS Colleagues: Michael W. Ross, Ronny Tikkanen, Jan Odgaard-Jensen, Karianne T Hammerstrøm Researchers who sent us information: Drs Thomas L. Patterson, Kirk von Sternberg, Beryl L. Koblin, and Marla Husnik. Special thanks to Dr van Kesteren who shared the unpublished report of her studySeptember 15, 2011 17
  • 18. THANK YOUContact details:Rigmor ”Rimo” C Berg rigmor.berg@nokc.noSeptember 15, 2011 18