Effectiveness of Motivational Interviewing on HIV risk behaviors among men who have  sex withKunnskapsesenterets of the   ...
I - BACKGROUND     MSM 53% of all new HIV infections in U.S. (CDC, 2010)     MSM most affected by HIV in EU/EEA (van de ...
I - BACKGROUND Motivational Interviewing (MI) = "directive, client-centred  counseling style for eliciting behavior chang...
II - OBJECTIVE Conduct a systematic review of the effectiveness of  behavioral interventions adapting the principles and ...
III - METHODS Systematic review (transparent, reproducible) Search: 9 e-databases, Google Scholar,  motivationalintervie...
IV - RESULTS: 10 included studies 10 RCTs (1 cluster RCT) 6051 MSM (9 RCTs from U.S., 1 C-RCT from  Netherlands), in rep...
IV - RESULTS (1)       114 effect estimates from 32 unique outcomes were        extracted from the studies  10 were stat...
IV - RESULTS (2)       1 study (Explore, 2004) biological endpoint, acquisition        of HIV infection: odds ratio 0.84 ...
IV - RESULTS (3)       UAI with non-primary partner: NS                                                                  ...
IV - RESULTS (4)       UAI with primary partner: NS                                                                      ...
IV - RESULTS (5)       UAI short-term follow-up: NS                                      MI          Control          Std...
IV - RESULTS (6)       Drinks per day (short term): Sign.                                       MI          Control      ...
IV - RESULTS (7)       Drinks per day (long term): NS                                       MI          Control          ...
V - SUMMARY Study level: Few differences between groups, but … Rate of HIV acquisition in Explore study almost 16%  lowe...
VI - DISUSSION MI effective as intervention for excessive drinking? MI less effective in changing MSM’s sexual risk beha...
VII - CONCLUSIONS Effectiveness of MI as an intervention strategy for unsafe  sexual and substance use behaviors among MS...
IV - ACKNOWLEDGEMENTS Colleagues: Michael W. Ross, Ronny Tikkanen, Jan  Odgaard-Jensen, Karianne T Hammerstrøm Researche...
THANK YOUContact details:Rigmor ”Rimo” C Berg rigmor.berg@nokc.noSeptember 15, 2011                         18
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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

  1. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 18. THANK YOUContact details:Rigmor ”Rimo” C Berg rigmor.berg@nokc.noSeptember 15, 2011 18

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