Implementation of male-specific motivational interviewing in Malawi
An assessment of intervention fidelity and barriers to scale-up
Bibliographic Data
INTRODUCTION: Treatment interruption (TI), defined as >28 days late for antiretroviral therapy appointment, is one of the greatest challenges in controlling southern African HIV epidemics. Negative client-provider interactions remain a major reason for TI and a barrier to return to care, especially for men. Motivational interviewing (MI) facilitates client-driven counselling and improves client-provider interactions by facilitating equitable, interactive counselling that helps clients understand and develop solutions for their unique needs. Fidelity of MI counselling in resource-constrained health systems is challenging. METHODS: We developed a male-specific MI curriculum for Malawian male TI clients. Four psychosocial counsellors (PCs, a high-level Malawian counselling cadre) received a 2.5-day curriculum training and job aid to guide MI counselling approaches. PCs implemented the MI curriculum with men >15 years who were actively experiencing TI. Clients were found at home (through tracing) or at the facility (for those who returned to care on their own). MI counselling sessions were recorded, transcribed, translated into English and coded in Atlas.ti V.9. MI quality was assessed using a modified version of the validated MI Treatment Integrity tool. The tool has two measures: (1) counts of key MI behaviours throughout the session (questions, reflections, etc) and (2) overarching scores (using a 5-point scale) that characterise three MI dimensions for an entire counselling session (cultivating change talk, partnership and empathy). RESULTS: 44 MI sessions were recorded and analysed between 1 April 2022 and 1 August 2022. 64% of counselling sessions focused on work and travel as the main reason for TI. 86% of sessions yielded client-driven, tailored solutions for overcoming TI. PCs implemented multiple MI behaviours very well: asking questions, giving information, simple reflections and client affirmation. Few PCs used complex reflection, emphasised autonomy or sought collaboration with clients. Among overarching MI dimensions, PCs scored high in partnership (promoting client-driven discussions) and cultivating change talk (encouraging client-driven language and behaviour change confidence) but scored suboptimal in empathy. Only five sessions had confrontational/negative PC attitudes. CONCLUSIONS: PCs implemented MI with fidelity and quality, resulting in tailored, actionable plans for male re-engagement in HIV treatment in Malawi. TRIAL REGISTRATION NUMBERS: NCT05137210 and NCT04858243
Fidelity · Goal setting · Interview · MEDLINE · Motivational interviewing · Psychological intervention · Public health · Community Health and Development · Gender Roles and Identity Studies · Psychological Testing and Assessment
The Motivational Interviewing Treatment Integrity Code (Miti 4)
Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence
Barriers and Facilitating Factors to HIV Treatment Among Men in a High-HIV-Burdened District in KwaZulu-Natal, South Africa
Health care workers’ perceptions and bias toward men as HIV clients in Malawi and Mozambique
Changes in patterns of retention in HIV care and antiretroviral treatment in Tanzania between 2008 and 2016
Distribution of advanced HIV disease from three high HIV prevalence settings in Sub-Saharan Africa
Hunger, waiting time and transport costs
The relationship between adherence to clinic appointments and year-one mortality for newly enrolled HIV infected patients at a regional referral hospital in Western Kenya, January 2011–December 2012
Factors associated with an interruption in treatment of people living with HIV in Usaid-supported states in Nigeria
Barriers and facilitators to facility HIV self-testing in outpatient settings in Malawi
The Feasibility of Implementing a Sexual Risk Reduction Intervention in Routine Clinical Practice at an ARV Clinic in Cape Town
Understanding the Unique Barriers and Facilitators that Affect Men’s Initiation and Retention in HIV Care
Transportation Costs Impede Sustained Adherence and Access to Haart in a Clinic Population in Southwestern Uganda
How HIV Clients Find Their Way Back to the ART Clinic
Rethinking external assistance for health
The impact of shifts in Pepfar funding policy on HIV services in Eastern Uganda (2015–21)
Barriers and facilitators to antiretroviral medication adherence among HIV-infected paediatric patients in Ethiopia
| Citation velocity | historical |
|---|---|
| Highly cited | No |