Onoya Dorina, Sineke Tembeka, Mokhele Idah, Vujovic Marnie, Holland Kate, Ruiter Robert A C
Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
medRxiv. 2024 Sep 23:2024.09.20.24314048. doi: 10.1101/2024.09.20.24314048.
We piloted a Motivational Interviewing (MI) training program for lay counsellors in South Africa (SA) to assess its impact on retention and viral suppression among newly diagnosed individuals living with HIV (PLHIV) at 12 months post-diagnosis. We randomized eight primary healthcare clinics (PHC) in Johannesburg to either the intervention clinics (n=4) where all lay counsellors were supported for 12 months before the PLHIV enrolment or the standard of care (n=4 clinics). Overall, 548 adults (≥ 18 years) PLHIV were recruited after HIV diagnosis from March 2020 to August 2021 (n=291 intervention, n=257 control). We conducted Poisson regression modelling to assess the intervention effect on patient attendance status (out of care - being ≥28 days late for the last appointment) and viral suppression (<50 copies/ml) at 12 months, reporting risk ratios (RR) with 95% confidence intervals (CIs). Of the 548 eligible participants enrolled, 56.3% were ≥28 days late (52.9% intervention vs 60.9% controls, RR 0.9, 95% CI: 0.7-1.0). Retention at 12 months positively correlated with baseline counselor MI skill levels (Cultivating change talk, RR 1.6, 95%CI: 1.1-2.5; Softening sustain talk, RR 1.5, 95%CI: 0.8-2.9; Empathy, RR 1.4, 95%CI: 1.0-1.8; Partnership RR 1.5, 95%CI: 1.2-1.9). Among those retained at 12 months, 65.3% of intervention participants were virally suppressed compared to 49.3% controls (RR 1.3, 95%CI: 1.0-1.7). Compared to control participants, the intervention group reported more positive counseling experiences, fewer concerns about HIV disclosure (RR 0.8 for high vs low-medium concerns, 95% CI: 0.7-1.0) and ART (RR 0.8, 95% CI: 0.7-1.0), and were more likely to express high confidence to take treatment in public (47.4% vs 28.8%, RR 1.4, 95% CI: 1.0-1.8) after counselling.
我们在南非（SA）为非专业咨询师开展了一项动机性访谈（MI）培训项目，以评估其对新诊断的艾滋病毒感染者（PLHIV）在诊断后12个月时的留存率和病毒抑制情况的影响。我们将约翰内斯堡的八家初级保健诊所（PHC）随机分为干预诊所（n = 4），在PLHIV入组前，所有非专业咨询师在12个月内都得到支持，以及标准护理组（n = 4家诊所）。总体而言，2020年3月至2021年8月期间，共招募了548名年龄≥18岁的成年PLHIV（n = 291名干预组，n = 257名对照组）。我们进行了泊松回归建模，以评估干预对12个月时患者就诊状态（失访 - 最后一次预约迟到≥28天）和病毒抑制（<50拷贝/毫升）的影响，报告风险比（RR）及95%置信区间（CI）。在548名符合条件的参与者中，56.3%的人迟到≥28天（干预组为52.9%，对照组为60.9%，RR 0.9，95% CI：0.7 - 1.0）。12个月时的留存率与基线咨询师的MI技能水平呈正相关（培养改变谈话，RR 1.6，95% CI：1.1 - 2.5；软化维持谈话，RR 1.5，95% CI：0.8 - 2.9；同理心，RR 1.4，95% CI：1.0 - 1.8；伙伴关系RR 1.5，95% CI：1.2 - 1.9）。在12个月时留存的参与者中，干预组65.3%的人实现了病毒抑制，而对照组为49.3%（RR 1.3，95% CI：1.0 - 1.7）。与对照组参与者相比，干预组报告了更多积极的咨询体验，对艾滋病毒披露（高关注与中低关注相比，RR 0.8，95% CI：0.7 - 1.0）和抗逆转录病毒治疗（RR 0.8，95% CI：0.7 - 1.0）的担忧更少，并且在咨询后更有可能在公开场合表达对接受治疗的高度信心（47.4%对28.8%，RR 1.4，95% CI：1.0 - 1.8）。
