Motivational Interviewing for HIV-Positive Youth in Thailand

Motivational Interviewing
for
HIV-Positive Youth in Thailand
Chokechai Rongkavilit, MD
Children’s Hospital of Michigan
Wayne State University School of Medicine
Detroit, MI, USA

Health risk behaviors in HIV+ Thai youth
Survey: 70 HIV+ Thai youth aged 16-24 years
In past 30 days
• Two-thirds were sexually active
• Half reported inconsistent condom use
• 25% reported alcohol use
• 47% of males had sex with HIV-unknown partners and 1/3 did
not disclose HIV status to partners
• 20% reported

Motivational Interviewing in HIV+ Thai youth
(Thai Healthy Choices)

Objective:
• To evaluate 4-session MI intervention to improve risk
behaviors among HIV+ Thai youth 16-25 years
▫ Condom use
▫ Alcohol use
HIV-NAT
Bangkok
Wayne State
University
▫ Adherence to HIV treatment
City
University
of New York

Adaptation
Thai Healthy Choices
• Step I: Translation of Healthy Choices U.S. manual
• Step II: Group discussion to review/modify manual
• Step III: Counselor training
• Step IV: Pilot-testing Healthy Choices in 11 HIV+ youth
Feasibility Testing
• Step V: Pilot randomized trial in 110 HIV+ youth
▫ 55 in Healthy Choices vs. 55 in Control
▫ Assessment of behavior changes before, 1 month and 6
months after intervention

Group Discussion
1. HIV+ youth (2 males, 2 females, 1 transgender)
2. Health providers (1 MD, 1 nurse, 2 counselors, 1 peer
advocate)
Discussions focus on
• How helpful/suitable is MI for Thai youth?
• Role of peer, family and Buddhism and applicability in MI
• Modification needed to increase relevance for Thai youth?

Group Discussion
HIV+ Youth Providers
MI is appropriate, applicable and promising
MI sessions must be flexible enough for youth to attend
4 sessions might not be enough to affect behavior change
Peer important for urban youth;
family important for rural youth
Buddhism is not relevant either to
youth or MI
Family is an important factor for
youth (collectivist society)
Buddhist doctrine can be applied in
MI

Pilot Testing of MI
• 11 HIV+ Thai youth: 5 men (4 homosexuals) and 6 women (1 bisexual)
• 6 were on HIV medications.
• 10 (91%) completed 4 MI sessions and 1-mo post-intervention F/U
• Youth reported being comfortable talking with counselor at the scale
of 9.8 out of 10.
• Over half wanted more contacts with counselor (based on phone calls
from youth between sessions).
Rongkavilit, C. J Assoc Nurse AIDS Care 2012; in press

Pilot Randomized Trial in HIV+ Thai Youth (16-25 y)
4 sessions of MI
(1,2, 6, 12 weeks)
114 approached
110 enrolled
4 sessions of Health Education
(1,2, 6, 12 weeks)
50/55 (91%) attended ≥3 sessions 46/53 (87%) attended ≥3 sessions
Both groups were followed at 1 & 6 mo for
•Sexual risk
•Alcohol/drug use
•Medication adherence
•Mental health
MITI coding to assess counselor’s fidelity to MI
MITI rating feedback reviewed with counselor
Koken JA. Health Edu Behavior 2012; in press

Sexual
Risk
Scores
Mental
health
scores
Pilot Randomized Trial in HIV+ Thai Youth (16-25 y)
MI (Intervention) Health Education (Control)
Baseline 1 M 6 M Baseline 1 M 6 M
4.3±3.6 3.3±3.1 3.4±3.4 3.9±3.5 2.9±2.7 4.3±3.8
P=0.04
1.9±0.3 1.7±0.4 1.7±0.3 1.8±0.5 1.8±0.4 1.7±0.4
P

Thai Healthy Choices: Conclusion
• MI intervention improved sexual risks and mental health
among HIV+ Thai youth.
• Its person-centered approach was well accepted by youth.
• Integration of MI-based intervention in standard care for
HIV+ youth in less-developed countries is feasible and should
be considered.

Acknowledgement
ACKNOWLEDGMENT
Thailand: HIVNAT
Apirudee Panthong, MA
Sanya Umasa, BA
Theshinee Chuenyam, RN
Torsak Bunupuradah, MD
Pichai Saengcharnchai, MD
Praphan Phanuphak, MD, PhD
City University of New York
Juline Koken, PhD
Jeffrey Parsons, PhD
Wayne State University
Sylvie Naar-King, PhD
Bo Wang, PhD
Linda Kaljee, PhD
Kathryn Wright, DO
Bonita Stanton, MD
US NIH