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A Multisite Randomized Trial of a Motivational Intervention Targeting Multiple Risk Behaviors

Sylvie Naar-King, PhD; Jeffrey T. Parsons, PhD; Debra A. Murphy, PhD; Xinguang Chen, MD, PhD; D. Robert Harris, PhD; Marvin E. Belzer, MD

Arch Pediatr Adolesc Med. 2009;163(12):1092-1098.

Objective  To determine if Healthy Choices, a motivational interviewing intervention targeting multiple risk behaviors, improved human immunodeficiency virus (HIV) viral load.

Design  A randomized, 2-group repeated measures design with analysis of data from baseline and 6- and 9-month follow-up collected from 2005 to 2007.

Setting  Five US adolescent medicine HIV clinics.

Participants  A convenience sample with at least 1 of 3 risk behaviors (nonadherence to HIV medications, substance abuse, and unprotected sex) was enrolled. The sample was aged 16 to 24 years and primarily African American. Of the 205 enrolled, 19 did not complete baseline data collections, for a final sample size of 186. Young people living with HIV were randomized to the intervention plus specialty care (n = 94) or specialty care alone (n = 92). The 3- and 6-month follow-up rates, respectively, were 86% and 82% for the intervention group and 81% and 73% for controls.

Intervention  Healthy Choices was a 4-session individual clinic-based motivational interviewing intervention delivered during a 10-week period. Motivational interviewing is a method of communication designed to elicit and reinforce intrinsic motivation for change.

Outcome Measure  Plasma viral load.

Results  Youth randomized to Healthy Choices showed a significant decline in viral load at 6 months postintervention compared with youth in the control condition (β = –0.36, t = –2.15, P = .03), with those prescribed antiretroviral medications showing the lowest viral loads. Differences were no longer significant at 9 months.

Conclusion  A motivational interviewing intervention targeting multiple risk behaviors resulted in short-term improvements in viral load for youth living with HIV.

Trial Registration  clinicaltrials.gov Identifier: NCT00103532

Author Affiliations: Wayne State University, Detroit, Michigan (Drs Naar-King and Chen); Hunter College and the Graduate Center of the City University of New York, New York, New York (Dr Parsons); University of California–Los Angeles, Los Angeles (Dr Murphy); Westat Inc, Rockville, Maryland (Dr Harris); and Childrens Hospital Los Angeles, University of Southern California (Dr Belzer).

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