596. Case Study of Motivational Interviewing Intervention in Patients Non-Adherent to Antiretroviral Therapy

Abstract

BackgroundMotivational interviewing (MI) may have a positive impact on antiretroviral therapy (ART) adherence. However, few studies focus on non-adherent patients at high risk of viral transmission, as identified by unsuppressed viral load.MethodsPatients on ART with detectable viral load (VL) were identified from a major academic HIV clinic and referred to the study by physicians. Inclusion criteria were patients with over two clinic visits in the year prior, with most recent VL over 200 copies/mL. An MI trained social worker recruited participants, obtained written consent and provided a small financial incentive, and conducted MI sessions. After initial session, patients chose whether to continue further follow-up sessions. Patient VLs were compared between those measured before and after the intervention. Statistical analysis was limited by small sample size.ResultsOf 700 active patients in May 2014, 62 patients met enrollment criteria by chart review. Of those, 29 were referred by physicians for enrollment. Nine declined participation and four were lost to follow-up before the first session. Three participants were excluded in this analysis due to missing VL measurements. Average sessions per participant were 3 (range 1–8). Average VLs measured after intervention were 8 (range 1–19), spanning an average of 25 months (range 2–36).Of the 13 patients enrolled, 10 achieved VL suppression after the intervention. Six of these patients had a reemergence of VL >200 copies/mL, but five were able to lower their VL again below 200 copies/mL. Thus by the end of study dates, 9/13 (69%) had a viral load <200 copies/mL. Of the eight who had not had a recorded VL <200 copies/mL in the year prior to study dates, six achieved suppression at some point after the intervention. At the end of the study dates, of 13 initial participants, eight remain engaged with the social worker, two had discontinued sessions after agreeing their goals had been accomplished, and three were lost to follow-up. There was an average 52% decrease in the log 10 VL of patients after intervention as compared with before.ConclusionAlthough small and descriptive, this study shows potential impact of MI on a population of non-adherent patients at high risk of viral transmission.Disclosures All authors: No reported disclosures.