HealthCall: Technology-based extension of motivational interviewing to reduce non-injection drug use in HIV primary care patients – a pilot study

Abstract

To reduce non-injection drug use (NIDU) among HIV primary care patients, more than a single brief intervention may be needed, but clinic resources are often too limited for extended interventions. To extend brief motivational interviewing (MI) to reduce NIDU, we designed and conducted a pilot study of “HealthCall,” consisting of brief (1–3 minutes) daily patient calls reporting NIDU and health behaviors to a telephone-based interactive voice response (IVR) system, which provided data for subsequent personalized feedback. Urban HIV adult clinic patients reporting ≥4 days of NIDU in the previous month were randomized to two groups: MI-only (n=20) and MI+HealthCall (n=20). At 30 and 60 days, patients were assessed and briefly discussed their NIDU behaviors with their counselors. The outcome was the number of days patients used their primary drug in the prior 30 days. Medical marijuana issues precluded HealthCall with patients whose primary substance was marijuana (n=7); excluding these, 33 remained, of whom 28 patients (MI-only n=17; MI+HealthCall n=11) provided post-treatment data for analysis. Time significantly predicted reduction in “days used” in both groups (p<0.0001). At 60 days, between-group differences approached trend level, with an effect size of 0.62 favoring the MI+HealthCall arm. This pilot study suggests that HealthCall is feasible and acceptable to patients in resource-limited HIV primary care settings and can extend patient involvement in brief intervention with little additional staff time. A larger efficacy trial of HealthCall for NIDU-reduction in such settings is warranted.

Keywords:

• HIV
• treatment
• drug use
• IVR
• brief intervention

Acknowledgements

We acknowledge Jennifer Smith, PhD, for her work in providing MI training and the work of study coordinator Joaquin Aracena, MA. We also acknowledge the support of K23 DA016743 and K05 AA014223 as well as St. Vincent's Hospital (now under the auspices of Mt. Sinai Medical Center) and the New York State Psychiatric Hospital, New York, NY. The findings and conclusions in this report are those of the authors and do not necessarily represent the official view of the Centers for Disease Control and Prevention.