Provider perspectives on the use of motivational interviewing and problem-solving counseling paired with the point-of-care nucleic acid test for HIV care

PLoS One. 2022 Jun 22;17(6):e0270302. doi: 10.1371/journal.pone.0270302. eCollection 2022.

Abstract

Aims: To evaluate provider perspectives on the use of a point-of-care nucleic acid test (POC NAT) and preferential opinions for motivational interviewing (MI) or problem-solving counseling (PSC) as an ultra-brief intervention for patients experiencing challenges to antiretroviral therapy (ART) adherence.

Methods: A qualitative study was conducted among providers at an HIV care clinic in Seattle, Washington. Ten in-depth interviews with HIV care providers were completed, which explored determinants of acceptability, feasibility and preferences for a combined adherence counseling and POC NAT intervention for patients living with HIV. Interviews were analyzed through consensus coding and the Five A's Framework to inform thematic analysis.

Results: Providers favored the use of a combined adherence counseling technique and POC NAT for their non-adherent patients living with HIV. Providers believed the intervention was an improvement on current assessment and advising practices. However, concerns about extended wait times for the POC NAT results influenced perceptions about feasibility around clinic flow and incorporation into clinic practice. Providers believed that acceptability of POC NAT implementation would be enhanced by including a subset of patient populations whom tend to be in the clinic for longer periods, and in tandem face greater ART adherence challenges.

Conclusion: The GAIN Study will be the first project to evaluate the implementation of POC NAT in the U.S. Continued formative work is ongoing and may illustrate how best to address feasibility and concern around the two-hour time to result. The planned GAIN study will incorporate some of the findings found in this qualitative study and pilot this intervention, including a time-in-motion analyses of clinic flow, which may help reduce perceived wide-scale adaptation of POC NAT and ART adherence counselling among PLHW. Future work, including a shorter time to results and/or lower limit detection could make a significant improvement in the provision of HIV care.

MeSH terms

  • Anti-Retroviral Agents / therapeutic use
  • Counseling / methods
  • HIV Infections* / diagnosis
  • Humans
  • Motivational Interviewing*
  • Nucleic Acids* / therapeutic use
  • Point-of-Care Systems

Substances

  • Anti-Retroviral Agents
  • Nucleic Acids

Grant support

This project received financial support from the Center for Disease Control & Prevention (6 U01 PS 005196-01-00). Two co-authors of the manuscript are employed by the funder (MT and KH), and were involved in the study concept and review of the manuscript. All other authors (DLA, LV, DR, and JDS) received salary support using the grant award paid from the CDC to the University of Washington.