Integration of motivational interviewing and cognitive behavioral therapy to improve HIV medication adherence and reduce substance use among HIV-positive men and women: results of a pilot project.

Directly addressing HIV medication adherence and substance use together is ideal in light of the research on the complex connections between these two behaviors. This paper describes the development of a pilot program in which a combined motivational interviewing and cognitive behavioral therapy intervention was used to increase adherence to highly active antiretroviral therapy (HAART) and reduce substance use in HIV-infected adults. The main goals of the pilot study were (1) to confirm the ability to recruit HIV-positive substance users taking HAART; (2) to demonstrate the ability to retain participants over the course of an eight-session intervention; and (3) to examine changes in substance use and HAART adherence from pretreatment to posttreatment. Twelve HIV-positive adults with a substance use disorder participated in an 8-week intervention, which consisted of weekly individual sessions with a trained therapist. Results showed that despite the small sample size, there was a significant reduction in substance use from pretreatment to posttreatment. No statistically significant differences were found for changes in HIV medication adherence, but the trends suggest the potential for positive results with a larger sample. Retention for all eight sessions of the treatment was 73.3%. Eighty percent completed the 3-month follow-up assessment. Participants reported high therapeutic alliance reflecting comfort with their therapists and in the treatment. Overall, the pilot demonstrated feasibility and acceptability of the treatment. Furthermore, results suggest that this may, in fact, be an effective intervention to reduce substance use and improve HIV medication adherence.