Evaluation of a computer-based and counseling support intervention to improve HIV patients' viral loads.

We sought to integrate a brief computer and counseling support intervention into the routine practices of HIV clinics and evaluate effects on patients' viral loads. The project targeted HIV patients in care whose viral loads exceeded 1000 copies/ml at the time of recruitment. Three HIV clinics initiated the intervention immediately, and three other HIV clinics delayed onset for 16 months and served as concurrent controls for evaluating outcomes. The intervention components included a brief computer-based intervention (CBI) focused on antiretroviral therapy adherence; health coaching from project counselors for participants whose viral loads did not improve after doing the CBI; and behavioral screening and palm cards with empowering messages available to all patients at intervention clinics regardless of viral load level. The analytic cohort included 982 patients at intervention clinics and 946 patients at control clinics. Viral loads were assessed at 270 days before recruitment, at time of recruitment, and +270 days later. Results indicated that both the control and intervention groups had significant reductions in viral load, ending with approximately the same viral level at +270 days. There was no evidence that the CBI or the targeted health coaching was responsible for the viral reduction in the intervention group. Results may stem partially from statistical regression to the mean in both groups. Also, clinical providers at control and intervention clinics may have taken action (e.g., conversations with patients, referrals to case managers, adherence counselors, mental health, substance use specialists) to help their patients reduce their viral loads. In conclusion, neither a brief computer-based nor targeted health coaching intervention reduced patients' viral loads beyond levels achieved with standard of care services available to patients at well-resourced HIV clinics.

Results From 10 Years of Interprofessional Training on Motivational Interviewing.

Motivational interviewing (MI) is a popular evidence-based method to support health behavior change. We examined evaluations from 10 years of interprofessional workshops on MI to identify trends in trainees' MI-related knowledge, attitude, and behavior. From 2006 to 2015, 394 trainees participated in continuing education MI workshops with our team and completed a validated posttraining questionnaire. Participants were 90% female and 66% White, with M = 12 years in practice. They worked in pediatric and adult care; urban and rural locations; and inpatient, outpatient, and nonhealth settings. The largest groups were nurses (20%), allied health professionals (20%), and health educators or case managers (15%). Trainees' professional diversity increased over time, their average age and years in practice decreased, and the percentage with prior MI training increased. Practitioners in telehealth and nonhealth settings had lower scores overall. Outcomes varied significantly by professional discipline: Mental health professionals, case managers, health educators, and nurses had higher scores on some outcome variables than nonhealth professionals. Years of clinical experience predicted MI-consistent attitude, but prior training, other demographic variables, and training process variations had no consistent effects. Although many trainees had already received MI training, outcome measures showed room for improvement. MI presents continued opportunities for interprofessional education.

Tobacco Use Among Arab Immigrants Living in Colorado: Prevalence and Cultural Predictors.

PURPOSE: The authors determined the prevalence of smoking among Arab immigrants living in Colorado. The authors also evaluated the relationship between acculturation and tobacco use, including both cigarettes and hookah among Arab immigrants. METHOD: A cross-sectional survey of 100 adult Arab immigrants living in Colorado was carried out. RESULTS: The results revealed that 19% of the study participants were current cigarette smokers and 21% were current hookah smokers. Participants who were more integrated into Arab culture were more likely to use tobacco products ( p = .03) and to have family members ( p = .02) and friends who use tobacco products ( p = .007). CONCLUSIONS: Acculturation plays a major role in affecting the health habits of Arab immigrants living in Colorado, especially in the area of hookah smoking. IMPLICATIONS FOR PRACTICE: Understanding some culturally relevant predictors of tobacco use might assist health care providers in designing successful smoking cessation programs.