Motivational Interviewing for antiretroviral therapy adherence in Nigeria: A feasibility study

Background: Motivational Interviewing (MI) is a person-centred directive approach that can support HIV patients to improve antiretroviral therapy (ART) adherence. Although MI has a growing literature within HIV contexts, studies have not yet examined the feasibility of using it for ART adherence counselling in Nigerian clinical contexts. Methods: A mixed method approach was used for this study. Counsellors and a sample of HIV patients were recruited from a HIV clinic in Abuja, Nigeria between March and June 2017. The counsellors received five hours training, then used MI in audiotaped sessions with patients. Following the clinical encounters, counsellors and patients were interviewed about the process. Fidelity of counsellors to MI was assessed using the OnePass system which is a tool for measuring the competence of practitioners in MI, while the interviews data were analysed thematically to explore the experiences of study participants. Findings: All clinicians in the clinic participated in the study and attended the training. Nineteen sessions were recorded from the interactions between 18 patients and seven counsellors in English, Pidgin and Yoruba. The counsellors did not achieve the threshold for competency described in literature, however interview responses revealed that MI improved the consultation practices of the counsellors and was well-accepted by patients. Interviews also revealed significant challenges during routine consultations, such as low clinic capacity, perception of counsellors about adherence support, stigma, bribing, religious/traditional beliefs, privacy issues in the clinic and economic barriers; this may prevent the routine application of the approach in Nigerian hospitals. Conclusions: This study indicates that MI has potential to be used for ART adherence support within Nigerian context. It is acceptable to clinicians and patients and perceived as being different from current practice. However, for future implementation, time needs to be dedicated to MI training and further professional development around patient-centred approaches to adherence support.