Tailored Motivational Interviewing (TMI) delivers brief motivational interviewing (MI) counseling sessions customized to encourage people with HIV to engage in HIV care, take HIV medications as prescribed, and improve other health-related behaviors. Three sites implemented TMI as part of Using Evidence-Informed Interventions to Improve Health Outcomes among People Living with HIV (E2i), an initiative funded by the Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance (SPNS) program from 2017 to 2021. Clients who participated in TMI had significant improvement in engagement in care, prescription of antiretroviral therapy (ART), retention in care, and viral suppression.
Fort Lauderdale, FL
Black men who have sex with men (MSM) with HIV experience persistent gaps along the HIV care continuum, such as engagement in care, retention in care, adherence to ART, and viral suppression.1 They are also among the priority populations most in need of interventions that promote high quality and culturally-tailored services. TMI is designed to address barriers and concerns specific to young people of color, including Black, Indigenous, and Hispanic/Latino people and has demonstrated effectiveness in improving HIV health outcomes for young Black MSM.2-4
“Through TMI, we have had meaningful conversations with clients that raise their morale. We have seen clients take control of their lives and equip themselves with what they need to achieve an undetectable viral load.”
- Change Talk—moving clients toward a particular goal
- Spirit—collaborative and empathetic interaction
- Skills—using “you” statements, providing information, using reflections, and using open ended questions
- Processes—engaging, focusing, evoking, and planning
TMI sessions address key behaviors for people with HIV by encouraging them to:
- Engage in HIV care
- Adhere to ART
- Reduce or stop unhealthy substance use
- Reduce sexual risk behaviors
“TMI has helped us save lives, and that was the biggest goal. When you increase contact with someone, it motivates that person to live their best life, and increases their ability to achieve viral suppression.”
During a 12-month period, 177 clients enrolled in TMI across the three sites. The enrolled MSM were young (aged 25–33 years), and nearly all (97%) identified as Black; with 2% identifying as Hispanic/Latino. From enrollment through 12 months later, engagement in care, prescription of ART, retention in care, and viral suppression all improved significantly.
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Source: Tailored Motivational Interviewing (TMI): E2i Implementation Guide. Rockville, MD: U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau; 2021.
“TMI is an approach that has worked for our clients. Prior to implementing TMI, these clients were struggling. With TMI, we can see them really adhering to their medications and maintaining viral suppression.”
Staff training. Staff training included a two-day virtual or in-person experiential training, at least six coaching sessions over three months, quarterly fidelity monitoring, and an annual one-day booster training. Training may be provided through an external vendor or a local trainer. TMI providers may also need additional training to ensure that they have adequate knowledge of HIV and related topics like screening and referring for other needs and/or trauma-informed care. Coaching and training approaches across the three sites varied based on internal capacity and familiarity with MI.
Outreach and recruitment. Sites developed outreach and recruitment plans to identify potential clients through internal referrals from clinical and non-clinical staff, internal data analysis, outreach through other organizations and targeted communications, and community referrals.
Process flow development. Sites developed a process flow that is flexible but clearly lays out the roles of the TMI team members; how clients will move through the intervention; where sessions will be held (in private space); and incorporates feedback from staff on the process. Sites needed to address barriers to appointment adherence by considering options such as transportation and telehealth options or non-traditional meeting times and places.
Three sites participated in the TMI E2i initiative. Learn more about their implementations below.