Randomized controlled trial of motivational interviewing for reducing injection risk behaviours among people who inject drugs

Abstract

Aim We tested the efficacy of a brief intervention based on motivational interviewing (MI) to reduce high‐risk injection behaviours over a 6‐month period among people who inject drugs (PWID). Design A single‐site two‐group parallel randomized controlled trial comparing MI with a brief educational intervention (EI). Setting A study office located in downtown Montréal, Canada, close to the community‐based harm reduction programmes where PWID were recruited. Participants PWID who had shared drug injection equipment or shared drugs by backloading or frontloading in the month prior to recruitment were randomized to either the MI (112) or EI (109) groups. Intervention The MI aimed to (1) encourage PWID to voice their desires, needs and reasons to change behaviours; (2) boost motivation to change behaviours; and (3) when the person was ready, support the plan he or she chose to reduce injection risk behaviours. The EI consisted of an individual session about safe injection behaviours. Measurements The primary outcome was defined as having any of these risk behaviours at 6 months: having shared syringes, containers, filters or water to inject drugs in the previous month and backloading/frontloading; each behaviour was examined separately, as secondary outcomes. Findings The probability of reporting a risk injection behaviour decreased in both the MI and the EI groups. At 6‐month follow‐up, participants who reported any risk behaviours were 50% [odds ratio (OR) = 0.50; confidence interval (CI) = 0.13–0.87] less likely to be in the MI group than in the EI group as well as those who reported sharing containers (OR = 0.50; CI = 0.09–0.90). PWID who reported sharing equipment excluding syringes were 53% less likely to be in the MI group (OR = 0.47; CI = 0.11–0.84). Conclusions A brief motivational interviewing intervention was more effective than a brief educational intervention in reducing some high risk injecting behaviours up in the subsequent 6 months.

Preventing blood-borne virus infection in people who inject drugs in the UK: systematic review, stakeholder interviews, psychosocial intervention development and feasibility randomised controlled trial

“…Twenty-four trials were included in the meta-analysis. 22,[68][69][70][71][72][73]75,76,81,82,173,175,179,180,182,186,188,189,[192][193][194][195]197 The reasons for excluding eight trials from the meta-analysis were not providing the number of PWID for control and intervention groups at follow-up, 84,174,176,177,196 only providing risk ratios, 178 outcome combined HIV infections with sexually transmitted infections 77 and data for 'unsafe injection practices' were presented only at baseline. 74 …”

“…In total, 12,840 participants (35% female, range 0-100%) were enrolled in the trials; the majority were PWID (84.5%) (the proportion of participants enrolled in the trials who were PWID ranged from 16% to 100%). The majority (n = 18) of trials were conducted in the USA, 22,68,[70][71][72]76,81,84,174,176,177,179,182,186,189,193,195,196 three were conducted in Russia, 74,75,194 two were conducted in Canada, 175,178 two were conducted in Vietnam, 82,180 one was conducted in Kazakhstan, 73 one was conducted in Georgia, 188 one was conducted in Australia, 197 one was conducted in the UK, 173 one was conducted in Mexico, 77 one was conducted in Puerto Rico 192 and one was conducted in both the USA and Thailand. 69 Trials included in the systematic review compared psychosocial interventions with usual care (n = 4), 22,68,178,195 education or information (n = 9), 70,76,77,175,176,180,188,…”

“…69 Trials included in the systematic review compared psychosocial interventions with usual care (n = 4), 22,68,178,195 education or information (n = 9), 70,76,77,175,176,180,188,196,197 HIV infection testing and counselling (n = 5), 69,82,84,192,193 interventions of lesser time or intensity with OST (n = 12) [72][73][74]81,173,174,177,179,182,190,194 and without OST (n = 2). 71,186 Of the 32 interventions delivered in the RCTs included in the systematic review, most (n = 14) were delivered to individual participants, 22,68,70,71,75,77,81,173,175,178,192,[195][196][197] eight were delivered to groups of participants 69...…”

“…69,72,74,76,179,180,182,190 The majority of interventions contained at least three sessions (n = 25), 22,[69][70][71][72][73][74]76,81,82,173,174,[176][177][178][179][180]182,186,188,190,[192][193][194]196,197 four interventions contained two sessions, 68,75,187,195 and three interventions contained only one session. 77,175,197 Most interventions were delivered in drug treatment settings, including outpatient and hospital clinics, 71,72,173,[192][193][194] methadone maintenance clinics, 174,…”

“…[68][69][70][71][72][73][74][75][76][77]81,82,84,173,174,176,177,179,180,186,190,193,194,197 The most common reporting time frame for outcomes was in the past 30 days (n = 19), 22,68,69,[73][74][75][76][77]81,[174][175][176]186,188,[192][193][194][195]197 followed by the past 3 months (n = 10), 74,82,84,174,177,179,180,182,…”