# Interactive Internet-Based Motivational Interviewing Training for HIV Counseling Support Staff to Improve Health Communication in HIV Care Interactions: Protocol for Training Development and a Pilot Randomized Controlled Trial

## TL;DR

This study aims to develop and test an online training program to improve communication skills of HIV counseling staff using motivational interviewing techniques.

## Contribution

The study introduces an interactive internet-based motivational interviewing training program tailored for HIV counseling support staff.

## Key findings

- The iMI4HIV training program will be developed and piloted with feedback from focus groups and interviews.
- A pilot randomized controlled trial will assess the feasibility and acceptability of the training program.
- The program aims to improve MI skills and potentially enhance HIV care outcomes.

## Abstract

HIV counseling support staff (CSS) play a crucial role in HIV care outcomes, providing essential access to HIV test counseling, linkage-to-care support, adherence counseling, peer support, and navigation. Effective training in evidence-based interventions like motivational interviewing (MI) is imperative to maximize the impact of CSS in enhancing HIV care outcomes. MI is a collaborative, goal-oriented communication method aimed at bolstering an individual’s motivation and movement toward specific goals by eliciting and exploring personal arguments for change. MI has demonstrated efficacy across various medical and mental health outcomes, including its significant impact on the status-neutral HIV Care Continuum.

The objective of this study is to develop and pilot an interactive internet-based MI training program for HIV counseling support staff (iMI4HIV), aiming to enhance their communication skills in HIV care interactions.

The iMI4HIV Study will have 2 phases. In phase 1, Development, we will conduct formative focus groups (FGs) with CSS (n=16) to identify HIV care interactions for demonstration videos and to assess acceptability of gamification components; create MI demonstration videos depicting key interactions from status-neutral HIV Care Continuum; program iMI4HIV (including skills development tasks, gamification components, etc); and pilot a virtual MI (VMI) workshop followed by iMI4HIV (n=8). We will also conduct qualitative interviews with 8 leaders from HIV care agencies to explore their use of existing online MI training programs, acceptability of iMI4HIV, and possible facilitators and impediments to its adoption for training HIV CSS. In phase 2, pilot randomized controlled trial (RCT), we will randomize 30 CSS at a 2:1 ratio (VMI workshop + iMI4HIV vs VMI workshop + waitlist control) to assess the feasibility and acceptability of iMI4HIV and to pilot the RCT processes and assessments for a future efficacy trial. We will also explore the preliminary impact of iMI4HIV on MI skills acquisition.

The CSS focus groups began in August 2024, and programming of the training is near completion. We plan to conduct a pilot with 8 participants by the end of 2025, to obtain feedback and conclude phase 1 of the study. The phase 2 pilot RCT is expected to be launched in February 2026, with all data collection to be completed by October 2026.

Our pilot study aims to demonstrate the feasibility and acceptability of an internet-based MI training program for HIV CSS. If successful, this training program has the potential to enhance the delivery of evidence-based interventions in HIV care settings, ultimately improving patient outcomes and adherence to treatment protocols. Further research and larger trials will be needed to confirm these findings and refine the training approach.

DERR1-10.2196/82241