Compendium of Evidence-Based Interventions and
Best Practices for HIV Prevention
Modelo de Intervención Psicomédica (MIP)
Hispanic drug injectors
Goals of Intervention
- To reduce injection-related HIV risk behaviors
- To engage injection drug users in drug treatment and health care
- To enhance self-efficacy
MIP is an intensive intervention that combines counseling and case management. The 6 one-on-one counseling sessions conducted by a registered nurse use motivational interviewing strategies to engage injection drug users for behavior change. The first 3 counseling sessions focus on participants’ motivation to change behavior, the development of a work plan to facilitate behavior change, encouragement to enter into drug treatment, and strategies for relapse prevention. Session 4 focuses on strategies participants can use to explain to their peers why they rejected the practice of needle sharing. Session 5 provides skill building for safer sex negotiation and correct male and female condom use. The final session reinforces self-efficacy to reduce risk behaviors and drug injection and to increase the use of health care and drug treatment services. The case management component involves active assistance from a case manager to help participants get through the intervention and to provide access to drug treatment, primary health care services, and other legal or social welfare services. Participants also received standard HIV counseling and testing.
Miller’s Motivational Interviewing Model
6 weekly sessions with ongoing case management
Study site or drug treatment program
Registered nurse and case manager
- Case management
- Goal setting
- Motivational interviewing
- Role plays and practice
- Risk reduction supplies (condoms and needle hygiene materials)
The intervention package and training are available through CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project.
The original evaluation study was conducted in Vega Baja, Puerto Rico between 1998 and 2001. The study included a sample of 557 injection drug using Puerto Rican men and women who were not in treatment.
Key Intervention Effects
- Reduced continued injection drug use in the overall sample and among participants entering drug treatment
- Reduced needle sharing among participants who continued to inject
- 100% Hispanic
- 89% Male; 11% Female
- 34.4% < 25 years; 36.6% 25 to 34 years; 29% 35 years or older
Copping areas, shooting galleries, prostitute strolls, and hang outs frequented by drug users
Injection drug users who were at least 18 years of age, not currently in treatment, and injected drugs during the past 30 days
Participants were randomly assigned to either the MIP intervention (n = 226) or a comparison intervention (n = 214).
The comparison intervention included 2-sessions of HIV counseling and testing. The pretest counseling session included a discussion of HIV/AIDS, the practice of safer needle use and safe sex skills, a discussion of HIV testing and an invitation to return to the study site for the HIV test results. The posttest counseling session included provision of HIV test results and referrals for drug treatment and health care services. A registered nurse delivered the counseling sessions, and outreach workers delivered condoms and needle hygiene materials to participants at shooting galleries and other drug locations.
Relevant Outcomes Measured and Follow-up Time
- Drug injection behaviors during the prior 30 days and prior 6 months (including percentage continuing injection drug use, percentage sharing needles, and percentage sharing cotton) were assessed 6 months post-baseline.
- Sexual risk behaviors during the prior 30 days and prior 6 months (including unprotected vaginal or anal sex with any partner, primary partner or non-primary partner) were assessed at 6 months post-baseline.
- The follow-up time point translates to approximately 3.5 months after the MIP intervention and 5.5 months after the comparison intervention.
- MIP Intervention:
79% retained at 3.5 months post-intervention
79% retained at 5.5 months post-intervention
At the follow-up, injection drug users receiving the MIP intervention reported a significantly greater reduction in continued injection drug use than those in the comparison group (p = 0.04). This significant reduction in injection drug use was also found among the subsample of drug injectors who entered drug treatment (p < 0.05). Among participants who continued to inject at follow-up, those receiving the MIP intervention were significantly less likely to report needle sharing than those receiving the comparison intervention (p < 0.05).
There were no significant differences in sexual risk behaviors between the intervention and comparison groups at the follow-up.
- Marrero, C. A., Robles, R. R., Colon, H. M., et al. (2005). Factors associated with drug treatment dropout among injection drug users in Puerto Rico. Addictive Behaviors, 30, 397–402.
- Robles, R. M., Reyes, J. C., Colon, H. M., et al. (2004). Effects of combined counseling and case management to reduce HIV risk behaviors among Hispanic drug injectors in Puerto Rico: A randomized controlled study. Journal of Substance Abuse Treatment, 27, 145–152.
Researcher: Dr. Rafaela R. Robles
Center for Addiction Studies
Universidad Central del Caribe
School of Medicine
P.O. Box 60327
Bayamón, PR 00960-6032