Working alliance in HIV counseling and testing: Team and mobile counseling models

HIV Counseling and Testing Centers play an important role in reaching populations at increased risk for HIV infection. Although different counseling modalities are used in these settings, little is known about the relational quality of brief HIV counseling encounters. Working alliance (WA), a core indicator of relationship quality in psychotherapy and health care, has not previously been examined in HIV counseling. This study investigated whether WA can be established during brief HIV counseling sessions and whether it differs across counseling modalities, professional backgrounds, and testing settings.

A quasi-experimental study was conducted with 253 first-time users of an HIV testing center in Portugal. Participants were allocated to one of three counseling conditions (team counseling, nurse-led counseling, psychologist-led counseling) or to a control condition (information only). Sessions took place in a stand-alone center or a mobile unit. Users and professionals completed the Working Alliance Inventory, and WA scores were analyzed using MANOVA and post-hoc tests.

Working alliance was established across all counseling modalities and settings. From the users' perspective, team counseling resulted in higher WA scores, whereas professionals rated WA lower in team sessions than in individual sessions. No significant differences in WA were found between stand-alone and mobile settings or between nurse- and psychologist-led counseling. All counseling conditions also showed significantly higher WA scores than the information-only condition (p < .001).

Meaningful working alliance can be established during a single HIV counseling session, regardless of setting or professional background. From the user perspective, team-based counseling was associated with higher relational quality, while mobile counseling appeared to support relational quality comparably to stand-alone services.

Working alliance may serve as a useful indicator of relational quality in HIV counseling and testing services, with potential implications for patient engagement, stigma reduction, and service delivery.