The Setting-Intervention Fit of Nine Evidence-Based Interventions for Substance Use Disorders Within HIV Service Organizations Across the United States: Results of a National Stakeholder-Engaged Real-Time Delphi Study.
The Setting-Intervention Fit of Nine Evidence-Based Interventions for Substance Use Disorders Within HIV Service Organizations Across the United States: Results of a National Stakeholder-Engaged Real-Time Delphi Study.
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DOI：
10.1097/qai.0000000000002981
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发表时间：
2022-07-01
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鉴于艾滋病毒感染者中药物使用障碍（SUD）非常普遍，需要将药物使用障碍服务纳入艾滋病毒服务环境，以帮助结束艾滋病毒的流行。在这项研究中，我们评估了9种循证SUD干预措施的设置-干预匹配（SIF）：阿坎酸，双硫仑，口服纳洛酮，注射纳洛酮，口服丁丙诺啡，注射丁丙诺啡，应急管理，动机访谈（MI）和认知行为治疗（CBT）。美国的临床和非临床HIV服务组织（HSO）。2020年5月，完成了一个由203个HSO组成的、由企业主参与的实时德尔菲。HSO受访者对每项SUD干预措施的可资助性、可实施性、可恢复性、可持续性、可扩展性和HSO及时性进行了评分，并将这六个项目汇总为SIF评分（可能范围为0至18）。MI的平均SIF评分最高（11.42），临床（11.51）和非临床HSO（11.36）的SIF评分高于中点（9.5）。对于非临床HSO，其他干预措施均未超过中点。对于临床HSO，CBT（10.97）和口服丁丙诺啡（9.51）的平均SIF评分高于中点。多变量回归分析，控制HSO受访者的特点，揭示了美国的地理区域，以及HSO目前是否提供任何物质使用服务作为SIF分数的两个最佳预测因素。尽管需要改善其他循证SUD干预措施的SIF，但MI、CBT和口服丁丙诺啡是目前最适合纳入美国HSO的循证SUD干预措施。
Given substance use disorders (SUDs) among people with HIV are highly prevalent, integrating SUD services within HIV service settings is needed to help end the HIV epidemic. In this study we assessed the setting-intervention fit (SIF) of nine evidence-based SUD interventions: acamprosate, disulfiram, oral naltrexone, injectable naltrexone, oral buprenorphine, injectable buprenorphine, contingency management, motivational interviewing (MI), and cognitive behavioral therapy (CBT). Clinical and non-clinical HIV service organizations (HSOs) in the United States. In May 2020, a stakeholder-engaged real-time Delphi was completed with 203 HSOs. HSO respondents rated the extent to which each SUD intervention was fundable, implementable, retainable, sustainable, scalable, and timely for their HSO, and these six items were summed into an SIF score (possible range of 0 to 18). MI had the highest average SIF score (11.42), with SIF scores above the midpoint (9.5) for clinical (11.51) and non-clinical HSOs (11.36). For non-clinical HSOs, none of the other interventions were above the midpoint. For clinical HSOs, the average SIF scores were above the midpoint for CBT (10.97) and oral buprenorphine (9.51). Multivariate regression analyses, which controlled for characteristics of the HSO respondent, revealed geographic region of United States and whether the HSO currently offered any substance use services as two of the best predictors of SIF scores. Notwithstanding the need to improve the SIF for the other evidence-based SUD interventions, MI, CBT, and oral buprenorphine are currently the evidence-based SUD interventions with greatest perceived fit for integration within HSOs in the United States.