Alcohol Research Consortium in HIV: Implementation Research Arm

尽管有基于证据的酒精减少干预措施(EBI)，但不健康的酒精使用仍然是 阻碍艾滋病毒药物依从性、病毒抑制和在艾滋病毒护理中的滞留，从而阻碍艾滋病毒 治疗即预防(TasP)。因此，优化酒精EBI到临床HIV临床的转换 实践是美国结束艾滋病毒流行倡议的一个重要方面。以互补为导向 执行和评价框架--执行研究综合框架(CFIR) 和RE-AIM(REACH、有效性、采用、实施和维护)，我们将进行混合 类型3成效--执行工作将执行成果作为主要和有效性评价 结果是次要的。我们将具体测试实践便利化，一种基于证据的多方面 实施战略，扩大覆盖范围、采用、实施和维护分级护理 三个艾滋病研究中心(CFAR)网络的不健康饮酒(我们的临床干预) 位于波士顿、圣地亚哥和教堂山的综合临床系统(CNICs)艾滋病毒诊所。我们会 第二，测试练习便利化是否与减少不健康的酒精使用有关，并改善 患者层面的抗逆转录病毒药物依从性和病毒抑制。在练习促进方面，练习教练将提供 工具、资源、实践指导和内容专业知识，以帮助站点提供分级护理模式 酒精治疗对不健康饮酒的患者。阶梯式护理将包括短暂干预、认知 行为疗法和酒精药物疗法。与患者和提供者的偏好保持一致，灵活 将提供干预交付的方式(面对面、远程医疗和计算机交付)。实践 便利化干预将在不同地点顺序推出，允许以前的经验为未来提供信息 实施。每个站点将分为三个阶段：实施前规划、实施和 形成性评价和实施后总结性评价。使用混合方法，我们特别 建议达到以下具体目标：(目标1)裁缝对每个站点的实践促进干预 使用混合方法(实施前)；(目标2a)确定练习便利化对REACH的影响， 采用和维护使用混合方法的循证酒精治疗(形成性 评价)；(目标2b)确定实践便利化对实施分级护理的影响(初级) 和酒精使用和艾滋病毒相关结果(二级)使用中断的时间序列分析与合成 控制(总结性评价)和(目标3)描述了酒精执行的障碍和促进者： 每个站点的相关干预措施，以描述维护并告知广泛的可持续发展 实施。我们的研究充分利用了我们强大的跨学科团队，并与Oar保持良好的一致性 优先处理TasP障碍、艾滋病毒相关共病和推进跨领域研究 实施科学。

Despite availability of evidence-based alcohol reduction interventions (EBI), unhealthy alcohol use remains a barrier to HIV medication adherence, viral suppression and retention in HIV care and consequently HIV treatment as prevention (TASP). As such, optimizing translation of alcohol EBIs into clinical HIV clinical practice is an important aspect of U.S. Ending the HIV Epidemic initiatives. Guided by complementary implementation and evaluation frameworks–the Consolidated Framework for Implementation Research (CFIR) and RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance), we will conduct a Hybrid Type 3 effectiveness-implementation evaluating implementation outcomes as primary and effectiveness outcomes as secondary. We will specifically test whether practice facilitation, an evidence-based multifaceted implementation strategy, increases reach, adoption, implementation, and maintenance of stepped care for unhealthy alcohol use (our clinical intervention) in three Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) HIV clinics located in Boston, San Diego, and Chapel Hill. We will secondarily test whether practice facilitation is associated with decreased unhealthy alcohol use, and improved ART adherence and viral suppression at the patient level. In practice facilitation, a practice coach will offer tools, resources, hands-on guidance, and content expertise to assist sites in offering a stepped care model of alcohol treatment to patients with unhealthy alcohol use. Stepped care will include brief intervention, cognitive behavioral therapy, and alcohol pharmacotherapy. To align with patient and provider preferences, flexible modes of intervention delivery (in-person, telemedicine, and computer-delivered) will be available. The practice facilitation intervention will be rolled out sequentially across sites, allowing prior experiences to inform future implementation. There will be three phases at each site: pre-implementation planning, implementation with formative evaluation, and post-implementation summative evaluation. Using mixed methods, we specifically propose to meet the following specific aims: (Aim 1) Tailor the practice facilitation intervention to each site using mixed methods (pre-implementation); (Aim 2a) Determine the effect of practice facilitation on reach, adoption, and maintenance of evidence-based alcohol treatment using mixed methods (formative evaluation); (Aim 2b) Determine the effects of practice facilitation on implementation of stepped care (primary) and alcohol use and HIV-related outcomes (secondary) using interrupted time series analysis with synthetic controls (summative evaluation) and (Aim 3) Describe barriers and facilitators to implementation of alcohol- related interventions at each site to describe maintenance and inform widespread sustainable implementation. Our study capitalizes on our strong transdisciplinary team and is well aligned with OAR priorities of addressing TASP barriers, HIV related comorbidities, and advancing cross-cutting research in implementation science.