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），不健康的酒精使用仍然是一个问题。 艾滋病毒治疗依从性、病毒抑制和保留的障碍， 治疗即预防（TASP）。因此，优化酒精EBI转化为临床HIV临床 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 实施和评价框架-实施研究综合框架 和RE-AIM（到达，有效性，采用，实施和维护），我们将进行混合 第3类有效性-执行将执行成果作为主要评价指标， 结果是次要的。我们将专门测试实践促进，一个基于证据的多方面， 实施战略，增加了阶梯式护理的覆盖范围、采用、实施和维护， 不健康的酒精使用（我们的临床干预）在三个艾滋病研究中心（CFAR）网络 位于波士顿、圣地亚哥和查佩尔山的综合临床系统（CNICS）HIV诊所。我们将 其次，测试练习促进是否与减少不健康的酒精使用有关， 在患者水平上坚持抗逆转录病毒疗法和抑制病毒。在实践促进中，实践教练将提供 工具、资源、实践指导和内容专业知识，以协助研究中心提供以下方面的分步护理模式 对不健康饮酒的患者进行酒精治疗。分步护理将包括短暂干预、认知干预 行为疗法和酒精药物疗法为了与患者和提供者的偏好保持一致， 将提供各种干预方式（面对面、远程医疗和计算机提供）。实践 促进干预将在各地点依次推出，使以前的经验为今后的经验提供借鉴。 实施.每个地点将分三个阶段：实施前规划、实施 形成性评价和实施后总结性评价。使用混合方法，我们特别 建议实现以下具体目标：（目标1）针对每个地点制定促进实践的干预措施 使用混合方法（实施前）;（目标2a）确定实践促进对覆盖范围的影响， 采用和维持基于证据的酒精治疗使用混合方法（形成 （目标2b）确定实践促进对实施阶梯式护理的影响（初级） 酒精使用和艾滋病毒相关的结果（次要）使用中断时间序列分析与合成 控制（总结性评价）和（目标3）描述实施酒精的障碍和促进因素- 在每个站点进行相关干预，以描述维护情况，并告知广泛的可持续发展 实施.我们的研究利用了我们强大的跨学科团队，并与OAR保持一致 解决TASP障碍，艾滋病毒相关合并症，并推进跨领域研究的优先事项， 执行科学。

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.