Alcohol Research Consortium in HIV: Implementation Research Arm

艾滋病毒酒精研究联盟：实施研究部门

• 批准号: 10304375
• 负责人: GEETANJALI CHANDER
• 金额: $ 69.5万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10304375
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adherence; Adoption; Age; Alcohol consumption; Alcohols; Area; Boston; Cardiovascular Diseases; Caring; Clinic; Clinical; Cognition; Cognitive Therapy; Computers; Consolidated Framework for Implementation Research; Continuity of Patient Care; Effectiveness; Epidemic; Epidemiology; Evaluation; Evidence based intervention; Future; HIV; High Prevalence; Hybrids; Infrastructure; Interruption; Intervention; Investments; Knowledge; Liver diseases; Maintenance; Malignant Neoplasms; Methods; Modeling; National Institute on Alcohol Abuse and Alcoholism; Outcome; Patient Care; Patients; Persons; Pharmacology; Pharmacotherapy; Phase; Provider; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Research Priority; Resources; Risk; Risk Behaviors; Sexual Transmission; Site; System; Telemedicine; Testing; Time; Time Series Analysis; Translations; Treatment Efficacy; Viral; Viral hepatitis; Work; alcohol abuse therapy; alcohol misuse; alcohol research; antiretroviral therapy; arm; behavioral pharmacology; brief intervention; clinical practice; comorbidity; effectiveness outcome; effectiveness testing; evidence base; experience; flexibility; formative assessment; frailty; implementation outcomes; implementation research; implementation science; implementation strategy; improved; medication compliance; preference; primary outcome; reduced alcohol use; therapy adherence; tool; transmission process; treatment as prevention; uptake

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.

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