Substance Abuse Treatment to HIV Care (SAT2HIV)

药物滥用治疗到艾滋病毒护理 (SAT2HIV)

• 批准号: 8883478
• 负责人: Bryan R Garner
• 金额: $ 81.12万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8883478
• 关键词: AIDS/HIV problem; Address; Adherence; Adopted; Adult; Advisory Committees; Alcohol consumption; Alcohol or Other Drugs use; Americas; Area; Buprenorphine; Caring; Client; Clinical; Communities; Competence; Complement; Educational workshop; Effectiveness; Employee Strikes; Evidence based practice; Feedback; Funding; HIV; Health; Health Benefit; Human immunodeficiency virus test; Hybrids; Individual; Infection; Intervention; Knowledge; Leadership; Letters; Life; Measures; Modeling; Outcome Measure; Patients; Performance; Persons; Policies; Prevention; Provider; Randomized; Readiness; Relative (related person); Reporting; Research; Risk Behaviors; Science; Services; Site; Staging; Technology; Testing; Tobacco use; Training; United States; United States Substance Abuse and Mental Health Services Administration; Viral; addiction; adolescent substance use; alcohol and other drug; antiretroviral therapy; base; blind; brief intervention; cost; cost effective; cost effectiveness; effectiveness research; experience; implementation research; improved; individualized feedback; medication compliance; meetings; member; motivational enhancement therapy; primary care setting; programs; public health relevance; research study; screening and brief intervention; screening, brief intervention, referral, and treatment; substance abuse treatment; therapy adherence; transmission process; treatment as usual; treatment center

DESCRIPTION (provided by applicant): The proposed study is a Type 2 Effectiveness-Implementation Hybrid Trial. Aim 1 will experimentally test the effectiveness of a motivational interviewing-based brief intervention (BI) for substance use within community- based HIV/AIDS service organizations, relative to usual care (UC). Aim 2 will test the effectiveness of adding an organizational-level implementation intervention called Implementation & Sustainment Facilitation (ISF) to the implementation strategy currently used by SAMHSA-funded Addiction Technology Treatment Centers (ATTCs; i.e., staff workshop training + feedback + coaching). Aim 3 will examine the incremental cost- effectiveness of the ISF implementation intervention. Over the course of the five-year project, 42 community- based HIV/AIDS service organizations will be randomized to one of two implementation conditions (ATTC-only vs. ATTC+ISF). Across conditions, two frontline HIV/AIDS service organization staff from each participating HIV/AIDS organization will be selected at random and invited to receive the usual ATTC staff-focused BI training model. In addition, HIV/AIDS organizations assigned to the ATTC+ISF condition will receive the ISF intervention, which focuses on providing feedback and coaching to organizational leadership. During the Initial Implementation stage of the study, approximately 72 clients from each of the 42 organizations (3,024 clients in total) will be randomized to one of two clinical conditions (UC vs. UC+BI). Clients in both conditions will receive the organization's respective UC for substance use (i.e., referral to treatment). In addition, clients assigned to UC+BI will receive a 20-30 minute motivational interviewing-based BI as delivered by one of two BI trained staff. Aim 1 will examine 3-month improvements in client-level measures of Alcohol and Other Drug (AOD) Change Readiness, Days of AOD Treatment, and Antiretroviral Therapy (ART) adherence. Aim 2 will examine client-level implementation outcome measures including independently rated assessments of BI adherence and competence (i.e., BI Integrity) conducted by trained raters blind to condition assignment. Finally, Aim 3 will include estimating costs of th implementation strategies, which will be measured from the perspective of program providers in order to increase the real-world usefulness of the results, with the relative cost-effectiveness of the two implementation conditions being assessed using both incremental cost- effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs). Although substance use among people living with HIV/AIDS has been associated with increased psychiatric problems, poorer HIV viral suppression, poorer HIV medication adherence, and increased likelihood of engaging in risk behaviors that result in infection transmission to others, integration of substance use and HIV/AIDS services remains limited. The proposed study seeks to address this gap by providing new knowledge regarding the effectiveness of BI for substance use within community-based HIV/AIDS service settings, as well as new knowledge regarding how to address the well-documented underutilization of evidence-based practices in real-world settings.

描述（由申请方提供）：拟定研究是一项2型重复性-实施混合试验。目标1将实验性地测试基于动机访谈的简短干预（BI）在社区艾滋病毒/艾滋病服务组织内对物质使用的有效性，相对于常规护理（UC）。目标2将测试在SAMHSA资助的成瘾技术治疗中心（ATTC;即，员工研讨会培训+反馈+辅导）。目标3将审查国际战略框架实施干预的增量成本效益。在这个为期五年的项目中，42个社区艾滋病毒/艾滋病服务组织将被随机分配到两个实施条件之一（仅ATTC与ATTC+ISF）。在所有条件下，将从每个参与的艾滋病毒/艾滋病组织中随机选择两名一线艾滋病毒/艾滋病服务组织工作人员，并邀请他们接受通常的ATTC工作人员为重点的BI培训模式。此外，被分配到ATTC+ISF条件的艾滋病毒/艾滋病组织将接受ISF的干预，重点是向组织领导提供反馈和辅导。在研究的初始实施阶段，来自42个组织中的每个组织的大约72名客户（总共3，024名客户）将被随机分配到两个 临床状况（UC vs. UC+BI）。这两种情况的客户都将收到该组织各自的药物使用UC（即，转介治疗）。此外，分配到UC+BI的客户将获得由两名BI培训人员之一提供的20-30分钟基于动机的BI访谈。目标1将检查3个月内酒精和其他药物（AOD）更换准备，AOD治疗天数和抗逆转录病毒治疗（ART）依从性的客户级指标的改善。目标2将检查客户层面的实施结果措施，包括对BI依从性和能力的独立评级评估（即，BI完整性）由经过培训的评分员进行，该评分员对条件分配不知情。最后，目标3将包括估计实施战略的成本，这将从计划提供者的角度来衡量，以增加结果的实际效用，相对成本效益为 这两个实施条件是使用增量成本效益比（ICER）和成本效益可接受性曲线（CEAC）进行评估的。尽管艾滋病毒/艾滋病感染者使用药物与精神问题增加、艾滋病毒抑制效果较差、艾滋病毒药物依从性较差以及参与导致感染传播给他人的风险行为的可能性增加有关，但药物使用与艾滋病毒/艾滋病服务的整合仍然有限。拟议的研究旨在通过提供有关BI在社区艾滋病毒/艾滋病服务环境中对药物使用的有效性的新知识，以及有关如何解决真实世界环境中证据充分的实践利用不足的新知识，来解决这一差距。