Motivational interviewing implementation-effectiveness trial in multidisciplinary adolescent HIV settings

多学科青少年艾滋病毒环境中动机性访谈实施效果试验

• 批准号: 9546875
• 负责人: SYLVIE NAAR
• 金额: $ 62.05万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9546875
• 关键词: Address; Adherence; Adolescent; Behavior; Behavior Therapy; Behavioral Research; Caring; Clinic; Clinic Visits; Clinical; Communication; Community Practice; Community of Practice; Competence; Data; Educational workshop; Effectiveness; Elements; Equilibrium; Evidence based practice; Goals; Guidelines; HIV; HIV risk; Healthcare; Hybrids; Individual; Intervention; Interview; Investigation; Link; Maintenance; Measurement; Methods; Modeling; Monitor; Motivation; NIH Office of AIDS Research; Outcome; Patients; Phase; Preparation; Process; Provider; Qualitative Methods; Randomized; Research; Role; Science; Self Management; Series; Services; Site; Testing; Training; Viral Load result; Waiting Lists; Work; Youth; base; behavior change; cost effectiveness; design; effectiveness trial; flexibility; follow-up; implementation research; implementation science; improved; innovation; motivational enhancement therapy; multidisciplinary; programs; scale up; success; treatment as usual; uptake

Motivational Interviewing (MI) is the only behavioral intervention to date shown to be effective to improve self- management for youth living with HIV. Implementation science is the scientific study of methods to promote the uptake of research findings and evidence-based practice (EBP) to improve the quality and effectiveness of behavior change approaches such as MI in health care settings. A primary challenge of scaling up EBPs is to balance flexibility (adaptation to context) and fidelity (provider adherence and competence). The goal of this proposal is to test a multi-faceted Tailored MI Implementation intervention (“TMI”) based on the dynamic adaptation process to scale up an EBP in multidisciplinary adolescent HIV care settings while balancing flexibility and fidelity. The dynamic adaptation process guides tailoring of MI implementation through a series of phases: exploration, preparation, implementation, and sustainment. The proposed project is a hybrid implementation-effectiveness (Type 3) trial. We will test the effect of TMI on fidelity to the EBP, and secondarily on HIV care cascade-related outcomes, using a dynamic wait-listed design with 165 providers nested within 10 ATN4 HIV sites. With this design, the clinics will be randomly assigned in 5 clusters to receive TMI. For each randomization, 2 clinics receive TMI and the others remain in the wait-list condition. This will continue until the 5th cluster has been randomized to TMI. After one year of TMI’s external facilitation, a second randomization will compare internal facilitator monitoring and coaching plus the encouragement of Communities of Practice versus Communities of Practice alone. Fidelity will be assessed on a quarterly basis through the 24 months of intervention and an additional 6 months of follow-up. We will nest our qualitative method (in-depth interviews) within the quantitative study to provide a deeper understanding of the implementation context and understand why or why not MI is integrated with fidelity across the 150 providers. Providers and key stakeholders will complete qualitative interviews and brief assessments at baseline, after one year of TMI (first randomization), and after 1 year of follow-up (second randomization). We hypothesize that MI competency ratings will be higher among providers during the TMI phase compared to the treatment as usual phase. We also expect that successful implementation will be associated with improved cascade-related outcomes, namely undetectable viral load and greater number of clinic visits among youth living with HIV as well as increased numbers of youth tested and linked to care.

动机访谈（MI）是迄今为止唯一被证明能有效提高自我的行为干预。 艾滋病毒感染青年的管理。执行学是研究方法促进的科学 吸收研究成果和循证实践（EBP），以提高质量和有效性， 行为改变方法，如医疗保健环境中的MI。扩大EBP的主要挑战是 平衡灵活性（适应环境）和忠诚度（提供者的遵守和能力）。这个目标 一项建议是测试一个多方面的定制MI实施干预（“TMI”）的基础上的动态 在多学科青少年艾滋病毒护理环境中扩大EBP的适应过程， 灵活性和忠诚度。动态适应过程通过一系列 阶段：探索、准备、实施和维持。拟议的项目是一个混合体 实施有效性（第3类）试验。我们将测试TMI对EBP保真度的影响，其次是 艾滋病毒护理级联相关成果，采用动态等待名单设计，165个提供者嵌套在10个 ATN4艾滋病毒站点。在这种设计下，诊所将被随机分配到5个群组接受TMI。为每个 随机化后，2家诊所接受TMI，其他诊所仍处于等待状态。这将持续到 第5个群集已随机分配至TMI。经过一年的TMI的外部促进，第二次随机化， 我将比较内部辅导员的监督和辅导，以及对实践社区的鼓励 与实践社区相比。富达将在24个月内按季度进行评估， 干预和额外6个月的随访。我们将嵌套我们的定性方法（深入访谈） 在定量研究中，更深入地了解实施背景， 为什么或为什么不MI与150个提供商的保真度集成。供应商和主要利益相关者将 在基线时完成定性访谈和简要评估，TMI一年后（首次随机化）， 随访1年后（第二次随机化）。我们假设，MI能力评级将是 与常规治疗阶段相比，在TMI阶段提供者中的比例更高。我们也期待 成功的实施将与改进级联相关的结果相联系，即不可检测 感染艾滋病毒的青年的病毒载量和就诊人数增加， 测试并与护理联系起来。