Substance Abuse Treatment to HIV Care (SAT2HIV)

描述(申请人提供)：建议的研究是一项II型有效性-实施混合试验。目标1将在实验中测试基于激励性访谈的短暂干预(BI)相对于常规护理(UC)在社区艾滋病毒/艾滋病服务组织中使用物质的有效性。目标2将测试在SAMHSA资助的成瘾技术治疗中心(ATTC；即工作人员讲习班培训反馈指导)目前使用的实施战略中增加一种名为实施和持续促进(ISF)的组织一级实施干预措施的有效性。目标3将审查国际安全框架执行干预措施的增量成本效益。在这项为期五年的项目中，42个以社区为基础的艾滋病毒/艾滋病服务组织将被随机分配到两种实施条件中的一种(ATTC-Only与ATTC ISF)。在不同的条件下，每个参与的艾滋病毒/艾滋病服务组织将随机挑选两名前线艾滋病毒/艾滋病服务组织的工作人员，并邀请他们接受通常以ATTC工作人员为重点的商务智能培训模式。此外，被分配到ATTC ISF条件下的艾滋病毒/艾滋病组织将接受ISF干预，其重点是向组织领导层提供反馈和指导。在研究的初始实施阶段，42个组织中每个组织的大约72名客户(总共3024名客户)将随机分为两组 临床情况(UC与UC BI)。在这两种情况下的患者将接受组织各自的UC物质使用(即转介到治疗)。此外，分配给UC BI的客户将获得20-30分钟的激励性面试，由两名受过BI培训的员工之一提供。目标1将检查客户级别的酒精和其他药物(AOD)变化准备情况、AOD治疗天数和抗逆转录病毒治疗(ART)依从性的3个月改进情况。目标2将审查客户一级的实施成果衡量标准，包括由训练有素的评分员对BI遵从性和能力(即BI完整性)进行的独立评级评估，而不考虑条件分配。最后，目标3将包括估计执行战略的费用，这将从方案提供者的角度进行衡量，以增加成果的实际有用性，并具有相对成本效益。 使用增量成本效益比(ICER)和成本效益可接受曲线(CEAC)对这两个执行条件进行评估。虽然艾滋病毒/艾滋病患者的物质使用与精神问题增加、艾滋病毒病毒抑制较差、艾滋病毒用药依从性较差以及从事导致感染传播给他人的危险行为的可能性增加有关，但物质使用和艾滋病毒/艾滋病服务的整合仍然有限。拟议的研究试图通过提供关于在以社区为基础的艾滋病毒/艾滋病服务环境中使用物质的商业智能的有效性的新知识，以及关于如何解决在现实世界环境中充分利用基于证据的做法的新知识来解决这一差距。

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.