Substance Abuse Treatment to HIV Care (SAT2HIV)

描述（由申请人提供）：拟议的研究是2型有效性-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）在基于社区的艾滋病毒/艾滋病服务组织内的物质使用的有效性，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（atcs，即员工研讨会培训+反馈+指导）目前使用的实施策略中增加一个名为实施和维持促进（ISF）的组织层面实施干预的有效性。目标3将检查ISF实施干预的增量成本效益。在这个为期五年的项目中，42个基于社区的艾滋病毒/艾滋病服务组织将被随机分配到两种实施条件之一（仅ATTC与ATTC+ISF）。在不同情况下，将从每个参与的艾滋病组织中随机抽取两名前线艾滋病服务机构的工作人员，并邀请他们接受惯常的以员工为中心的商业智能培训模式。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，将从42个组织（总共3,024个客户）中的每一个组织中随机抽取大约72个客户

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.