Identifying and Disseminating Substance, Treatment, and Strategy (STS) Recommendations to AIDS Service Organizations

项目摘要/摘要 艾滋病毒/艾滋病携带者中的物质使用障碍非常普遍和有问题， 减少护理中的滞留、服药依从性和病毒抑制，并显著提高 新感染艾滋病毒的风险。广泛认识到艾滋病毒/艾滋病并存的流行率和问题性质 物质使用障碍引发了改善物质使用障碍服务整合的迫切呼吁 (SUDSI)在艾滋病毒/艾滋病环境中。然而，尽管十多年来一直呼吁在 艾滋病服务组织(ASOS)，这仍然是一个迫切需要。因此，提议的一个关键推动因素 应用是需要在ASOS内改进SUDSI(迫切需要#)。这是另一个关键的推动力 应用程序是更广泛且可以说更迫切的需要，以改进关于如何 最好沿着探索、准备、实施、 维持(EPIS)在现实世界环境中的连续体(紧急需求2)。为了解决这两个紧迫的需求， 我们的研究团队将实现两个具体目标。具体目标1将根据经验确定利益相关者驱动的 物质治疗战略(STS)建议在全国范围内改善ASOS内的SUDSI。 更具体地说，将进行三个连续的实时Delphi，以经验地识别多个 物质(如酒精)、治疗(如激励性访谈)、战略(如讲习班培训+ 反馈+指导)对被发现对艾滋病毒护理连续体产生负面影响的物质进行组合。特定的 目标1很重要，因为它将产生STS建议，这些建议将指导数百个ASO 美国致力于改善其组织内的SUDSI(迫切需要#1)。特定目标2将 实验测试外部促进(EF；交互问题的过程)的增量有效性 在认识到需要改进和支持的情况下进行的解决和支持 人际关系)，以促进基于经验的创新的进步(即STS 建议)，超出了通过通常的传播(即，邮件， 电子邮件、网站帖子)。目标2意义重大，因为系统审查得出的结论是，这种常见的 传播策略是传播基于经验的创新的重要但不充分的方式 超越EPIS连续体的探索阶段。此外，尽管有证据支持外部 在EPIS连续体的中间两个阶段(准备和实施)期间，没有研究 通过实验测试了外部促进在关键勘探期间的有效程度 在这一阶段，特别是在其通过通常的传播所取得的递增效力方面，并不是如此。 因此，目标2具有额外的意义，因为它将推进关于如何最好地 将基于经验的创新从EPIS模型的探索阶段转移到后续的EPIS模型 现实世界环境中的阶段(迫切需要#2)。

PROJECT SUMMARY/ABSTRACT Substance use disorders among individuals living with HIV/AIDS are highly prevalent and problematic, leading to decreased retention in care, medication adherence, and viral suppression and significantly increasing the risk of new HIV infections. Wide recognition of the prevalence and problematic nature of comorbid HIV/AIDS and substance use disorders has led to urgent calls to improve substance use disorder service integration (SUDSI) within HIV/AIDS settings. However, despite more than a decade of calls to improve SUDSI within AIDS Service Organizations (ASOs), this remains an urgent need. As such, a key impetus for the proposed application is the need to improve SUDSI within ASOs (urgent need #1). Another key impetus for this application is the broader and arguably more urgent need to improve generalizable knowledge regarding how best to advance empirically based innovations along the Exploration, Preparation, Implementation, Sustainment (EPIS) continuum within real-world settings (urgent need #2). To address these two urgent needs, our research team will achieve two specific aims. Specific Aim 1 will empirically identify stakeholder-driven Substance-Treatment-Strategy (STS) recommendations for improving SUDSI within ASOs across the nation. More specifically, three sequential Real-Time Delphi's will be conducted to empirically identify multiple substance (e.g., alcohol), treatment (e.g., motivational interviewing), strategy (e.g., workshop training + feedback + coaching) combinations for substances found to negatively impact the HIV care continuum. Specific Aim 1 is significant because it will result in STS recommendations that will guide hundreds of ASOs across the United States towards improving SUDSI within their organization (urgent need #1). Specific Aim 2 will experimentally test the incremental effectiveness of external facilitation (EF; A process of interactive problem solving and support that occurs in a context of a recognized need for improvement and a supportive interpersonal relationship) for improving the advancement of empirically based innovations (i.e., the STS recommendations) along the EPIS continuum beyond what can be achieved via usual dissemination (i.e., mail, email, website postings). Aim 2 is significant because systematic reviews have concluded that such usual dissemination strategies are important yet insufficient ways to disseminate empirically based innovations beyond the exploration phase of the EPIS continuum. Additionally, although evidence supports external facilitation during the EPIS continuum's middle two phases (preparation, implementation), no research has experimentally tested the extent to which external facilitation can be effective during the critical exploration phase, especially not in terms of its incremental effectiveness beyond what is achieved via usual dissemination. Thus, Aim 2 has additional significance given it will advance generalizable knowledge regarding how best to move empirically based innovations from the EPIS model's exploration phase to subsequent EPIS model phases within real-world settings (urgent need #2).