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

项目总结/摘要 艾滋病毒/艾滋病感染者中的药物使用障碍非常普遍，问题很多， 减少护理保留，药物依从性和病毒抑制，并显着增加 新的艾滋病毒感染的风险。广泛认识到艾滋病毒/艾滋病共病的流行和问题性质 和物质使用障碍导致迫切要求改善物质使用障碍服务整合 在艾滋病毒/艾滋病背景下的SUDSI。然而，尽管十多年来一直呼吁改善SUDSI， 艾滋病服务组织（ASO），这仍然是一个迫切需要。因此，拟议的 应用是需要改善ASO内的SUDSI（紧急需求#1）。另一个关键的推动力 应用是更广泛和更紧迫的需要，以提高有关如何 最好是沿着探索、准备、实施， 在现实世界环境中的可持续性（EPIS）连续体（紧急需求#2）。为了满足这两个迫切需要， 我们的研究小组会达致两个目标。具体目标1将根据经验确定股东驱动的 物质治疗策略（STS）建议改善全国各地ASO内的SUDSI。 更具体地说，将进行三次连续的实时德尔菲，以经验性地确定多个 物质（例如，酒精），治疗（例如，动机面试），策略（例如，工作坊培训+ 反馈+指导）组合，用于发现对艾滋病毒护理连续性产生负面影响的物质。具体 目标1是重要的，因为它将产生STS建议，这些建议将指导整个 美国致力于改善其组织内的SUDSI（紧急需求#1）。具体目标2将 实验测试外部促进的增量有效性（EF;互动问题的过程 解决和支持，发生在一个公认的需要改进的背景下， 人际关系）以改善基于经验的创新的进步（即，的STS 沿着EPIS连续体，超出了通过通常的传播可以实现的目标（即，邮件， 电子邮件、网站帖子）。目标2是重要的，因为系统评价得出的结论是， 传播战略是重要的，但不足以传播基于经验的创新 超越EPIS连续体的探索阶段。此外，虽然有证据表明， 在EPIS连续体的中间两个阶段（准备，实施），没有研究 实验测试了外部促进在关键探索过程中的有效程度 这是一个阶段，特别是不是在其增量效果超过了通过通常的传播所取得的。 因此，目标2具有额外的意义，因为它将促进关于如何最好地 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 在现实世界中的设置阶段（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).