Working with HIV clinics to adopt addiction treatments using Implementation Facilitation (WHAT IF?)

 描述(由申请人提供)：烟草、酒精和阿片类药物使用障碍威胁艾滋病毒感染者的健康。如果艾滋病毒诊所常规提供针对烟草、酒精和阿片类药物使用障碍的循证咨询和药物治疗(在此称为成瘾治疗)，情况会怎样？实施便利化是一种既定的和可重复的战略，以增加循证治疗的接受。它是一个多组成部分的干预措施，评估主要利益相关者(管理人员、提供者、患者)的需求，并提供定制的实施战略，使用外部促进者、当地冠军、提供者教育、学术细节、利益相关者参与、绩效监测和反馈、形成性评估、学习协作和计划营销来实施循证治疗。我们的目标是评估实施便利化对四家大型艾滋病毒诊所使用成瘾治疗的影响。我们将在混合类型3研究中使用PARiHS(促进卫生服务研究实施行动)实施科学框架，以便同时评估实施情况及其有效性。我们将使用阶梯式楔形设计，随机分配诊所接受实施促进的顺序。我们的目标是：目标1-在主要利益攸关方中，使用混合方法来确定整合成瘾治疗的证据、背景和便利相关障碍和促进者，以帮助为每个诊所量身定做实施便利：目的2-评估实施便利对以下方面的影响：a)组织和提供者提供成瘾治疗的准备情况，b)提供成瘾治疗的情况，c)提供成瘾治疗的组织模式的变化；以及目标3--评估实施便利化对有资格接受成瘾治疗的患者接受抗逆转录病毒治疗、病毒抑制、Vacs指数(有效衡量死亡风险)和保留艾滋病毒护理的影响。该提案的新颖方面包括：1)在艾滋病毒诊所使用实施促进来解决一系列障碍，而不是单一物质使用障碍，2)将管理者、提供者和患者的意见纳入艾滋病毒诊所成瘾治疗的实施，3)用于评估艾滋病毒诊所对成瘾治疗的短期和长期吸收的混合实施-有效性设计，4)侧重于组织模式，确保在临床一级整合成瘾治疗，但允许根据利益相关者的投入和滥用物质灵活地提供这些治疗，5)Vacs指数的使用更好地反映了禁欲对健康的好处，而不是关注病毒载量，尽管持续使用烟草、酒精或阿片类药物，但在接受抗逆转录病毒治疗的患者中，病毒载量可能会被抑制。与艾滋病毒诊所合作，利用执行便利化采用成瘾治疗(如果呢？)这项研究特别有希望确定一项有效的战略，以增加艾滋病毒诊所对成瘾治疗的接受，从而扭转其对发病率和死亡率的破坏性影响。

 DESCRIPTION (provided by applicant): Tobacco, alcohol and opioid use disorders threaten the health of HIV-infected patients. What if evidence-based counseling and medication treatments for tobacco, alcohol and opioid use disorders (herein referred to as addiction treatments) were routinely provided in HIV clinics? Implementation Facilitation is an established and reproducible strategy to increase the uptake of evidence-based treatments. It is a multi-component intervention that assesses key stakeholder's (administrators, providers, patients) needs and provides a tailored implementation strategy using an external facilitator, local champions, provider education, academic detailing, stakeholder engagement, performance monitoring and feedback, formative evaluations, learning collaborative and program marketing to implement evidence-based treatments. Our goal is to evaluate the impact of Implementation Facilitation on the use of addiction treatments in four large HIV clinics. We will use the PARiHS (Promoting Action on Research Implementation in Health Services) Implementation Science framework in a Hybrid Type 3 study that allows for simultaneous evaluation of the implementation and its effectiveness. We will use a stepped wedge design that randomly assigns the order in which the clinics receive Implementation Facilitation. Our aims are: Aim 1-Among key stakeholders, to use mixed methods to identify evidence, context and facilitation-related barriers and facilitators to the integration of addiction treatments to help tailor an Implementation Facilitation for each clinic: Aim 2-To assess the impact of Implementation Facilitation on: a) organizational and provider readiness to deliver addiction treatments, b) the provision of addiction treatments, c) changes in organizational models used to deliver addiction treatments; and Aim 3- To evaluate the impact of Implementation Facilitation on antiretroviral receipt, viral suppression, VACS Index (a validated measure of mortality risk) and retention in HIV care among patients eligible for addiction treatment. The novel aspects of this proposal include: 1) the use of Implementation Facilitation to address a range of disorders, rather than a single substance use disorder in HIV clinics, 2) incorporation of administrator, provider and patient input into the implementation of addiction treatment in HIV clinics, 3) a hybrid implementation- effectiveness design for assessing short and long-term uptake of addiction treatments in HIV clinics, 4) a focus on organizational models that ensure that there is integration of addiction treatments at the clinic level but allows flexibility as to who provides these treatments based on stakeholder input and the abused substance, and 5) the use of the VACS Index that better reflects the health benefits of abstinence than a focus on viral load which may be suppressed in patients on antiretroviral treatment despite ongoing tobacco, alcohol or opioid use. The Working with HIV Clinics to adopt Addiction Treatments using Implementation Facilitation (WHAT IF?) study holds exceptional promise of identifying an effective strategy to increasing the uptake of addiction treatments into HIV clinics thereby reversing their devastating impact on morbidity and mortality.