Advancing Integrated Alcohol-HIV Training of Frontline Providers in a Global Priority Setting

项目摘要 南非是全球艾滋病毒流行病的中心，拥有最多的个人人口 艾滋病毒感染者的数量南非的饮酒率也令人震惊，这对非洲的经济发展构成了重大影响。 艾滋病毒护理级联的挑战。酒精-艾滋病毒综合护理是黄金标准，但提供综合护理 在南非，这是非常罕见的。为了促进治疗一体化，南非艾滋病毒ATTC（由M- PIs Becker，Kuo和Sibeko）成立于2017年10月。南非艾滋病毒ATTC是一个全国性的 该中心由药物滥用和精神卫生服务管理局（SAMHSA）和 总统艾滋病紧急救援计划（PEPFAR），致力于为卫生专业人员提供培训 以及为艾滋病患者、酗酒者和其他精神健康问题患者提供服务的非专业工作者。每年 在此基础上，南非艾滋病毒ATTC负责培训1,000人，作为推动接受 以证据为基础的方法来解决全国各地的酒精艾滋病毒。认识到有害的 重度饮酒和酒精使用障碍对艾滋病毒护理级联的影响，并应对 南非艾滋病毒ATTC正在对国家利益相关者和政策制定者进行评估， 关于危险酒精筛查、短暂干预和转诊治疗的国家培训倡议 使用.南非艾滋病毒ATTC将采用一种新的任务分担方法，提供SBIRT培训， 为900多名卫生专业人员和艾滋病毒治疗组织的非专业工作者提供咨询 在三年的时间里。推出这一国家倡议提供了前所未有的发展机会 在全球优先地点实施酒精-艾滋病毒综合治疗科学。然而，研究和 南非艾滋病毒ATTC收集的数据受到SAMSHA和PEPFAR资助的严格限制 溪流事实上，南非艾滋病毒ATTC目前收集的唯一数据是一份简短的SAMHSA要求的 政府绩效和报告法案（GPRA）工具，该工具衡量 培训参与者。因此，本研究建议先编纂，再进行综合评价 一系列关键实施科学结构的培训有效性。研究活动将在 三个阶段。首先，我们将开发一个SBIRT培训员手册，其中包括一个编码系统， 培训保真度，这将大大提高拟议培训推出的严谨性。第二，我们将评估 SBIRT培训员培训模式在关键实施科学成果方面的有效性， 训练者（例如，忠诚度，知识），提供者（例如，态度、自我效能、可接受性）和患者水平 (e.g.,接受SBIRT每个组成部分（筛查、短暂干预和转诊）的患者比例 治疗）。最后，我们将检查培训师层面、提供者层面和患者层面之间的关系 结果。这项研究的结果将推进关键实施科学问题的知识， 促进将酒精和艾滋病毒护理纳入全球优先事项。

PROJECT SUMMARY South Africa is at the epicenter of the global HIV pandemic with the largest country population of individuals living with HIV in the world. South Africa also has alarming rates of alcohol use, which pose a significant challenge to the HIV care cascade. Integrated alcohol-HIV care is the gold standard, but delivery of integrated care in South Africa is extremely rare. To promote treatment integration, the South Africa HIV ATTC (led by M- PIs Becker, Kuo, and Sibeko) was established in October 2017. The South Africa HIV ATTC is a national center, jointly funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the President’s Emergency Plan for AIDS Relief (PEPFAR), dedicated to providing training to health professionals and lay workers who serve patients with HIV, alcohol use, and other mental health problems. On an annual basis, the South Africa HIV ATTC is charged with training 1,000 individuals as a means of driving the uptake of evidence-based approaches to address alcohol-HIV throughout the country. Recognizing the detrimental effects of heavy alcohol use and alcohol use disorders on the HIV care cascade, and in response to a needs assessment of national stakeholders and policy-makers, the South Africa HIV ATTC is preparing to roll out a national training initiative on Screening, Brief Intervention, and Referral to Treatment (SBIRT) for risky alcohol use. Using a novel task sharing approach, the South Africa HIV ATTC will provide SBIRT training and ongoing consultation to over 900 health professionals and lay workers embedded within HIV treatment organizations over a three-year period. Rollout of this national initiative presents unparalleled opportunities to advance implementation science for integrated alcohol-HIV treatment in a global priority site. However, research and data collected by the South Africa HIV ATTC is severely restricted under the SAMSHA and PEPFAR funded streams. Indeed, the only data currently collected by the South Africa HIV ATTC is a brief SAMHSA-required form called the Government Performance and Reporting Act (GPRA) tool, which measures satisfaction of training attendees. Thus, the current study proposes to first codify and then conduct comprehensive evaluation of training effectiveness on a range of key implementation science constructs. Study activities will occur across three phases. First, we will develop a SBIRT train-the-trainer manual consisting of a coding system to measure training fidelity, which will greatly enhance the rigor of the proposed training rollout. Second, we will evaluate the effectiveness of the SBIRT train-the-trainer model on key implementation science outcomes measured at the trainer (e.g., fidelity, knowledge), provider (e.g., attitudes, self-efficacy, acceptability), and patient levels (e.g., proportion of patients who receive each component of SBIRT – screening, brief intervention, and referral to treatment). Finally, we will examine the relationship among trainer-level, provider-level, and patient-level outcomes. Results of this study will advance knowledge of key implementation science questions, while promoting the integration of alcohol and HIV care, in a global priority setting.