The Substance Abuse Treatment to HIV care (SAT2HIV-II) Project

尽管药物使用服务与公共卫生有关，但将药物使用服务纳入艾滋病毒服务环境已 仅限于到目前为止。物质滥用干预措施，如动机访谈(MI)，已经被 在临床试验中有效，但在实践环境中实施可能具有挑战性，包括基于社区的艾滋病毒 对艾滋病毒护理至关重要的组织(艾滋病毒-CBO)。自2014年以来，拟议的研究团队已经 我在这个主题上进行了一些最具创新性的大规模实施研究，作为 药物滥用治疗到艾滋病毒护理(SAT2HIV)项目。由国家药物滥用研究所资助 (NIDA)，这项39个地点的双随机2型有效性-实施混合试验同时进行了测试 (1)以MI为基础的短期干预(MIBI)对药物滥用作为日常护理辅助的有效性 以及(2)以团队为中心的实施和可持续发展促进(ISF)作为 成瘾技术转移中心(ATTC)以员工为中心的战略(即在线培训+面对面 培训+反馈+咨询)。SAT2HIV项目的结果表明，ATTC+ISF战略 大大提高了执行效力(即执行的一致性和质量)和 干预有效性(即MIBI对减少物质滥用的有效性)。然而，即使在 ATTC+ISF的情况下，执行方面仍有改进的余地。此外，无论是研究条件，还是 结果是提供了足够的支持。因此，有必要进行执行研究，以确定 可以进一步改善ATTC+ISF战略之外的成果。根据实施效果 理论、实施环境(即预期、支持和奖励实施的程度) 是实施战略影响实施的关键变革机制 有效性。尽管ISF战略已经寻求通过改进来最大化实施效果 实施环境，拟议的研究小组先前的实施研究表明，按绩效支付薪酬 (P4P；即实现预定目标的货币奖金)是一种可能显著 提高ATTC+ISF战略的有效性。因此，我们的研究团队提出了SAT2HIV-II 项目，一项30个站点的随机群组第三类有效性-实施混合试验，以测试有效性 P4P(即比较ATTC+ISF策略和ATTC+ISF+P4P策略)显著提高 执行成果(主要目标)和客户成果(次要目标)。2019年结束艾滋病毒 疫情倡议寻求在10年内结束艾滋病毒的流行。这一目标是可以实现的，但可能不会实现 在不改进物质使用服务纳入艾滋病毒服务环境的程度的情况下，这是可能的。 虽然SAT2HIV-II项目的重点是测试战略，以改善MIBI对 在药物滥用方面，所获得的知识可以帮助艾滋病毒--社区组织改进其他创新的整合。 因此，SAT2HIV-II项目有可能对改善公共卫生产生巨大和持续的影响。

Despite its relevance to public health, the integration of substance use services into HIV service settings has been limited to date. Substance misuse interventions such as motivational interviewing (MI) have been effective in clinical trials but can be challenging to implement in practice settings, including HIV community-based organizations (HIV-CBOs) that are essential to HIV care. Since 2014, the proposed research team has been conducting some of the most innovative, large-scale implementation research on this topic as part of the Substance Abuse Treatment to HIV Care (SAT2HIV) project. Funded by the National Institute on Drug Abuse (NIDA), this 39-site, dual-randomized, type 2 effectiveness-implementation hybrid trial simultaneously tested (1) the effectiveness of an MI-based brief intervention (MIBI) for substance misuse as an adjunct to usual care and (2) the effectiveness of team-focused Implementation & Sustainment Facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center’s (ATTC’s) staff-focused strategy (i.e., online training + in-person training + feedback + consultation). Results from the SAT2HIV project showed that the ATTC+ISF strategy significantly improved implementation effectiveness (i.e., consistency and quality of implementation) and intervention effectiveness (i.e., effectiveness of MIBI to reduce substance misuse). However, even in the ATTC+ISF condition, room for improvement in implementation remained. Additionally, neither study condition resulted in sufficient sustainment. Thus, there is a need for implementation research to identify strategies that can further improve outcomes beyond the ATTC+ISF strategy. According to implementation effectiveness theory, implementation climate (i.e., the extent to which implementation is expected, supported, and rewarded) is a key mechanism of change through which an implementation strategy impacts implementation effectiveness. Although the ISF strategy already seeks to maximize implementation effectiveness by improving implementation climate, the proposed research team’s prior implementation research suggests that pay-for-performance (P4P; i.e., monetary bonuses for achieving predefined targets) is a strategy that may significantly enhance the effectiveness of the ATTC+ISF strategy. Thus, our research team proposes the SAT2HIV-II project, a 30-site, cluster-randomized, type 3 effectiveness-implementation hybrid trial to test the effectiveness of P4P (i.e., compare the ATTC+ISF strategy and the ATTC+ISF+P4P strategy) to significantly improve implementation outcomes (primary aim) and client outcomes (secondary aim). The 2019 Ending the HIV Epidemic initiative seeks to end the HIV epidemic within 10 years. This goal is achievable but may not be possible without improving the extent to which substance use services are integrated into HIV service settings. Although the SAT2HIV-II project focuses on testing strategies to improve the integration of an MIBI for substance misuse, the knowledge gained could help HIV-CBOs improve the integration of other innovations. As such, the SAT2HIV-II project has potential to have a large and sustained impact on improving public health.