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

项目总结 南非是全球艾滋病毒大流行的中心，是世界上个人人口最多的国家 世界上艾滋病毒携带者的生活。南非也有惊人的酒精使用率，这对 对艾滋病毒护理瀑布的挑战。酒精-艾滋病毒综合护理是黄金标准，但提供综合 护理在南非是极其罕见的。为促进治疗一体化，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是一家全国性的 中心，由药物滥用和精神健康服务管理局(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 以及为艾滋病毒患者、酗酒患者和其他精神健康问题患者提供服务的非专业工作人员。一年一次 在此基础上，南非艾滋病毒ATTC负责培训1000人，以此作为推动吸纳 在全国范围内采取循证办法解决酗酒艾滋病毒问题。认识到有害的 酗酒和酒精使用障碍对艾滋病毒护理级联的影响，以及对需求的反应 对国家利益攸关方和政策制定者的评估，南非艾滋病毒ATTC正准备推出一项 危险酒精筛查、短期干预和转诊治疗(SBIRT)国家培训计划 使用。利用一种新的任务分担办法，南非艾滋病毒防治中心将提供SBIRT培训和正在进行的 向900多名艾滋病毒治疗组织中的卫生专业人员和非专业人员提供咨询 在三年内。这一国家倡议的推出提供了无与伦比的推进机会 全球优先地点酒精-艾滋病毒综合治疗的实施科学。然而，研究和 南非艾滋病毒ATTC收集的数据在SAMSHA和PEPFAR资助下受到严格限制 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-Required 被称为政府绩效和报告法(GPRA)工具的表格，该工具衡量对 培训参与者。因此，本研究建议先进行编纂，然后进行综合评价 对一系列关键实施科学结构的培训有效性进行评估。学习活动将在以下地点进行 三个阶段。首先，我们将开发SBIRT培训培训员手册，该手册由一个编码系统组成，用于测量 培训保真度，这将大大提高拟议培训推广的严谨性。第二，我们将评估 SBIRT培训教员模式在关键实施科学成果方面的有效性 培训者(例如，忠诚度、知识)、提供者(例如，态度、自我效能、可接受性)和患者级别 (例如，接受SBIRT筛查、简短干预和转诊各部分的患者比例 到治疗)。最后，我们将检查培训师级别、提供者级别和患者级别之间的关系 结果。这项研究的结果将促进对关键实施科学问题的了解，同时 在全球优先事项中促进酒精与艾滋病毒护理的结合。

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.