Motivational interviewing implementation-effectiveness trial in multidisciplinary adolescent HIV settings

动机访谈(MI)是迄今为止被证明对提高自我有效的唯一行为干预 对感染艾滋病毒的青少年的管理。实施科学是对方法的科学研究，以促进 吸收研究成果和循证实践(EBP)以提高质量和有效性 改变行为的方法，如医疗保健环境中的MI。扩大EBPS的主要挑战是 平衡灵活性(适应环境)和忠诚度(提供商的忠诚度和能力)。这样做的目的是 建议测试基于动态的多方面定制MI实施干预(“TMI”) 适应进程，在多学科青少年艾滋病毒护理环境中扩大EBP，同时平衡 灵活性和保真度。动态适应过程通过一系列 阶段：探索、准备、实施和维持。拟议的项目是一个混合体。 实施--有效性(类型3)试验。我们将测试TMI对EBP保真度的影响，其次是 关于艾滋病毒护理级联相关结果，使用动态等待名单设计，165个提供者嵌套在10个 ATN4个艾滋病毒感染地点。在这种设计下，诊所将被随机分配到5个集群中接受TMI。对于每个 随机抽样，2家诊所接受TMI，其余仍在等待名单中。这种情况将一直持续到 第五个簇已被随机分配到TMI。在TMI的外部促进一年后，第二次随机 将比较内部促进者监控和指导以及对实践社区的鼓励 与实践社区的对抗。Fidelity将在24个月内每季度进行一次评估 干预和另外6个月的随访。我们将嵌套我们的定性方法(深度访谈) 在量化研究中提供对实施背景和理解的更深层次的理解 为什么或为什么不将MI与150家提供商的保真度集成在一起。提供商和主要利益相关者将 在TMI(首次随机化)一年后，在基线上完成定性访谈和简短评估， 随访1年后(第2次随机分组)。我们假设MI能力评级将是 与正常治疗阶段相比，在TMI阶段提供者中的比例更高。我们还预计， 成功的实施将与改善与级联有关的结果有关，即不可检测的结果 艾滋病毒携带者青年的病毒载量和就诊次数增加，以及青年人数增加 经过测试，并与护理挂钩。

Motivational Interviewing (MI) is the only behavioral intervention to date shown to be effective to improve self- management for youth living with HIV. Implementation science is the scientific study of methods to promote the uptake of research findings and evidence-based practice (EBP) to improve the quality and effectiveness of behavior change approaches such as MI in health care settings. A primary challenge of scaling up EBPs is to balance flexibility (adaptation to context) and fidelity (provider adherence and competence). The goal of this proposal is to test a multi-faceted Tailored MI Implementation intervention (“TMI”) based on the dynamic adaptation process to scale up an EBP in multidisciplinary adolescent HIV care settings while balancing flexibility and fidelity. The dynamic adaptation process guides tailoring of MI implementation through a series of phases: exploration, preparation, implementation, and sustainment. The proposed project is a hybrid implementation-effectiveness (Type 3) trial. We will test the effect of TMI on fidelity to the EBP, and secondarily on HIV care cascade-related outcomes, using a dynamic wait-listed design with 165 providers nested within 10 ATN4 HIV sites. With this design, the clinics will be randomly assigned in 5 clusters to receive TMI. For each randomization, 2 clinics receive TMI and the others remain in the wait-list condition. This will continue until the 5th cluster has been randomized to TMI. After one year of TMI’s external facilitation, a second randomization will compare internal facilitator monitoring and coaching plus the encouragement of Communities of Practice versus Communities of Practice alone. Fidelity will be assessed on a quarterly basis through the 24 months of intervention and an additional 6 months of follow-up. We will nest our qualitative method (in-depth interviews) within the quantitative study to provide a deeper understanding of the implementation context and understand why or why not MI is integrated with fidelity across the 150 providers. Providers and key stakeholders will complete qualitative interviews and brief assessments at baseline, after one year of TMI (first randomization), and after 1 year of follow-up (second randomization). We hypothesize that MI competency ratings will be higher among providers during the TMI phase compared to the treatment as usual phase. We also expect that successful implementation will be associated with improved cascade-related outcomes, namely undetectable viral load and greater number of clinic visits among youth living with HIV as well as increased numbers of youth tested and linked to care.