Alcohol Research Consortium in HIV: Implementation Research Arm

Despite availability of evidence-based alcohol reduction interventions (EBI), unhealthy alcohol use remains a barrier to HIV medication adherence, viral suppression and retention in HIV care and consequently HIV treatment as prevention (TASP). As such, optimizing translation of alcohol EBIs into clinical HIV clinical practice is an important aspect of U.S.

Ending the HIV Epidemic initiatives.

Guided by complementary implementation and evaluation frameworks?the Consolidated Framework for Implementation Research (CFIR) and RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance), we will conduct a Hybrid Type 3 effectiveness-implementation evaluating implementation outcomes as primary and effectiveness outcomes as secondary.

We will specifically test whether practice facilitation, an evidence-based multifaceted implementation strategy, increases reach, adoption, implementation, and maintenance of stepped care for unhealthy alcohol use (our clinical intervention) in three Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) HIV clinics located in Boston, San Diego, and Chapel Hill.

We will secondarily test whether practice facilitation is associated with decreased unhealthy alcohol use, and improved ART adherence and viral suppression at the patient level.

In practice facilitation, a practice coach will offer tools, resources, hands-on guidance, and content expertise to assist sites in offering a stepped care model of alcohol treatment to patients with unhealthy alcohol use. Stepped care will include brief intervention, cognitive behavioral therapy, and alcohol pharmacotherapy.

To align with patient and provider preferences, flexible modes of intervention delivery (in-person, telemedicine, and computer-delivered) will be available.

The practice facilitation intervention will be rolled out sequentially across sites, allowing prior experiences to inform future implementation.

There will be three phases at each site: pre-implementation planning, implementation with formative evaluation, and post-implementation summative evaluation.

Using mixed methods, we specifically propose to meet the following specific aims: (Aim 1) Tailor the practice facilitation intervention to each site using mixed methods (pre-implementation); (Aim 2a) Determine the effect of practice facilitation on reach, adoption, and maintenance of evidence-based alcohol treatment using mixed methods (formative evaluation); (Aim 2b) Determine the effects of practice facilitation on implementation of stepped care (primary) and alcohol use and HIV-related outcomes (secondary) using interrupted time series analysis with synthetic controls (summative evaluation) and (Aim 3) Describe barriers and facilitators to implementation of alcohol- related interventions at each site to describe maintenance and inform widespread sustainable implementation.

Our study capitalizes on our strong transdisciplinary team and is well aligned with OAR priorities of addressing TASP barriers, HIV related comorbidities, and advancing cross-cutting research in implementation science.