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Testing a Motivational Interviewing Implementation Intervention in Adolescent HIV Clinics: Protocol for a Type 3, Hybrid Implementation-Effectiveness Trial.
JMIR Res Protoc. 2019 Jun 07; 8(6):e11200.JR

Abstract

BACKGROUND

Motivational interviewing (MI) has been shown to effectively improve self-management for youth living with HIV (YLH) and has demonstrated success across the youth HIV care cascade-currently, the only behavioral intervention to do so. Substantial barriers prevent the effective implementation of MI in real-world settings. Thus, there is a critical need to understand how to implement evidence-based practices (EBPs), such as MI, and promote behavior change in youth HIV treatment settings as risk-taking behaviors peak during adolescence and young adulthood.

OBJECTIVE

This study aims to describe the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) protocol of a tailored MI (TMI) implementation-effectiveness trial (ATN 146 TMI) to scale up an EBP in multidisciplinary adolescent HIV settings while balancing flexibility and fidelity. This protocol is part of the Scale It Up program described in this issue.

METHODS

This study is a type 3, hybrid implementation-effectiveness trial that tests the effect of TMI on fidelity (MI competency and adherence to program requirements) while integrating findings from two other ATN protocols described in this issue-ATN 153 Exploration, Preparations, Implementation, Sustainment and ATN 154 Cascade Monitoring. ATN 153 guides the mixed methods investigation of barriers and facilitators of implementation, while ATN 154 provides effectiveness outcomes. The TMI study population consists of providers at 10 adolescent HIV care sites around the United States. These 10 clinics are randomly assigned to 5 blocks to receive the TMI implementation intervention (workshop and trigger-based coaching guided by local implementation teams) utilizing the dynamic wait-listed controlled design. After 12 months of implementation, a second randomization compares a combination of internal facilitator coaching with the encouragement of communities of practice (CoPs) to CoPs alone. Participants receive MI competency assessments on a quarterly basis during preimplementation, during the 12 months of implementation and during the sustainment period for a total of 36 months. We hypothesize that MI competency ratings will be higher among providers during the TMI implementation phase compared with the standard care phase, and successful implementation will be associated with improved cascade-related outcomes, namely undetectable viral load and a greater number of clinic visits among YLH.

RESULTS

Participant recruitment began in August 2017 and is ongoing. As of mid-May 2018, TMI has 150 active participants.

CONCLUSIONS

This protocol describes the underlying theoretical framework, study design, measures, and lessons learned for TMI, a type 3, hybrid implementation-effectiveness trial, which has the potential to scale up MI and improve patient outcomes in adolescent HIV settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03681912; https://clinicaltrials.gov/ct2/show/NCT03681912 (Archived by WebCite at http://www.webcitation.org/754oT7Khx).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/11200.

Authors+Show Affiliations

College of Medicine, Florida State University, Tallahassee, FL, United States.Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, United States.Oregon Social Learning Center, Eugene, OR, United States.Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, United States.Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States.Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States.Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States.Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States. Health Psychology and Clinical Science Doctoral Program, Graduate Center, City University of New York, New York, NY, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31237839

Citation

Naar, Sylvie, et al. "Testing a Motivational Interviewing Implementation Intervention in Adolescent HIV Clinics: Protocol for a Type 3, Hybrid Implementation-Effectiveness Trial." JMIR Research Protocols, vol. 8, no. 6, 2019, pp. e11200.
Naar S, MacDonell K, Chapman JE, et al. Testing a Motivational Interviewing Implementation Intervention in Adolescent HIV Clinics: Protocol for a Type 3, Hybrid Implementation-Effectiveness Trial. JMIR Res Protoc. 2019;8(6):e11200.
Naar, S., MacDonell, K., Chapman, J. E., Todd, L., Gurung, S., Cain, D., Dilones, R. E., & Parsons, J. T. (2019). Testing a Motivational Interviewing Implementation Intervention in Adolescent HIV Clinics: Protocol for a Type 3, Hybrid Implementation-Effectiveness Trial. JMIR Research Protocols, 8(6), e11200. https://doi.org/10.2196/11200
Naar S, et al. Testing a Motivational Interviewing Implementation Intervention in Adolescent HIV Clinics: Protocol for a Type 3, Hybrid Implementation-Effectiveness Trial. JMIR Res Protoc. 2019 Jun 7;8(6):e11200. PubMed PMID: 31237839.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Testing a Motivational Interviewing Implementation Intervention in Adolescent HIV Clinics: Protocol for a Type 3, Hybrid Implementation-Effectiveness Trial. AU - Naar,Sylvie, AU - MacDonell,Karen, AU - Chapman,Jason E, AU - Todd,Lisa, AU - Gurung,Sitaji, AU - Cain,Demetria, AU - Dilones,Rafael E, AU - Parsons,Jeffrey T, Y1 - 2019/06/07/ PY - 2018/05/31/received PY - 2018/10/29/accepted PY - 2018/09/26/revised PY - 2019/6/26/entrez PY - 2019/6/27/pubmed PY - 2019/6/27/medline KW - implementation science KW - motivational interviewing KW - youth living with HIV SP - e11200 EP - e11200 JF - JMIR research protocols JO - JMIR Res Protoc VL - 8 IS - 6 N2 - BACKGROUND: Motivational interviewing (MI) has been shown to effectively improve self-management for youth living with HIV (YLH) and has demonstrated success across the youth HIV care cascade-currently, the only behavioral intervention to do so. Substantial barriers prevent the effective implementation of MI in real-world settings. Thus, there is a critical need to understand how to implement evidence-based practices (EBPs), such as MI, and promote behavior change in youth HIV treatment settings as risk-taking behaviors peak during adolescence and young adulthood. OBJECTIVE: This study aims to describe the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) protocol of a tailored MI (TMI) implementation-effectiveness trial (ATN 146 TMI) to scale up an EBP in multidisciplinary adolescent HIV settings while balancing flexibility and fidelity. This protocol is part of the Scale It Up program described in this issue. METHODS: This study is a type 3, hybrid implementation-effectiveness trial that tests the effect of TMI on fidelity (MI competency and adherence to program requirements) while integrating findings from two other ATN protocols described in this issue-ATN 153 Exploration, Preparations, Implementation, Sustainment and ATN 154 Cascade Monitoring. ATN 153 guides the mixed methods investigation of barriers and facilitators of implementation, while ATN 154 provides effectiveness outcomes. The TMI study population consists of providers at 10 adolescent HIV care sites around the United States. These 10 clinics are randomly assigned to 5 blocks to receive the TMI implementation intervention (workshop and trigger-based coaching guided by local implementation teams) utilizing the dynamic wait-listed controlled design. After 12 months of implementation, a second randomization compares a combination of internal facilitator coaching with the encouragement of communities of practice (CoPs) to CoPs alone. Participants receive MI competency assessments on a quarterly basis during preimplementation, during the 12 months of implementation and during the sustainment period for a total of 36 months. We hypothesize that MI competency ratings will be higher among providers during the TMI implementation phase compared with the standard care phase, and successful implementation will be associated with improved cascade-related outcomes, namely undetectable viral load and a greater number of clinic visits among YLH. RESULTS: Participant recruitment began in August 2017 and is ongoing. As of mid-May 2018, TMI has 150 active participants. CONCLUSIONS: This protocol describes the underlying theoretical framework, study design, measures, and lessons learned for TMI, a type 3, hybrid implementation-effectiveness trial, which has the potential to scale up MI and improve patient outcomes in adolescent HIV settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT03681912; https://clinicaltrials.gov/ct2/show/NCT03681912 (Archived by WebCite at http://www.webcitation.org/754oT7Khx). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/11200. SN - 1929-0748 UR - https://www.unboundmedicine.com/medline/citation/31237839/Testing_a_Motivational_Interviewing_Implementation_Intervention_in_Adolescent_HIV_Clinics:_Protocol_for_a_Type_3_Hybrid_Implementation_Effectiveness_Trial_ DB - PRIME DP - Unbound Medicine ER -
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