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.

Grant Number: 5P01AA029544-05
NIH Institute/Center: NIH
Principal Investigator: GEETANJALI CHANDER