Tailored Motivational Interviewing in Adolescent HIV Clinics: Primary Outcome Analysis of a Stepped Wedge Implementation Trial

Abstract

Background:Youth continue to have the poorest outcomes along the HIV prevention and care continua. Motivational Interviewing (MI) may promote behavior change and reduce perceived stigma, but providers often demonstrate inadequate MI competence. This study tested Tailored Motivational Interviewing (TMI), a set of implementation strategies designed to improve MI competence in youth HIV providers.Setting:Ten HIV clinics in the Adolescent Trials Network for HIV/AIDS Interventions.Methods:In a stepped wedge design, 10 clinics (N = 151 providers) were randomized in 5 clusters every 3 months to receive TMI for a 12-month implementation period. Sites were rerandomized within each cluster to receive communities of practice guidance with or without internal facilitator support in the sustainment period. Standard patient assessments were coded every 3 months for 36 months.Results:Nesting was addressed using mixed-effects regression models, with random effects for providers and sites. TMI resulted in significantly improved MI competence over baseline. Despite small reductions in competence in the sustainment window, competence was still significantly improved over baseline, with no difference between the 2 sustainment conditions.Conclusions:TMI may be an important tool to capacitate the HIV HealthForce to end the HIV epidemic in young people.

Understanding implementation completion of tailored motivational interviewing in multidisciplinary adolescent HIV clinics

“…( Idalski Carcone et al, 2019 , 2022 ) previously described the EPIS study (ATN 153), and ( Naar et al 2022 ) described the methods for the hybrid randomized trial of TMI in which it was embedded (ATN 146). In brief, using a stepped-wedge design, clinics were randomized to the implementation phase in five steps ( N = 10 clinics, 2 per step).…”

“…Within the ATN, ATN protocol (146) ( Naar et al, 2019 , 2022 ) was a Type III hybrid effectiveness-implementation trial testing the effects of TMI implementation strategies on provider competence to deliver MI to address substance use and other risk behaviors while utilizing EPIS (ATN 153; Idalski Carcone, 2019 , 2022 ) to understand implementation context. Pre-implementation interviews were previously coded using inner and outer context factor codes.…”

Mechanisms of Successful Implementation of Tailored Motivational Interviewing in a Multisite Study of Youth HIV Clinics in the United States

“…To compute a site-specific competency score, we selected MI-CRS data from the implementation phase of the parent study. 5 The continuous MI competency data were structure with repeated measurements (level 1, N = 463) nested within providers (level 2; N = 141) nested within sites (level 3; N = 10). We performed an unconditional (ie, no predictors) mixed-effects regression model 17 in HLM software, 18 retaining the overall fitted values and empirical Bayes residual estimates.…”

“…The measure has demonstrated reliability and validity on several indicators using Rasch modeling in diverse settings and samples 14 and has been successfully used as an implementation outcome measure. 5,12 In this study, all participants completed the same 15-to 20-minute standard patient interaction by phone quarterly throughout the study for a total of 13 assessments across the baseline, implementation, and sustainment periods (13 assessments).…”

“…In an stepped-wedge implementation trial, we tested the effect of an implementation package called tailored motivational interviewing (TMI) on MI competency in providers serving youth with HIV; TMI resulted in significantly improved MI competence across 10 multidisciplinary adolescent HIV clinics within the Adolescent Trials Network for HIV/AIDS interventions (ATN Protocol 146). 5 However, there was significant variability in postimplementation competence, indicating variable degrees of implementation success.…”