Testing a Motivational Interviewing Implementation Intervention in Adolescent HIV Clinics: Protocol for a Type 3, Hybrid Implementation-Effectiveness Trial

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; http...

Proof of Concept for the FLEX Intervention: Feasibility of Home Based Coaching to Improve Physical Activity Outcomes and Viral Load Suppression among African American Youth Living with HIV

“…Once FLEX was finalized, a Research Assistant (referred to as a Coach) was trained in MI by a member of MI Network of Trainers and in fitness components by a licensed physical therapist, Prior to the start of our study, the Coach submitted video-recorded roleplays that were scored for physical activity coaching accuracy and MI competency using a standard rating scale. 17 Study recruitment began after the Coach attained and sustained high fidelity in both MI and physical activity intervention components; this took about 1 month of time and training.…”

Adolescent Trials Network for HIV-AIDS Scale It Up Program: Protocol for a Rational and Overview

“…ATN 146 , TMI [17] addresses the training of health care providers to deliver MI, a method of communication shown to improve multiple points across the youth prevention and care cascades [27,34-45]. Pilot work to develop the TMI included tailoring initial workshop training based on innovative methods in communication science, developing efficient fidelity measurement, and preliminary testing of implementation strategies.…”

“…As a Hybrid Type 3 Implementation-Effectiveness, the primary focus is also on exploring the role of the barriers and facilitators to implementation with repeated qualitative interviews and quantitative surveys of implementation context (see ATN 153 below). Details are provided in ATN 146 TMI [17].…”

Cascade Monitoring in Multidisciplinary Adolescent HIV Care Settings: Protocol for Utilizing Electronic Health Records

“…The longitudinal data also allow the SIU scientific team to track the impact of SIU clinic-based interventions, including ATN 146, Tailored Motivational Interviewing Implementation Intervention [20]. The EHR is beneficial as it reduces secondary data entry error when creating data files shared between sites and SIU personnel and does not rely on youth self-report of health.…”