The Implementation & Sustainment Facilitation Strategy improved implementation effectiveness and intervention effectiveness: Results from a cluster-randomized type 2 hybrid trial

Abstract

Background Substance use disorders (SUD) among people with HIV are both prevalent and problematic. In 2014, the Substance Abuse Treatment to HIV care (SAT2HIV) Project was funded to test the team-focused Implementation & Sustainment Facilitation (ISF) strategy as an adjunct to the staff-focused Addiction Technology Transfer Center (ATTC) strategy for integrating a motivational interviewing-based brief intervention (MIBI) for SUD within HIV community-based organizations (CBOs). This article presents the main findings from the project.Methods Using a cluster-randomized, type 2 hybrid trial design, 39 HIV-CBOs were randomized to either: 1) ATTC (n = 19); or 2) ATTC+ISF (n = 20). HIV-CBOs identified two staff to be prepared to implement the MIBI (N = 78 MIBI staff). Subsequently, during the implementation phase, HIV-CBOs in each condition randomized client participants (N = 824 client participants) to one of two intervention conditions: 1) usual care (UC; n = 415); or 2) UC+MIBI (n = 409). Both staff-level outcomes and clientlevel outcomes were examined. ResultsThe ISF strategy had a significant impact on implementation effectiveness (i.e., the consistency and quality of implementation; β = 0.65, p = 01), but not on time-to-proficiency (β = -0.02) or level-of-sustainment (β = 0.09). Additionally, the ISF strategy was found to have a significant impact on intervention effectiveness (i.e., the effectiveness of the MIBI), at least in terms of significantly decreasing the odds (odds ratio = 0.11, p = .02) of clients using their primary substance daily during follow-up. ConclusionsThe ATTC strategy was sufficient for the preparation of HIV-CBO staff to implement a MIBI for SUDs, yet the ISF strategy was found to be an effective adjunct to the ATTC strategy in terms of implementation effectiveness and intervention effectiveness. Based on these findings, it is recommended future efforts to integrate the project's MIBI for SUD within HIV-CBOs use the ATTC+ISF strategy. However, given the ISF strategy did not have a significant impact on level-of-sustainment, which was similarly low in both implementation conditions, implementation research testing the extent to which the ATTC+ISF strategy can be significantly enhanced via effective sustainment strategies is warranted. 4Trial registration: ClinicalTrials.gov: NCT02495402. Registered 7/6/2015. ClinicalTrials.gov:NCT03120598. Registered 4/18/2017, retrospectively registered. Contributions To The LiteratureThe Addiction Technology Transfer Center (ATTC) strategy was found to be an effective strategy for helping prepare individuals to implement a motivational interviewing-based brief interventions (MIBI) for substance use disorders.The Implementation & Sustainment Facilitation (ISF) strategy was found to be an effective adjunct to the ATTC strategy in terms of impact on implementation effectiveness (i.e., the consistency and quality of implementation) and intervention effectiveness (i.e., the effectiveness of the MIBI for improving client-level outcomes).Underscoring the signi...