Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam.
Implement Sci. 2024 Jun 12;19(1):40. doi: 10.1186/s13012-024-01368-6.
Evidence-based interventions (EBIs) often address normative behaviors. If a behavior is also common among clinicians, they may be skeptical about the necessity or effectiveness of an EBI. Alternatively, clinicians' attitudes and behaviors may be misaligned, or they may lack the knowledge and self-efficacy to deliver the EBI. Several EBIs address unhealthy alcohol use, a common and often culturally acceptable behavior. But unhealthy alcohol use may be particularly harmful to people with HIV (PWH). Here, we present an implementation trial using an experiential implementation strategy to address clinicians' knowledge, attitudes, and behaviors. Clinicians receive the experiential intervention before they begin delivering an evidence-based brief alcohol intervention (BAI) to PWH with unhealthy alcohol use.
Design: In this hybrid type 3 implementation-effectiveness cluster randomized controlled trial, ART clinics (n = 30) will be randomized 1:1 to facilitation, a flexible strategy to address implementation barriers, or facilitation plus the experiential brief alcohol intervention (EBAI). In the EBAI arm, clinicians, irrespective of their alcohol use, will be offered the BAI as experiential learning. EBAI will address clinicians' alcohol-related attitudes and behaviors and increase their knowledge and confidence to deliver the BAI.
ART clinic staff will be enrolled and assessed at pre-BAI training, post-BAI training, 3, 12, and 24 months. All PWH at the ART clinics who screen positive for unhealthy alcohol use will be offered the BAI. A subset of PWH (n = 810) will be enrolled and assessed at baseline, 3, and 12 months.
We will compare implementation outcomes (acceptability, fidelity, penetration, costs, and sustainability) and effectiveness outcomes (viral suppression and alcohol use) between the two arms. We will assess the impact of site-level characteristics on scaling-up the BAI. We will also evaluate how experiencing the BAI affected clinical staff's alcohol use and clinic-level alcohol expectations in the EBAI arm.
This trial contributes to implementation science by testing a novel strategy to implement a behavior change intervention in a setting in which clinicians themselves may engage in the behavior. Experiential learning may be useful to address normative and difficult to change lifestyle behaviors that contribute to chronic diseases.
NCT06358885 (04/10/2024), https://clinicaltrials.gov/study/NCT06358885 .
循证干预措施（EBIs）通常针对规范行为。如果一种行为在临床医生中也很常见，他们可能会对 EBI 的必要性或有效性持怀疑态度。或者，临床医生的态度和行为可能不一致，或者他们缺乏提供 EBI 的知识和自我效能感。有几种 EBIs 针对的是不健康的饮酒行为，这是一种常见且通常被社会认可的行为。但是，不健康的饮酒行为对 HIV 感染者（PWH）可能特别有害。在这里，我们提出了一项实施试验，该试验采用体验式实施策略来解决临床医生的知识、态度和行为问题。在为有不健康饮酒行为的 PWH 提供循证简短酒精干预（BAI）之前，临床医生会接受体验式干预。
设计：在这项混合类型 3 实施有效性聚类随机对照试验中，将 30 个 ART 诊所随机分为 1:1 组，分别接受促进治疗（一种灵活的策略，用于解决实施障碍）或促进治疗加体验式简短酒精干预（EBAI）。在 EBAI 组中，无论其饮酒量如何，临床医生都会接受 BAI 作为体验式学习。EBAI 将解决临床医生与酒精相关的态度和行为问题，并提高他们提供 BAI 的知识和信心。
ART 诊所的工作人员将在接受 BAI 培训前、培训后、3、12 和 24 个月进行评估。所有在 ART 诊所筛查出有不健康饮酒行为的 PWH 都将接受 BAI。其中一部分 PWH（n=810）将在基线、3 和 12 个月进行入组和评估。
我们将比较两种干预措施的实施结果（可接受性、保真度、渗透率、成本和可持续性）和效果结果（病毒抑制和饮酒量）。我们将评估站点特征对推广 BAI 的影响。我们还将评估体验 BAI 如何影响 EBAI 组中临床工作人员的饮酒行为和诊所级别的酒精期望。
该试验通过测试一种在行为本身可能由临床医生参与的环境中实施行为改变干预措施的新策略，为实施科学做出了贡献。体验式学习可能有助于解决导致慢性疾病的规范性和难以改变的生活方式行为。
NCT06358885（2024 年 4 月 10 日），https://clinicaltrials.gov/study/NCT06358885。
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