Testing the implementation and sustainment facilitation (ISF) strategy as an effective adjunct to the Addiction...

Area of Science:

• Implementation Science
• Public Health
• Behavioral Health

Background:

• Integrating evidence-based practices (EBPs) into routine care is a persistent challenge in health services.
• The National Institute on Drug Abuse funded the substance abuse treatment to HIV Care (SAT2HIV) Project, a hybrid trial examining implementation strategies.
• This paper details the protocol for the Implementation and Sustainment Facilitation (ISF) Experiment, focusing on organizational-level strategies.

Purpose of the Study:

• To evaluate the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model.
• To assess ISF's impact on the preparation, implementation, and sustainment phases of integrating motivational interviewing-based brief interventions (MIBI) in AIDS service organizations (ASOs).
• To improve the capacity of ASOs to address substance use and enhance the HIV Care Continuum.

Main Methods:

• A cluster randomized design was used, with 39 ASOs randomized to either the ATTC strategy (control) or ATTC + ISF strategy (experimental).
• The ISF strategy involved organization-focused approaches like using an implementation advisor and cyclical tests of change.
• Effectiveness was measured by time-to-proficiency, implementation effectiveness, and level of sustainment, guided by the Exploration-Preparation-Implementation-Sustainment (EPIS) framework.

Main Results:

• The ISF experiment demonstrated a rigorous, hypothesis-driven approach within a high-need setting.
• A large sample size (39 ASOs) and broad geographic representation (23 states) enhance the study's generalizability.
• The study effectively tested strategies across multiple phases of the EPIS continuum: preparation, implementation, and sustainment.

Conclusions:

• The ISF experiment offers valuable insights into optimizing the integration of EBPs within ASOs.
• Findings are expected to significantly advance generalizable knowledge on effective preparation, implementation, and sustainment strategies.
• Enhancing ASO capacity for substance use treatment holds promise for improving the HIV Care Continuum.