Scaling up a brief alcohol intervention to prevent HIV infection in Vietnam: a cluster randomized, implementation trial.

Autor: Bartels SM; Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA. sophiamb@ad.unc.edu., Phan HTT; Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam., Hutton HE; Johns Hopkins Hospital University School of Medicine, Baltimore, MD, USA., Nhan DT; Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam., Sripaipan T; Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA., Chen JS; Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA., Rossi SL; Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA., Ferguson O; Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA., Nong HTT; UNC Vietnam, Hanoi, Vietnam., Nguyen NTK; UNC Vietnam, Hanoi, Vietnam., Giang LM; Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam., Bui HTM; Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam., Chander G; Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA., Sohn H; Seoul National University College, Seoul, Korea., Kim S; Seoul National University College, Seoul, Korea., Tran HV; UNC Vietnam, Hanoi, Vietnam., Nguyen MX; Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.; Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam., Powell BJ; Brown School, Washington University in St. Louis, St. Louis, MI, USA., Pence BW; Department of Epidemiology, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA., Miller WC; Department of Epidemiology, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA., Go VF; Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
Jazyk: angličtina
Zdroj: Implementation science : IS [Implement Sci] 2024 Jun 12; Vol. 19 (1), pp. 40. Date of Electronic Publication: 2024 Jun 12.
DOI: 10.1186/s13012-024-01368-6
Abstrakt: Background: 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.
Methods: 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.
Participants: 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.
Outcomes: 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.
Discussion: 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.
Trial Registration: NCT06358885 (04/10/2024), https://clinicaltrials.gov/study/NCT06358885 .
(© 2024. The Author(s).)
Databáze: MEDLINE
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