Sheila Vipul Patel

Background: Strategies that improve integration of evidence-based substance use disorder (SUD) innovations within HIV service organizations (HSOs) are needed. Building on research supporting the effectiveness of facilitation to improve HSOs’ implementation of a motivational interviewing-based brief intervention (MIBI) for SUDs, this dissemination research sought to test the effectiveness of brief exploration facilitation to improve organization-level MIBI adoption/preparation (primary outcome) and exploration (secondary outcome) after an initial distributing educational materials strategy. Methods: HSOs that did not transition to adoption/preparation within one week of the initial distributing educational materials strategy were randomized to either (a) continue in the distributing educational materials condition or (b) receive exploration facilitation. Outcomes were assessed four months post-dissemination. The primary dissemination outcome was organizational-level adoption/preparation, defined as 1+ HSO staff downloading the manual and/or enrolling in online asynchronous training. The secondary dissemination outcome was organization-level exploration of the intervention (i.e., 1+ HSO staff opened the dissemination email). Results: At the end of week 1 after the initial distributing educational materials strategy, 327 (46.7%) of 700 HSOs had transitioned to exploration and an additional 15 HSOs (2.1%) had transitioned to adoption/preparation. After randomization, no additional HSOs achieved adoption as a function of being in either study condition. Of 341 HSOs randomized to exploration facilitation, only 11 HSOs (3.2%) received the single facilitation session delivered by our team of facilitators. Conclusion: The project’s initial distributing educational materials dissemination strategy led to minimal MIBI adoption by HSOs. Despite several phone attempts per HSO, the project’s facilitators were generally unsuccessful in engaging HSOs and unable to deliver the exploration facilitation strategy; thus, the exploration facilitation strategy was not effective. Future research should consider testing alternative dissemination strategies, such as incentivization, which has demonstrated effectiveness as an implementation strategy.

Background: People with HIV are more likely than the general population to have a substance use disorder (SUD), which can impact the HIV care continuum. HIV service organizations (HSOs) can implement SUD interventions but may need assistance from support systems like the AIDS Education and Training Center (AETC) network. We assess the fit of strategies AETCs may use to help HSOs integrate SUD interventions. Method: We invited 74 of 91 AETCs (81.3%) to participate. Using a real-time Delphi approach, 64 AETCs (86.5% of those invited) rated the (a) importance of, (b) feasibility of, (c) readiness to offer, (d) scalability of, (e) pressure to offer, and (f) current need for 10 strategies their AETC could use to help HSOs integrate SUD interventions. Items were examined via confirmatory factor analyses. Responses were summed to create the Setting-Strategy Fit index score. We conducted pairwise t-tests to examine differences in scores between strategies, plotted the mean importance ratings for each strategy against the mean ratings for other criteria to review the strategies’ relative viability, and conducted bivariate and multiple regression analyses to examine correlates of the scores. Results: The items of the Setting-Strategy Fit index showed good internal consistency and model fit. Generally, strategies were considered somewhat important but AETCs felt very little pressure to offer them. Two strategies (disseminating information, providing access to asynchronous training) exceeded the “important” threshold. One strategy (disseminating information) was considered viable for also having high feasibility. Overall, AETCs were only somewhat ready to provide the strategies, which were perceived as only somewhat feasible or currently needed. Conclusions: Although AETCs recognized the importance of several strategies for helping HSOs integrate SUD interventions, their responses resulted in only one having good fit. These findings can guide efforts to further prepare AETCs to support HSOs and to end the HIV epidemic. Plain Language Summary: Strategies AIDS Education and Training Centers Could Use to Help HIV Service Organizations Implement Substance Use Interventions. Why was the study done?: Having a substance use disorder (SUD) can complicate care for people with HIV by reducing their engagement in services. HIV service organizations (HSOs) serve people with HIV but not all of them offer services to address SUD. We assessed the fit of different strategies that AIDS Education and Training Centers (AETCs), which provide technical assistance to HSOs, could use to help HSOs implement SUD interventions. What did the researchers do?: We engaged 74 AETC representatives nationally to rate 10 strategies. They were asked about (a) the importance of the strategies, (b) the feasibility of offering them, (c) their readiness to offer them, (d) the scalability of the strategies, (e) pressure they receive to offer them, and (f) the current need for them. Responses were summed into an index score reflecting the strategies’ fit for AETCs to help HSOs integrate SUD interventions. We looked for differences in scores between strategies and plotted the scores for each strategy to identify which are most promising. What did the researchers find?: Two of the strategies (sharing information about the SUD interventions and providing access to asynchronous trainings) exceeded the threshold for being “important.” One of those (sharing information) was also considered “feasible” for AETCs to offer, making it the only potentially viable strategy. Overall, AETCs were only somewhat ready to provide the strategies, which they felt very little pressure to offer. What do the findings mean?: Although AETCs recognized the importance of different strategies for helping HSOs implement SUD interventions, they only identified one strategy as having good fit. These findings can guide future efforts to further prepare AETCs to support HSOs and to end the HIV epidemic.

Objectives: We compared the effectiveness of audio-based care, as a replacement or a supplement to usual care, for managing diabetes. Background: Diabetes is a chronic condition afflicting many in the United States. The impact of audio-based care on the health of individuals with diabetes is unclear, particularly for those at risk for disparities—many of whom may only be able to access telehealth services through telephone. Methods: We used systematic review methods to synthesize available evidence. We systematically searched for English-language articles from 2012 reporting randomized controlled trials of adults diagnosed with diabetes. We abstracted data on clinical outcomes (including A1c), patient-reported health and quality-of-life, health care access and utilization, care quality and experience, and patient safety. Results: Evidence for replacing in-person care with audio care was limited (n = 2), with low certainty of evidence for greater and comparable effectiveness for A1c and harms, respectively. Supplemental audio care (n = 23) had a positive effect on A1c (pooled mean difference A1c −0.20%; n = 8763; 95% CI: −0.36% to −0.04%), with moderate certainty of evidence. Stratified results indicated that audio interventions supplementing usual care performed more favorably in individuals with A1c ≤ 9%; populations not at risk of disparities; interventions with at least monthly contact; and interventions using remote monitoring tools. Conclusions: This evidence base reveals some promise for managing diabetes with audio-based care as a supplement to in-person care. Future studies could further investigate the effectiveness of audio-based care as a replacement and modify interventions to better serve individuals with poor glucose control and those at risk for disparities.

Background: Telehealth services can increase access to care by reducing barriers. Telephone-administered care, in particular, requires few resources and may be preferred by communities in areas that are systemically underserved. Understanding the effectiveness of audio-based care is important to combat the current mental health crisis and inform discussions related to reimbursement privileges. Objectives: We compared the effectiveness of audio-based care to usual care for managing mental health and substance use disorders (MHSUD). Design: We used systematic review methods to synthesize available evidence. Studies: We searched for English-language articles reporting randomized controlled trials (RCTs) of adults diagnosed with MHSUD published since 2012. Outcomes: We abstracted data on clinical outcomes, patient-reported health and quality of life, health care access and utilization, care quality and experience, and patient safety. Results: We included 31 RCTs of participants diagnosed with depression, post-traumatic stress disorder (PTSD), other serious mental illness (SMI), anxiety, insomnia, or substance use disorder (SUD). Most of the evidence was for interventions targeting depression, PTSD, and SUD. The evidence demonstrates promise for: (1) replacing in-person care with audio care for depression, other SMI, and SUD (very low to moderate certainty of comparable effectiveness); and (2) adding audio care to monitor or treat depression, PTSD, anxiety, insomnia, and SUD (low to moderate certainty of evidence favoring audio care for clinical outcomes). Conclusions: MHSUD can be managed with audio care in certain situations. However, more evidence is needed across conditions, and specifically for anxiety and other conditions for which no research was identified.

Background In response to the recent and growing shift from injecting opioids to smoking fentanyl, an increasing number of syringe services programs (SSPs) in the USA are distributing safer smoking supplies. A recent federal ban prevents SSPs from using federal funding to procure safer smoking supplies. There is a lack of research on safer smoking supply distribution and harm reduction outcomes. Therefore, we assessed the relationship between distribution of safer smoking supplies by SSPs and levels of participant engagement and naloxone distribution. Methods We used data from the 2023 National Survey of Syringe Services Programs (NSSSP) (N=429), which measured services delivered in 2022. SSPs reported whether they distributed safer smoking pipes (yes/no). We examined the relationship between safer smoking pipe distribution and two outcomes: the number of participant encounters and naloxone doses distributed. Results There were 187 SSPs (43.6%) that distributed pipes for smoking to participants. Compared to SSPs that did not distribute pipes, those that distributed pipes reported more participant encounters (aRR=1.49, 95% CI: 1.09-2.02) and naloxone dose distribution (aRR=1.21, 95% CI: 0.89-1.65), though this latter finding was not statistically significant. Conclusions Findings showed SSPs distributing safer smoking pipes had more participant engagement and naloxone distribution. To maximize their full individual and population-level health benefits, SSPs should be supported technically, legally, and financially to implement safer smoking supply distribution for their participants. Highlights In 2022, 44% of syringe services programs (SSPs) distributed safer smoking pipes. More community-based organizations distributed pipes than public health or health care programs. Distribution of safer smoking pipes was associated with more participant encounters.

Physical distancing restrictions related to the COVID-19 pandemic accelerated the uptake of virtual options for prevention providers and clinical service provision in general. In this paper, we bring together experiences from the HEAL Prevention Cooperative, a unique cohort of research projects representing a continuum of care from community-level promotion to indicated prevention with older adolescents and young adults to increase access to services to prevent opioid misuse. We offer options that preventionists and other providers can implement or continue to use to expand access to youth and families who experience difficulty accessing opioid-related preventive services and supports. We also discuss challenges in implementing physical distancing adaptations that were required to operate during the pandemic. We discuss intervention adaptations along four pillars useful for providers and researchers: connecting with partners, recruitment, prevention service provision, and data collection and evaluation. We also provide recommendations for health professionals and practitioners and for future research.