Understanding the Impact of Discrimination on Substance Use Among Black Justice-Involved Youth: A NIDA K23 Study

Brittany Bryant, DSW, LCSW-CP/S
University of California San Francisco

ABSTRACT:
Substance use among Black justice-involved youth is a critical public health issue, often exacerbated by experiences of discrimination and systemic racism. This NIDA K23 study aims to investigate the complex relationship between discrimination and substance use within this vulnerable population. Through qualitative interviews, the study will explore how perceived discrimination shapes substance use behaviors and the protective factors that may buffer against these effects. The insights gained will inform the development of culturally adapted interventions designed to reduce substance use and promote mental health, addressing the broader issues of criminalization and health disparities among Black youth. The process for culturally adaptations will be discussed with examples of the culturally adapted intervention provided.

TITLE: TBD

Jeremy D Goldhaber-Fiebert, PhD
Stanford School of Medicine

ABSTRACT:
TBD

Integration of a 1-session pain relief skills intervention across patient populations and practice settings

Beth Darnall, PhD
Stanford School of Medicine

ABSTRACT:
While national best practices guidelines call for a biopsychosocial approach to treating acute and chronic pain, few evidence-based options are broadly accessible to the people who need them. Poor access to effective non-pharmacologic pain treatment contributes to substance use, pain care disparities and human suffering. Brief, effective, and online behavioral pain treatments are needed across the continuum of care. In this session, Dr. Darnall will review published efficacy data from 4 randomized trials on a 1-session pain relief skills intervention (Empowered Relief®). Empowered Relief is NIH and PCORI-funded, scalable, evidence-based, disseminated and adopted by major healthcare organizations across the U.S. and internationally (29 countries) within primary care, tertiary care and perioperative pathways. Adaptations and applications in special populations will be discussed (Veterans, Military, Corrections settings).

Tackling the Uptake of MOUD for Individuals Incarcerated in Jail

Todd Molfenter, PhD
University of Wisconsin-Madison

Faye Taxman, PhD
George Mason University

ABSTRACT:
In an experiment that explored which implementation strategy—coaching using the NIATx goal process and ECHO, which prepares clinicians to increase the use of MOUD—affects the uptake and penetration of MOUD in jail settings. The presentation will: 1)identify techniques to correct misinformation; 2) discuss the impact of interagency change teams; 3) discuss the efficacy of different coaching and/or ECHO implementation strategies; and 4) use a web-based coaching model. The study findings illustrate that improving MOUD utilization in jail settings requires attention to cultural and work process issues.

Better, Faster, Cheaper, and Scaled: Opioid Use Disorder Treatment in the Fentanyl Era

Stephen Martin, MD, EdM
Boulder Care

Stephanie Strong, CEO, Founder
Boulder Care

ABSTRACT:
Treating opioid use disorder may be described as a “strike while the iron’s hot” scenario. Treatment must occur before doubts, withdrawal, or challenging life circumstances overwhelm someone who is interested, closing the window of opportunity. Despite nationwide efforts to expand access to highly effective medications like methadone and buprenorphine, both remain underused due to a combination of regulatory and attitudinal barriers. These barriers manifest in long wait-times (a problem of timing) and treatment scarcity (a problem of scale).

Measuring Interprofessional Communication in Pediatric Hospital Care

Sara Malone, LCSW, PhD
Washington University in St. Louis

ABSTRACT:
This presentation will discuss multiple studies aimed at measuring interprofessional communication and assessing it as a determinant of implementation and sustainability. I will discuss measurement development and the use of network methods to assess provider communication.

Supervision in addiction treatment programs: (Some) insights and future research ideas.

Jure Baloh, PhD, MHA
University of Arkansas for Medical Sciences

ABSTRACT:
Substance use disorders (SUDs) are a significant public health burden in the US, affecting almost 50 million individuals annually. Community specialty SUD treatment programs (“SUD programs”) are key treatment providers and while effective treatments for SUD exist, significant issues in the organization and delivery of SUD programs undermine the delivery of high-quality services. Supervisors in SUD programs are centrally positioned to support SUD counselors (frontline clinical providers) and ensure high service quality. In this presentation, we will provide an overview of supervision and its conceptualization, highlight recent findings from Arkansas, and outline (some) research directions for the future.

Implementation and User-Centered Design in Outpatient Care: A Case-Study with Pediatric Asthma and Digital Health

Kristin Kan, MD, MPH, MSc
Ann & Robert H. Lurie Children’s Hospital of Chicago

ABSTRACT:
Of the 5.5 million US children with pediatric asthma, over half have uncontrolled symptoms due in part to poor asthma self-management, leading to high rates of acute unscheduled care and activity limitations. Guideline-based, preventive asthma care is a critical step in reducing uncontrolled symptoms among high-risk asthma populations. An asthma care model using technology-enhanced tools, like digital device monitoring and population health management, is one promising approach to aid patients’ adherence to recommended care. However, implementation of technology-based care in outpatient care settings poses real-world barriers with integration in health delivery systems, changing health provider behaviors, and shifting care out of the clinic into home and community environments. In 2016, the Center for Food Allergy and Asthma Research (NU) partnered with community and hospital-affiliated primary care practices with using digital medication sensors and a mobile app with patients in a randomized trial. Using CFIR, interviews with patients, nurses, and clinicians were conducted post-trial to understand implementation constructs. The findings informed an upcoming feasibility trial, leveraging a population health model and digital asthma app and device. This presentation will reflect on the dynamic context of health system’s use of digital-enhanced healthcare, engagement of health providers and patients in changed expectations with these tools, and redesign that had to be considered for implementing in the outpatient care setting.

Pragmatic Implementation Science Guides and Measures to Enhance the Impact of Your Research

Helene Chokron Garneau, PhD, MPH
Stanford School of Medicine

Bryan Garner, PhD
Ohio State University

Heather Gotham, PhD
Stanford School of Medicine

Beth McGinty, PhD
Weill Cornell Medical College

Terrinieka Powell, PhD
Johns Hopkins Bloomberg School of Public Health

ABSTRACT:
Implementation science focuses on how to get effective interventions into practice; however, there is a lack of feasible, pragmatic tools that intervention researchers or those curious about implementation science can use to increase the likelihood that effective treatments are spread and scaled up in healthcare. Workgroups composed of implementation science experts, addiction and pain management intervention developers, and health services researchers from the NIDA-funded Center for Dissemination and Implementation At Stanford (C-DIAS) and HEAL Data2Action Research Adoption Support Center (RASC) developed a set of pragmatic guides and measures to democratize implementation science concepts and frameworks. These guides and measures focus on five key components of implementation science and are designed to support researchers, and anyone seeking to evaluate or implement a health care innovation. 

At the Pace of Trust: The Role of Trustworthiness in Implementation Science

Whitney Irie, PhD
Boston College

ABSTRACT:
Abstract: This manuscript-in-progress presentation will prompt critical discourse around trustworthiness as a fundamental determinant, critical strategy, and indispensable outcome in implementation science. 

Partnering with a large health system to study the effectiveness of an innovative clinical program to improve care for hospital patients with substance use disorders:  Pragmatic trial of the Consult for Addiction Treatment and Care in Hospitals (CATCH) program in 6 New York City public hospitals

Jennifer McNeely, MD
NYU Grossman School of Medicine

ABSTRACT:
Individuals with substance use disorders (SUD) have high rates of hospitalization, and frequently have poor health outcomes and low rates of addiction treatment.  Hospital-based addiction consult services have the potential to improve inpatient and post-discharge care for patients with substance use disorders (SUD), and can be an important component of strategies to reduce opioid-related overdose.  Beginning in 2017, with special funds from the NYC Mayor’s Office to address the opioid crisis, the New York City Health + Hospitals (H+H) system began the Consult for Addiction Treatment and Care in Hospitals (CATCH) program in 6 hospitals.  We partnered with H+H to design the program model and conduct a NIDA-funded pragmatic trial of the CATCH program focused on patients with opioid use disorder (OUD).  A hybrid effectiveness-implementation study (Type 1) studied the effectiveness of CATCH for increasing post-discharge initiation and engagement in OUD treatment, while studying the process of implementing this large new program in public hospital settings to inform its adoption and sustainability.  A stepped-wedge cluster randomized trial design compared treatment outcomes for patients hospitalized during the CATCH versus treatment as usual periods.  A mixed methods approach primarily utilized Medicaid claims data to measure outcomes, while electronic health records data and interviews with staff and patients provided additional information on implementation fidelity and barriers.  Our study involved active ongoing collaboration with the H+H system, including through the first year of the COVID-19 pandemic, which presented unprecedented challenges to the City’s public hospitals.  This talk will reflect on the process of partnering with a large health system to study a new program, present findings on the program’s effectiveness, and discuss the implementation process and outcomes.

From single to multiple behaviour change approaches in implementation science

Justin Presseau, PhD
University of Ottawa

ABSTRACT:
Behaviour change theory-informed implementation intervention development and evaluation often focuses on improving sub-optimally performed clinical practice, redressing variations in care, or de-implementing lower-value care. In many instances, such approaches focus on a given clinical action as the target for change. However, the professional context of those delivering healthcare and the lived experience of those receiving healthcare are characterised by navigating contexts involving engaging in multiple behaviours; where engaging in a given action may impact on other competing demands and/or the actions of others. Predominant methodological approaches and theoretical lenses used in implementation science may not yet be accounting for this system of multiple behaviours. This talk will explore the challenges and opportunities of shifting from a single behaviour to a multiple behaviour approach in implementation science. With examples of implementation research across a variety of chronic disease topic areas, this talk will explore the implications and opportunities for shifting to a multiple behaviour change approach for: identifying gaps in care and selecting focal behaviour(s), identifying theory-informed barriers/enablers to change, selecting intervention strategies and change techniques, and evaluating implementation strategies.

The Stanford Lightning Report: An Implementation Science Rapid Qualitative Approach for Formative Evaluation

Catherine Brown Johnson, PhD
Stanford School of Medicine

Steve Asch, MD, MPH
Stanford School of Medicine

ABSTRACT:
The Stanford Lightning Report is a structured but flexible rapid qualitative approach used to increase the pace of learning in healthcare implementation. Supporting Learning Health System goals as well as large-scale research agendas, it can be applied across settings, from quality improvement and to randomized trials, ensuring more successful implementation. This talk includes examples of Lightning Report use in addiction settings (e-cigarettes and opioid use), step-by-step instructions on how to employ the approach, and hands-on just-in-time consultation on how to incorporate the Lightning Report into your projects.

Implementing Collaborative Care for Co-Occurring Disorders in low-resourced settings

Katherine Watkins, MD, MSHS
RAND Corporation

ABSTRACT:
Untreated co-occurring opioid use disorders and mental illness are prevalent and can have devastating consequences for the individual, their families, and the community. The Collaborative Care Model (CoCM) improves outcomes by addressing problems in access and quality for primary care patients with common behavioral health conditions but has not been implemented and tested for co-occurring disorders. This presentation will describe the development and implementation of a CoCM program for co-occurring opioid and mental health disorders in 17 primary care clinics in New Mexico and California. Using Proctor et al.’s 2011/2022 taxonomy of implementation outcomes and data from an ongoing clinical trial, we present the methods used to assess implementation outcomes and results of implementation efforts on model reach and fidelity. We compare the characteristics of individuals who received an initial session with a care coordinator with those whom the care coordinator was unable to engage. Understanding who does and does not receive CC may aid in developing implementation strategies to increase reach and fidelity

Assessing Implementation Strategies for the Uptake of Bundled Interventions to Improve Culturally Relevant Care for Black women with HIV

Andrea Dakin, PhD, MA
AIDS Foundation Chicago

Serena Rajabiun, PhD
University of Massachusetts Lowell

Alicia Downes, LMSW
AIDS United

Corliss Heath, PhD
US Department of Health and Human Services

ABSTRACT:
The Health Resources and Services Administration (HRSA), HIV/AIDS Bureau(HAB), Ryan White HIV/AIDS Program (RWHAP), Part F- Special Projects of National Significance initiative entitled Improving Care and Treatment Coordination for Black women with HIV funded 12 clinical and community-based organizations and one evaluation center to adapt, implement, and assess the uptake of evidence based/informed (EB/EI) bundled interventions to improve health outcomes and well-being for Black women with HIV. This study examines the successes, challenges, and adaptations to implementation strategies to support intervention uptake and cultural responsiveness for Black women with HIV.

Guided by the Expert Recommendations for Implementing Change (ERIC) compilation, the Evaluation and Technical Assistance Center working in partnership with the demonstration sites selected five implementation strategies for intervention uptake: tailoring interventions to local context; train/educate stakeholders; evaluation and iterative strategies; engaging consumers; and changing infrastructure. Tracking implementation strategies and adaptations across sites required multiple approaches to data collection, as each of the twelve sites bundled two-four EB/EIs. Modifications to strategies during the pre-implementation and implementation phases were documented using FRAME-IS core modules gathered through monthly coaching calls with sites and annual site visits with evaluation center coaches and site implementation teams. This presentation will outline the data collection and analysis methods employed by the evaluation center, as well as present a case study from one of the demonstration sites.

It takes a village: Implementing a pragmatic trial to evaluate a group telehealth intervention for family members affected by opioid use disorder

Karen Osilla, PhD
Stanford University School of Medicine

ABSTRACT:
Opioid use disorder (OUD) has devastating effects on individuals, families, and communities. This presentation describes eINSPIRE (INtegrating Support Persons Into REcovery), a pragmatic randomized trial that tests the Community Reinforcement Approach and Family Training (CRAFT) intervention delivered via group telehealth therapy compared to usual care. CRAFT is an evidence-based approach for the family members or close friends (referred to as Support Persons; SPs) of individuals with a substance use disorder. Patients and SP dyads were recruited across five community health systems in Southern and Northern California that provide buprenorphine treatment and mental health services. This presentation will describe our dyadic recruitment and implementation insights on the adoption, reach, and feasibility of intervening with SPs in these settings.

Eight characteristics of rigorous multilevel implementation research: a step-by-step guide.

Rebecca Lengnick-Hall, PhD, MSW, MPA
Washington University in St. Louis

Gregory Aarons, PhD
University of California, San Diego

ABSTRACT:
Although healthcare is delivered in inherently multilevel contexts, implementation science has no widely endorsed methodological standards defining the characteristics of rigorous, multilevel implementation research. Presenters will identify and describe eight characteristics of high-quality, multilevel implementation research to encourage discussion, spur debate, and guide decision-making around study design and methodological issues. These eight characteristics provide benchmarks for evaluating the quality and replicability of multilevel implementation research and promote a common language and reference points. This, in turn, facilitates knowledge generation across diverse multilevel settings and ensures that implementation research is consistent with (and appropriately leverages) what has already been learned in allied multilevel sciences. When a shared and integrated description of what constitutes rigor is defined and broadly communicated, implementation science is better positioned to innovate both methodologically and theoretically.

Four Ways to Conceptualize and Study Policy in Implementation Science Research

Jonathan Purtle, DrPH, MSc
New York University

ABSTRACT:
This presentation will offer a typology of four ways to conceptualize policy in implementation science research: 1) Policy as something to adopt, 2) Policy as something to implement, 3) Policy as context to understand, and 4) Policy as strategy to use. Examples will be provided of studies that have conceptualized policy in these different ways in the area of behavioral health.

Designing for Dissemination and Sustainability: Methods, Frameworks, Tools, and a Diabetes Case Example

Bethany M. Kwan, PhD, MSPH, FSBM
University of Colorado School of Medicine

ABSTRACT:
Designing for dissemination and sustainability (D4DS) refers to the process of ensuring that the products of research are likely to be adopted, implemented, and sustained in the context of intended use. D4DS involves use of methods such as participatory co-design, active dissemination planning, and pragmatic trial designs to develop evidence that “fits the context” and can be readily adopted in real-world settings. This presentation will provide an overview of the rationale, principles, methods, and frameworks for D4DS. The Fit to Context Framework for D4DS is a novel process framework to guide planning, conduct, and dissemination of research, based on a narrative review of the literature on D4DS. Tools to support application of the Fit to Context Framework, including https://dicemethods.org/ and https://app.d4dsplanner.com/, will be demonstrated. A case example will describe D4DS applications in the Invested in Diabetes study, a pragmatic, type II hybrid implementation-effectiveness trial of two models of diabetes shared medical appointments.

Prevention science and methodology: Considerations for working with Indigenous populations

Donald Warne, MD, MPH
Johns Hopkins Bloomberg School of Public Health

ABSTRACT:
American Indians and Alaska Natives (AI/ANs) endure some of the worst health disparities in the nation. The history of marginalization and exclusion of Indigenous voices from setting the research agenda, determining priorities, and conducting research will be explored. We will also define American Indian, Alaska Native, Native American, and Indigenous populations in the US; and we will describe the impact of preventable conditions on Indigenous health equity. We will also explore and identify opportunities to promote prevention science, methods, and implementation in AI/AN populations to improve outcomes.   

Beyond Jacobson & Truax: Modern Methods for Estimating Clinically Significant Change

Antonio Morgan-Lopez, PhD
RTI International

ABSTRACT:
In the majority of randomized controlled trials (RCTs) the focus is on differences in the average change over time on outcomes across intervention conditions, with variation in individual trajectories often treated as nuisance. In contrast, a primary focus on inferences regarding the improvement (or worsening) of individual participants is best represented by clinical significance or clinically significant change (CSC). One of the primary tools in the assessment of CSC is Jacobson and Truax (1991’s) Reliable Change Index (RCI). The RCI is still very popular, as evidenced by 12,000 total citations and over 300 citations in 2023 alone. However, three specific limitations have been identified with the RCI: a) the RCI estimate is based on a pre-post difference score, b) the scores upon which the RCI estimate is based (typically total scores) often contain both measurement bias and measurement error and c) the RCI standard error of measurement (SEM) is erroneously assumed to be constant across participants and time. We present an approach that addresses all three limitations simultaneously: a) scale score and SEM estimation using moderated nonlinear factor analysis and b) RCI estimation using a modification of a three-level multilevel model with modeling of observation-specific measurement uncertainty. We focus on two illustrations: one from a treatment trial targeting comorbid PTSD/alcohol use disorder among OEF/OIF Veterans and second from a school-based selective preventive intervention trial targeting conduct problems in late elementary through high school. We also provide sample SAS code for implementation that is easily accessible to those with experience with conventional multilevel models.

Peer-delivered Intervention to Improve Retention and Polysubstance Use in Mobile Telemedicine in Rural Maryland

Jessica Magidson, PhD
University of Maryland

Sarah Kattakuzhy, MD, MPH
University of Maryland

ABSTRACT:
There is a severe shortage of providers to treat opioid use disorder (OUD), which is further exacerbated in rural areas. Similar to the shortage of prescribers, there is also a severe shortage of trained behavioral health providers to meet the needs of patients with OUD. This talk will provide an overview of a newly launched NIDA-funded R01 trial “Peer Recovery to Improve Polysubstance Use and Mobile Telemedicine Retention” (PRISM)--a randomized Type 1 hybrid effectiveness-implementation trial (n=180) to examine a peer recovery specialist-delivered behavioral intervention to improve retention and polysubstance use on a mobile telemedicine treatment unit in rural Maryland. We will describe a novel telemedicine mobile treatment unit approach to expand access to OUD treatment in hard hit rural areas, as well as how our team is integrating an evidence-based, peer-delivered behavioral activation intervention to support retention and polysubstance use outcomes.

Adapting to the Fentanyl Epidemic: Implications for translation of a multi-component intervention and RCT in the Emergency Department and real world lessons from an implementation practitioner 

Lauren K. Whiteside, MD, MS
University of Washington

ABSTRACT:
The opioid epidemic is rapidly evolving with the proliferation of nonpharmaceutical fentanyl. Simultaneously, researchers, public health officials, and clinicians are working to develop and implement interventions to improve clinical care for patients with opioid use disorder (OUD). The Emergency Department Longitudinal Integrated Care (ED-LINC) randomized clinical trial harnesses the Collaborative Care model to reduce illicit opioid use and improve initiation and retention of evidence-based medications for opioid use disorder (MOUD) for patients that visit the ED with OUD. The original ED-LINC intervention was developed and pilot-tested prior to the overwhelming availability of fentanyl in our community.  We present information on a systematic rapid qualitative approach leveraging real-time clinical observations related to fentanyl use among the initial n=30 ED-LINC intervention participants.  This method was used to systematically produce and document protocol modifications and intervention adaptations required to ensure successful implementation of an intervention that is relevant to the target population amidst the rapidly intensifying fentanyl epidemic. As an implementation practitioner, there is an unavoidable urgency in treating patients with OUD due to fentanyl now and it is crucial that research does not lag behind the current state given the rapidly evolving epidemic. 

Understanding and Reducing Inequities in Substance Use Treatment Access and Utilization

Lesia Ruglass, PhD
City College of New York

ABSTRACT:
Data from the United States National Survey on Drug Use and Health (NSDUH, 2021) indicate that while certain racial/ethnic minoritized populations may have equivalent or lower rates of substance use disorders (SUD) compared to White people, evidence suggests that once developed, and given structural inequities and barriers, racial/ethnic minoritized people may suffer more deleterious consequences (i.e., health, criminal justice system involvement etc.) related to SUD than their White counterparts. In tandem, racial/ethnic minoritized people are less likely to access, utilize, and receive quality evidence-based SUD treatment than their White counterparts, which may further contribute to worsening of their SUD over time. This presentation will review research findings on some of the key factors (individual, interpersonal, community, and social) associated with inequities in treatment access and outcomes for racial/ethnic minoritized populations. Recommendations for research, clinical, and community/societal changes to advance health equity for racial/ethnic minoritized populations with SUD will be discussed.

Adjunctive Interventions in Implementation Research:​ One “thing”? Two things? Old thing? New thing?

Nanette Benbow, MA
Northwestern University

Dennis Li, MPH, PhD
Northwestern University

James Merle, PhD
University of Utah

ABSTRACT:
Implementation science currently groups change methods into two categories: (1) clinical, behavioral, or biomedical interventions targeting recipients’ health outcomes, and (2) implementation strategies—actions taken to improve system-level delivery of an intervention. Differentiating interventions from strategies based on their intended functions is critical to accurately attributing the effects of each change method on its respective health or implementation outcomes. However, in our work coordinating 200+ HIV implementation research projects and conducting systematic reviews of HIV intervention implementation, we identified change methods that had characteristics of both interventions and strategies and were inconsistently classified. To alleviate confusion and improve change method specification, we propose that implementation science should adopt the term adjunctive interventions to classify change methods that fall into this gray area. Adjunctive interventions are distinguished from other change methods by their intended targets, desired outcomes, and theory of action and causal processes. Whereas health interventions target recipients and have a direct, causal effect on the health outcome, adjunctive interventions enhance recipients’ motivation, self-efficacy, or capacity for initiating, adhering to, or engaging with the health intervention and thus have an indirect causal link to the health outcome via increasing the probability of recipients’ utilization of the health intervention. Adjunctive interventions are incapable of directly producing the health outcome and require additional implementation strategies to deliver alongside the health intervention. We will discuss case examples, logic modeling, and considerations for adjunctive intervention research. Conceptualizing adjunctive interventions as a separate type of change method will advance implementation research by improving tests of effectiveness and the specification of mechanisms and outcomes, which will accelerate research evidence to achieve public health impact.

Proposing and Applying the Observational-Implementation Hybrid Approach

Justin Knox, PhD, MPH
Columbia University

ABSTRACT:
We recently proposed the observational-implementation hybrid approach, or the incorporation of implementation science elements into observational studies in order to collect information that will allow for anticipation, estimation, and/or inference about the effects of interventions and implementation strategies. We describe this approach, including examples of how we are applying it to an ongoing observational study among n=600 Black sexual minority (SMM) men in order to collect relevant implementation data regarding the use of evidence-based practices to support drinking reductions. An initial step for employing an observational-implementation hybrid approach is knowing about the state of the research on relevant interventions or policies that aim to address the modifiable constructs relevant to the research questions of the study, including their implementation. Evidence-based practices that have been shown to help individuals reduce their alcohol use that we will focus on include: electronic screening and brief intervention, motivational interviewing, HealthCall (an mHealth intervention for people living with HIV), and naltrexone. We will employ various approaches to collect information on how to deliver these alcohol interventions to Black SMM. We are using survey measures to collect factors related to transportability of the alcohol interventions that we selected (e.g., access to a primary care physician, insurance status, treatment-seeking). We are conducting a discrete choice experiment among n=240 participants who report heavy drinking (AUDIT-C score >4) in order to collect preference data on the delivery of the alcohol interventions. Among a HIV-status neutral sub-sample of participants who report heavy drinking (n=30), we are using a human-centered design approach to collect journey maps of their experiences accessing HIV prevention and care service in clinical settings that will identify opportunities for co-delivery of alcohol interventions in these settings. Lastly, we are conducting in-depth interviews with n=10 HIV prevention and care service providers to collect input on implementation factors related to co-locating alcohol interventions into HIV prevention and care services. Applying this observational-implementation hybrid approach provides an opportunity to conduct observational research in ways that will allow it to achieve more rapid translational gains in terms of understanding how to deliver evidence-based practices to support reductions in alcohol use among Black SMM.

Developing Metrics to Improve Equitable Implementation of HIV Prevention

Moira McNulty, MD
University of Chicago

Maria Pyra, MEd, MPH, PhD
Northwestern University

ABSTRACT:
A daily pill, PrEP, has changed HIV prevention and could help end the HIV epidemic in the U.S. Thus far, use of PrEP has not been evenly or effectively distributed. Much of the focus to date on PrEP delivery has been on linkage and initiation of PrEP. We know that effectiveness of PrEP depends not only on initiation, but also on adherence, which typically requires retention in care for ongoing monitoring and prescriptions per the CDC guidelines; i.e., persistence on PrEP. While the annual number of PrEP users has been increasing, improvement in retention and adherence has lagged, with many individuals who initiate PrEP no longer adherent or retained at 6 months, despite the likelihood that risk of exposure to HIV continues. Furthermore, some of the most vulnerable populations such as young Black MSM are more likely to fall out of PrEP care than their non-Black peers. Yet, measuring persistence has been challenging, particularly in a way that is standardized and can be used across patient populations and PrEP programs. Dr. Moira McNulty, from the University of Chicago, and Dr. Maria Pyra, from Northwestern University, will present their work on PrEP metrics, particularly around persistence, and how these metrics can improve equitable implementation of PrEP.

Innovating Substance Use Disorder Treatment at Scale

Jeff DeFlavio, MD
Groups: Recover Together

ABSTRACT:
Across medicine clinical innovations take years to disseminate widely into practice, while some best practices in addiction medicine fail to ever gain widespread adoption. This presentation describes two private medical practices (Groups Recover Together and Affect Therapeutics) which have brought underutilized and evidence-based interventions to scale across the United States. The presentation will focus on the clinical models, patient outcomes, workforce considerations, revenue models and capital formation which was required to scale these effective care programs.

Supercharging implementation science with insights from behavioral economics

Rinad Beidas, MA, PhD
Northwestern University

ABSTRACT:
This presentation will describe efforts to apply the tools and insights from behavioral economics to improve upon implementation of evidence-based practices.

Design Considerations in Embedded Pragmatic Trials: Separating Rigor from Idolatry

Gregory E. Simon, MD, MPH
Kaiser Permanente Washington Health Research Institute

ABSTRACT:
This presentation will consider specific considerations in the design and implementation of embedded pragmatic trials, including: eligibility criteria, unit of allocation, method of allocation, standardization of “active” interventions, standardization of “control” interventions, blinding, and analytic strategy. For each of these design decisions, investigators must focus on the specific study question and consider scientific rigor, practical constraints, and ethical obligations to potential study participants.