Using incentivization as a strategy to improve implementation of a motivational interviewing brief intervention for substance use disorders in HIV settings

Abstract

BACKGROUND: To help improve the implementation of evidence-based substance use disorder (SUD) treatment in practice settings, the United States funds a support system called the Addiction Technology Transfer Center (ATTC) network. Prior implementation research in HIV care found the team-focused Implementation and Sustainment Facilitation (ISF) strategy as an effective addition to the ATTC's staff-focused training, feedback, and consultation (TFC) strategy. Using the ISF + TFC strategy as the control, this type-3 hybrid trial tested the effectiveness of adding a staff-focused incentivization (INC) strategy (ISF + TFC + INC vs. ISF + TFC). Staff-focused incentivization was selected because prior implementation research found it to be highly effective and cost-effective for improving SUD treatment implementation.

METHODS: Twenty-six HIV service organizations (HSOs), their staff participants (N = 87), and their client participants (N = 341) were cluster-randomized to either the ISF + TFC control condition or ISF + TFC + INC experimental condition. The INC strategy rewarded/reinforced motivational interviewing brief intervention (MIBI) implementation (US$10 per MIBI delivered) and MIBI implementation at or above a pre-defined level of quality (US$10 per demonstration). In addition to these outcomes, past 4-week changes/reductions in client participant's days of primary substance use and anxiety symptoms were examined.

RESULTS: The addition of the INC strategy had a large and significant (p < .05) effect on the number of MIBIs implemented (d = 1.30) and reduction in anxiety (d = -1.54). There was no significant impact on days of substance use.

CONCLUSIONS: The addition a staff-focused INC strategy improved implementation of an evidence-based brief intervention for adults with comorbid HIV and SUD, and also reduced anxiety. To help improve the integration of evidence-based SUD services in HSOs across the United States, use of the ISF + TFC + INC strategy by the ATTC network and/or the AIDS Education and Training Center (AETC) network is recommended.