Dissemination of an evidence-based motivational interviewing brief intervention for substance use disorders to HIV service organizations across the United States: protocol for a national-level cluster-randomized adaptive parallel-groups superiority experiment

Background: Given the high prevalence of substance use disorders (SUDs) among people with HIV, integration of evidence-based SUD services within HIV service settings is needed. Federally-funded training and technical assistance centers, such as the Health Resources and Services Administration-funded AIDS Education and Training Center (AETC) network, are part of the support system that deliver strategies to promote the uptake of evidence-based interventions. Previously, our program of research supported (1) the effectiveness of facilitation for improving both the implementation and effectiveness of a motivational interviewing-based brief intervention for SUDs in HIV service organizations (HSOs), (2) motivational interviewing as having the best setting-intervention fit for HSOs, and (3) distributing educational materials as having the best setting-strategy fit for AETCs. Because exploration and adoption/preparation are phases that must occur before implementation and sustainment, we seek to test the effectiveness of facilitation to augment an initial distributing educational materials dissemination strategy. Methods: Using a multi-cohort cluster-randomized adaptive parallel-groups superiority experiment design, our aim is to test the effectiveness of augmenting a standard distributing educational materials dissemination strategy with a brief exploration facilitation dissemination strategy to support implementation of a motivational interviewing-based brief intervention. For each rollout, HSOs not responding to the distributing educational materials strategy will be randomized to either (a) receive no further intervention or (b) receive the exploration facilitation strategy. Assessed 4-months post-dissemination, the primary dissemination outcome is organizational-level adoption/preparation of the intervention (i.e., 1 + HSO staff downloads the manual and/or enrolls in the online asynchronous training). The secondary dissemination outcome is organization-level exploration of the intervention (i.e., 1 + HSO staff opens the dissemination email). Discussion: Before evidence-based interventions are implemented in practice to improve health outcomes, they must first be successfully disseminated and then explored and adopted by service organizations and providers. Because training and technical assistance centers have limited resources for dissemination efforts, effective adaptive dissemination strategies that utilize limited resources are needed. If we find the exploration facilitation strategy to be an effective adjunct to the distributing educational materials strategy, we hope that this adaptive dissemination strategy can be widely adopted and implemented by training and technical assistance centers. Trial registration: Open Science Framework: https://osf.io/urgzd. Registered 1/30/2025. Protocol version: 1/30/2025 Version 1.