Protocol Number: ATN153

Leads: April Carcone & Karin Coyle

Summary: Effectiveness-Implementation Research to enhance HIV-related self-management among youth. The EPIS model has four phases – Exploration, Preparation, Implementation, and Sustainment – and examines contextual factors at two primary levels: outer and inner. The outer context represents larger, often external, factors that can either support or slow implementation, such as federal, state, county or local policies, funding and mandates, and organizational relationships. The inner context represents what is happening within a community or organization that is implementing an evidence-based practice, such as staffing, policies and procedures, and organizational culture and climate. Learn more by reading this EPIS Overview or the EPIS Framework.

Cascade Monitoring

Protocol Number: ATN154

Leads: Jason Chapman & Amy Pennar

Summary: All 11 sites across the U19 will provide de-identified patient data from electronic medical records regarding demographics and HIV treatment cascade variables (counseling and testing, new diagnoses, linkage to care, appointment adherence, and viral load) over a five year period. These data, to be assessed quarterly and reported annually, will provide rough but rapid estimations of demographic indices and measures of response (such as percent viral suppression, PrEP uptake). Data will be examined for trends in the HIV epidemic known as the treatment cascade, provide useful indicators of the epidemic at large for providers and community members, and give vital feedback to the sites themselves.

Communication Science

Lead: April Carcone

Summary: Patient-provider communication will be explored as a mechanism of change across all projects (including other U19s). Sequential analysis will be done to determine what provider communication behaviors directly relate to patient motivational statements (“change talk”). Then the relationship between change talk and outcome will be assessed. Motivational interviewing (MI) will be used as a framework using the Minority Youth Sequential Code of Process Exchanges (MY-SCOPE), adapted from existing MI coding schemes. This analysis generates transition probabilities for patient-provider communication sequences allowing the provider characteristics to predict providers' use of patient-centered communication strategies.

Self-Management Model

Lead: Amy Pennar

Summary: Projects that collect data directly from youth will include the same measures assessing the Five Components of Self-Management Model. Measures will be chosen in collaboration with research project Leads and the ATN4 Executive Committee. Sample measures include: a) the BRIEF to assess both problem solving and decision-making; b) the Measure of Process of Care-20 in which participants rate the relationship with their providers; c) an adapted version of the Services and Support measure utilized in ATN 004 (Healthy Choices) to capture participant self-report of health care and related services; and, d) self-reported medication adherence and condom use and viral suppression. The model will be tested across projects using structural equation modeling (Grady & Gough, 2014).