Trial Outcomes & Findings for Tailored Motivational Interviewing Implementation-Effectiveness Trial in Multidisciplinary Adolescent HIV Care Settings (NCT NCT03681912)

NCT ID: NCT03681912

Last Updated: 2025-01-15

Results Overview

Providers will complete a 15-minute standard patient role-play at each point during baseline, implementation and sustainment. The Research Assistant (RA) will code these interactions on the 12-item MI CRS and reliability will continue to be monitored with one coding per month co-coded by Dr. Naar. These reports will be cumulatively reported and collected quarterly. Each item on the CRS has a score of 1 (lowest) to 4 (highest). The 12 scores are added and averaged for a score that reflects competency: \<2.0=Beginner. \>=2.0 to \<2.6. \>=2.6 to \<3.3=Intermediate. \>=3.3=Advanced. The outcomes provided below represent the average of the provider scores and reported by site and implementation phase. For sites randomized to internal facilitation in the sustainment period, the RA will code the same interactions so that the facilitator ratings will not be used for research purposes.

Recruitment status

COMPLETED

Target enrollment

188 participants

Primary outcome timeframe

Every three months over fifteen months

Results posted on

2025-01-15

Participant Flow

TMI study staff will work with the SC at each site to introduce the project and recruit participants by scheduling and conducting introductory meetings. After the introductory meetings, the SC or PI from each site will send contact information (email, phone number) to the TMI study staff. The TMI study staff will contact participants via email and/or phone call to provide the information sheet and schedule of assessments.

Unit of analysis: Site

Participant milestones

Participant milestones
Measure	Block 1 Site 7 Site 7 was randomized into Block 1 at baseline. In our stepped wedged design, this site entered the implementation phase first, along with site 10, and randomized at the sustainment phase.	Block 1 Site 10 Site 10 was randomized into Block 1 at baseline. In our stepped wedged design, this site entered the implementation phase first, along with site 7, and randomized at the sustainment phase.	Block 2 Site 3 Site 3 was randomized into Block 2 at baseline. In our stepped wedged design, this site entered the implementation phase second, along with site 8, and randomized at the sustainment phase.	Block 2 Site 8 Site 8 was randomized into Block 2 at baseline. In our stepped wedged design, this site entered the implementation phase second, along with site 3, and randomized at the sustainment phase.	Block 3 Site 1 Site 1 was randomized into Block 3 at baseline. In our stepped wedged design, this site entered into implementation phase third, along with Site 11, and randomized at the sustainment phase.	Block 3 Site 11 Site 11 was randomized into Block 3 at baseline. In our stepped wedged design, this site entered the implementation phase third, along with site 1, and randomized at the sustainment phase.	Block 4 Site 2 Site 2 was randomized into Block 4 at baseline. In our stepped wedged design, this site entered the implementation phase fourth, along with site 12, and randomized at the sustainment phase.	Block 4 Site 12 Site 12 was randomized to Block 4 at baseline. In our stepped wedged design, this site entered the implementation phase fourth, along with Site 2, and randomized at the sustainment phase.	Block 5 Site 6 Site 6 was randomized into Block 5 at baseline. In our stepped wedged design, this site entered the implementation phase fifth, along with site 13, and randomized at the sustainment phase.	Block 5 Site 13 Site 13 was randomized into Block 5 at baseline. In our stepped wedged design, this site entered the implementation phase fifth, along with site 6, and randomized at the sustainment phase.
Overall Study STARTED	18 1	11 1	18 1	16 1	17 1	15 1	19 1	24 1	28 1	22 1
Overall Study COMPLETED	14 1	8 1	7 1	8 1	9 1	10 1	11 1	14 1	12 1	13 1
Overall Study NOT COMPLETED	4 0	3 0	11 0	8 0	8 0	5 0	8 0	10 0	16 0	9 0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Race and Ethnicity were not collected from any participant.

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Block 1 Site 7 n=18 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS) performed monthly but reported quarterly, starting at 3 months.	Block 1 Site 10 n=11 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS) performed monthly but reported quarterly, starting at 3 months.	Block 2 Site 3 n=18 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS) performed monthly but reported quarterly, starting at 3 months.	Block 2 Site 8 n=16 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS) performed monthly but reported quarterly, starting at 3 months.	Block 3 Site 1 n=17 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS) performed monthly but reported quarterly, starting at 3 months.	Block 3 Site 11 n=15 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS) performed monthly but reported quarterly, starting at 3 months.	Block 4 Site 2 n=19 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS) performed monthly but reported quarterly, starting at 3 months.	Block 4 Site 12 n=24 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS) performed monthly but reported quarterly, starting at 3 months.	Block 5 Site 6 n=28 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS) performed monthly but reported quarterly, starting at 3 months.	Block 5 Site 13 n=22 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS) performed monthly but reported quarterly, starting at 3 months.	Total n=188 Participants Total of all reporting groups
Age, Categorical <=18 years	0 Participants n=18 Participants	0 Participants n=11 Participants	0 Participants n=18 Participants	0 Participants n=16 Participants	0 Participants n=17 Participants	0 Participants n=15 Participants	0 Participants n=19 Participants	0 Participants n=24 Participants	0 Participants n=28 Participants	0 Participants n=22 Participants	0 Participants n=188 Participants
Age, Categorical Between 18 and 65 years	18 Participants n=18 Participants	11 Participants n=11 Participants	18 Participants n=18 Participants	16 Participants n=16 Participants	17 Participants n=17 Participants	15 Participants n=15 Participants	19 Participants n=19 Participants	24 Participants n=24 Participants	28 Participants n=28 Participants	22 Participants n=22 Participants	188 Participants n=188 Participants
Age, Categorical >=65 years	0 Participants n=18 Participants	0 Participants n=11 Participants	0 Participants n=18 Participants	0 Participants n=16 Participants	0 Participants n=17 Participants	0 Participants n=15 Participants	0 Participants n=19 Participants	0 Participants n=24 Participants	0 Participants n=28 Participants	0 Participants n=22 Participants	0 Participants n=188 Participants
Sex/Gender, Customized Male	17 Participants n=18 Participants	8 Participants n=11 Participants	14 Participants n=18 Participants	11 Participants n=16 Participants	9 Participants n=17 Participants	9 Participants n=15 Participants	12 Participants n=19 Participants	5 Participants n=24 Participants	6 Participants n=28 Participants	7 Participants n=22 Participants	98 Participants n=188 Participants
Sex/Gender, Customized Female	0 Participants n=18 Participants	2 Participants n=11 Participants	2 Participants n=18 Participants	2 Participants n=16 Participants	1 Participants n=17 Participants	2 Participants n=15 Participants	1 Participants n=19 Participants	3 Participants n=24 Participants	4 Participants n=28 Participants	0 Participants n=22 Participants	17 Participants n=188 Participants
Sex/Gender, Customized Unknown	1 Participants n=18 Participants	1 Participants n=11 Participants	2 Participants n=18 Participants	3 Participants n=16 Participants	7 Participants n=17 Participants	4 Participants n=15 Participants	6 Participants n=19 Participants	16 Participants n=24 Participants	18 Participants n=28 Participants	15 Participants n=22 Participants	73 Participants n=188 Participants
Race and Ethnicity Not Collected	—	—	—	—	—	—	—	—	—	—	0 Participants Race and Ethnicity were not collected from any participant.
Race/Ethnicity, Customized Asian	1 Participants n=18 Participants	1 Participants n=11 Participants	0 Participants n=18 Participants	1 Participants n=16 Participants	0 Participants n=17 Participants	0 Participants n=15 Participants	0 Participants n=19 Participants	0 Participants n=24 Participants	0 Participants n=28 Participants	0 Participants n=22 Participants	3 Participants n=188 Participants
Race/Ethnicity, Customized Black / African American	9 Participants n=18 Participants	1 Participants n=11 Participants	3 Participants n=18 Participants	6 Participants n=16 Participants	6 Participants n=17 Participants	4 Participants n=15 Participants	7 Participants n=19 Participants	3 Participants n=24 Participants	8 Participants n=28 Participants	4 Participants n=22 Participants	51 Participants n=188 Participants
Race/Ethnicity, Customized Middle Eastern / North African	0 Participants n=18 Participants	0 Participants n=11 Participants	0 Participants n=18 Participants	0 Participants n=16 Participants	0 Participants n=17 Participants	0 Participants n=15 Participants	0 Participants n=19 Participants	1 Participants n=24 Participants	0 Participants n=28 Participants	0 Participants n=22 Participants	1 Participants n=188 Participants
Race/Ethnicity, Customized White	7 Participants n=18 Participants	7 Participants n=11 Participants	12 Participants n=18 Participants	5 Participants n=16 Participants	4 Participants n=17 Participants	9 Participants n=15 Participants	7 Participants n=19 Participants	3 Participants n=24 Participants	2 Participants n=28 Participants	2 Participants n=22 Participants	58 Participants n=188 Participants
Race/Ethnicity, Customized Other	0 Participants n=18 Participants	1 Participants n=11 Participants	1 Participants n=18 Participants	1 Participants n=16 Participants	0 Participants n=17 Participants	0 Participants n=15 Participants	0 Participants n=19 Participants	2 Participants n=24 Participants	0 Participants n=28 Participants	1 Participants n=22 Participants	6 Participants n=188 Participants
Race/Ethnicity, Customized Unknown	1 Participants n=18 Participants	1 Participants n=11 Participants	2 Participants n=18 Participants	3 Participants n=16 Participants	7 Participants n=17 Participants	2 Participants n=15 Participants	5 Participants n=19 Participants	15 Participants n=24 Participants	18 Participants n=28 Participants	15 Participants n=22 Participants	69 Participants n=188 Participants
Race/Ethnicity, Customized Hispanic	0 Participants n=18 Participants	5 Participants n=11 Participants	6 Participants n=18 Participants	2 Participants n=16 Participants	0 Participants n=17 Participants	1 Participants n=15 Participants	0 Participants n=19 Participants	4 Participants n=24 Participants	0 Participants n=28 Participants	1 Participants n=22 Participants	19 Participants n=188 Participants
Race/Ethnicity, Customized Not Hispanic	17 Participants n=18 Participants	5 Participants n=11 Participants	10 Participants n=18 Participants	11 Participants n=16 Participants	10 Participants n=17 Participants	12 Participants n=15 Participants	14 Participants n=19 Participants	5 Participants n=24 Participants	10 Participants n=28 Participants	6 Participants n=22 Participants	100 Participants n=188 Participants
Race/Ethnicity, Customized Uknown Hispanic	1 Participants n=18 Participants	1 Participants n=11 Participants	2 Participants n=18 Participants	3 Participants n=16 Participants	7 Participants n=17 Participants	2 Participants n=15 Participants	5 Participants n=19 Participants	15 Participants n=24 Participants	18 Participants n=28 Participants	15 Participants n=22 Participants	69 Participants n=188 Participants
Motivational Interviewing (MI) Coach Rating Scale (CRS) (Raw Average)	2.21 Units on a scale STANDARD_DEVIATION 0.44 • n=18 Participants	1.99 Units on a scale STANDARD_DEVIATION 0.24 • n=11 Participants	1.77 Units on a scale STANDARD_DEVIATION 0.26 • n=18 Participants	1.80 Units on a scale STANDARD_DEVIATION 0.36 • n=16 Participants	1.92 Units on a scale STANDARD_DEVIATION 0.34 • n=17 Participants	2.36 Units on a scale STANDARD_DEVIATION 0.41 • n=15 Participants	1.98 Units on a scale STANDARD_DEVIATION 0.42 • n=19 Participants	1.77 Units on a scale STANDARD_DEVIATION 0.32 • n=24 Participants	1.92 Units on a scale STANDARD_DEVIATION 0.35 • n=28 Participants	2.03 Units on a scale STANDARD_DEVIATION 0.36 • n=22 Participants	1.96 Units on a scale STANDARD_DEVIATION 0.39 • n=188 Participants
Motivational Interviewing (MI) Coach Rating Scale (CRS) Criterion Score	1.89 Units on a scale STANDARD_DEVIATION 0.68 • n=18 Participants	1.50 Units on a scale STANDARD_DEVIATION 0.50 • n=11 Participants	1.28 Units on a scale STANDARD_DEVIATION 0.34 • n=18 Participants	1.33 Units on a scale STANDARD_DEVIATION 0.47 • n=16 Participants	1.39 Units on a scale STANDARD_DEVIATION 0.52 • n=17 Participants	2.06 Units on a scale STANDARD_DEVIATION 0.66 • n=15 Participants	1.63 Units on a scale STANDARD_DEVIATION 0.69 • n=19 Participants	1.33 Units on a scale STANDARD_DEVIATION 0.48 • n=24 Participants	1.46 Units on a scale STANDARD_DEVIATION 0.52 • n=28 Participants	1.58 Units on a scale STANDARD_DEVIATION 0.52 • n=22 Participants	1.53 Units on a scale STANDARD_DEVIATION 0.58 • n=188 Participants

PRIMARY outcome

Timeframe: Every three months over fifteen months

Population: Participants may choose to leave the study at any point. Participants may be removed from the study based on changes in their clinical role and if they have less than 4 hours of client contact per week on average. Participant data will be included, unless a participant requests that their data is removed. In such cases, the participant's data will be deleted.

Outcome measures

Outcome measures
Measure	Block 1 Site 7 - CoP Alone n=16 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. CoP development without internal facilitation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity	Block 1 Site 10 - CoP Facilitated n=10 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. Randomized Guided Development of COPs with an internal facilitator after one year of implementation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity monitoring, and prevent drift. In addition to CoP, half the sites will be randomized to receive an internal facilitator who will be trained to continue quarterly fidelity monitoring and coaching feedback when scores fall below competency.	Block 2 Site 3 - CoP Facilitated n=13 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. Randomized Guided Development of COPs with an internal facilitator after one year of implementation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity monitoring, and prevent drift. In addition to CoP, half the sites will be randomized to receive an internal facilitator who will be trained to continue quarterly fidelity monitoring and coaching feedback when scores fall below competency.	Block 2 Site 8 - CoP Alone n=13 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. CoP development without internal facilitation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity	Block 3 Site 1 - CoP Facilitated n=11 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. Randomized Guided Development of COPs with an internal facilitator after one year of implementation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity monitoring, and prevent drift. In addition to CoP, half the sites will be randomized to receive an internal facilitator who will be trained to continue quarterly fidelity monitoring and coaching feedback when scores fall below competency.	Block 3 Site 11 - CoP Alone n=12 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. CoP development without internal facilitation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity	Block 4 Site 2 - CoP Facilitated n=13 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. Randomized Guided Development of COPs with an internal facilitator after one year of implementation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity monitoring, and prevent drift. In addition to CoP, half the sites will be randomized to receive an internal facilitator who will be trained to continue quarterly fidelity monitoring and coaching feedback when scores fall below competency.	Block 4 Site 12 - CoP Alone n=19 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. CoP development without internal facilitation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity	Block 5 Site 6 - CoP Alone n=17 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. CoP development without internal facilitation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity	Block 5 Site 13 - CoP Facilitated n=17 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. Randomized Guided Development of COPs with an internal facilitator after one year of implementation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity monitoring, and prevent drift. In addition to CoP, half the sites will be randomized to receive an internal facilitator who will be trained to continue quarterly fidelity monitoring and coaching feedback when scores fall below competency.
Raw Average: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS) Implementation Phase	2.72 Units on a scale Standard Deviation 0.45	2.50 Units on a scale Standard Deviation 0.46	1.99 Units on a scale Standard Deviation 0.34	2.32 Units on a scale Standard Deviation 0.51	2.47 Units on a scale Standard Deviation 0.53	2.91 Units on a scale Standard Deviation 0.37	2.62 Units on a scale Standard Deviation 0.50	2.39 Units on a scale Standard Deviation 0.43	2.63 Units on a scale Standard Deviation 0.49	2.66 Units on a scale Standard Deviation 0.48
Raw Average: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS) Sustainment Phase	2.78 Units on a scale Standard Deviation 0.43	2.59 Units on a scale Standard Deviation 0.26	2.19 Units on a scale Standard Deviation 0.37	2.19 Units on a scale Standard Deviation 0.26	2.38 Units on a scale Standard Deviation 0.56	2.82 Units on a scale Standard Deviation 0.43	2.73 Units on a scale Standard Deviation 0.51	2.41 Units on a scale Standard Deviation 0.48	2.76 Units on a scale Standard Deviation 0.61	2.65 Units on a scale Standard Deviation 0.45

SECONDARY outcome

Timeframe: 12 months prior to start; The end of the 12 month intervention, and 6 months after end of implementation interview

Population: Record/Chart Abstraction was conducted based on number of patients at clinic for a given year. Clinic patient population numbers fluctuate.

Record/chart abstraction conducted for patients in care at the site for * The 12 months prior to the start of implementation * The 12 months during implementation; and * The 6 months after the end of the implementation intervention. These data include viral load

Outcome measures

Outcome measures
Measure	Block 1 Site 7 - CoP Alone n=246 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. CoP development without internal facilitation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity	Block 1 Site 10 - CoP Facilitated n=91 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. Randomized Guided Development of COPs with an internal facilitator after one year of implementation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity monitoring, and prevent drift. In addition to CoP, half the sites will be randomized to receive an internal facilitator who will be trained to continue quarterly fidelity monitoring and coaching feedback when scores fall below competency.	Block 2 Site 3 - CoP Facilitated n=146 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. Randomized Guided Development of COPs with an internal facilitator after one year of implementation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity monitoring, and prevent drift. In addition to CoP, half the sites will be randomized to receive an internal facilitator who will be trained to continue quarterly fidelity monitoring and coaching feedback when scores fall below competency.	Block 2 Site 8 - CoP Alone n=78 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. CoP development without internal facilitation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity	Block 3 Site 1 - CoP Facilitated n=186 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. Randomized Guided Development of COPs with an internal facilitator after one year of implementation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity monitoring, and prevent drift. In addition to CoP, half the sites will be randomized to receive an internal facilitator who will be trained to continue quarterly fidelity monitoring and coaching feedback when scores fall below competency.	Block 3 Site 11 - CoP Alone n=144 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. CoP development without internal facilitation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity	Block 4 Site 2 - CoP Facilitated n=124 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. Randomized Guided Development of COPs with an internal facilitator after one year of implementation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity monitoring, and prevent drift. In addition to CoP, half the sites will be randomized to receive an internal facilitator who will be trained to continue quarterly fidelity monitoring and coaching feedback when scores fall below competency.	Block 4 Site 12 - CoP Alone n=206 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. CoP development without internal facilitation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity	Block 5 Site 6 - CoP Alone n=130 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. CoP development without internal facilitation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity	Block 5 Site 13 - CoP Facilitated n=111 Participants Competency: 12-Item Motivational Interviewing (MI) Coach Rating Scale (CRS): Coaching feedback will be triggered by a provider falling below the competency threshold on the standardized patient interaction. Everyone will receive coaching for two assessments in the month following training. After that, if mean scores fall below competency, then the provider will receive a 45-minute coaching session by the external Motivational Interviewing Network of Trainers (MINT) facilitator. Feedback on two highest and two lowest ratings, review of the audio recording and interactive coaching activities (e.g., fidelity assessments) targeting the lowest ratings. While many aspects of this implementation strategy are adaptable, organizational leadership will review data on completion of coaching feedback sessions and will determine corrective action for suboptimal adherence. Randomized Guided Development of COPs with an internal facilitator after one year of implementation.: Development of the CoP will be guided by scheduling and assisting in setting the agenda for the first three meetings to encourage MI practice, peer coaching and potentially fidelity monitoring, and prevent drift. In addition to CoP, half the sites will be randomized to receive an internal facilitator who will be trained to continue quarterly fidelity monitoring and coaching feedback when scores fall below competency.
Change in Individual Patients' Records Report Related to HIV Viral Load Baseline Phase - 12 months prior to the start of implementation	1.88 Log of copies/mL Standard Deviation 0.80	2.43 Log of copies/mL Standard Deviation 1.04	2.29 Log of copies/mL Standard Deviation 1.05	2.28 Log of copies/mL Standard Deviation 1.12	2.30 Log of copies/mL Standard Deviation 1.17	2.20 Log of copies/mL Standard Deviation 0.99	2.36 Log of copies/mL Standard Deviation 1.25	2.35 Log of copies/mL Standard Deviation 1.20	1.92 Log of copies/mL Standard Deviation 1.70	1.11 Log of copies/mL Standard Deviation 2.89
Change in Individual Patients' Records Report Related to HIV Viral Load Implementation Phase - 12 months during implementation	1.85 Log of copies/mL Standard Deviation 0.86	1.81 Log of copies/mL Standard Deviation 0.61	2.12 Log of copies/mL Standard Deviation 1.25	1.89 Log of copies/mL Standard Deviation 0.97	2.00 Log of copies/mL Standard Deviation 1.07	2.07 Log of copies/mL Standard Deviation 1.09	2.12 Log of copies/mL Standard Deviation 1.27	2.10 Log of copies/mL Standard Deviation 1.21	1.78 Log of copies/mL Standard Deviation 1.49	2.38 Log of copies/mL Standard Deviation 1.25
Change in Individual Patients' Records Report Related to HIV Viral Load Sustainment Phase - 6 months after the end of the implementation	1.88 Log of copies/mL Standard Deviation 0.83	1.80 Log of copies/mL Standard Deviation 0.59	2.31 Log of copies/mL Standard Deviation 1.23	2.00 Log of copies/mL Standard Deviation 1.10	1.98 Log of copies/mL Standard Deviation 1.08	1.90 Log of copies/mL Standard Deviation 0.77	2.22 Log of copies/mL Standard Deviation 1.19	1.76 Log of copies/mL Standard Deviation 0.87	1.79 Log of copies/mL Standard Deviation 0.77	2.17 Log of copies/mL Standard Deviation 1.15

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Sylvie Naar, PhD; Distinguished Endowed Professor

Florida State University

Phone: 850-644-2334

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place