Table 2 Examples of adjunctive interventions
Health intervention | Problem addressed by adjunctive intervention | Adjunctive intervention | Implementation strategies for the health interventiona | Implementation strategies for the adjunctive intervention |
|---|---|---|---|---|
Antiretroviral treatment (ART) | Poor adherence to ART or missed clinic appointments among viremic clinic patients | Connect4Care [35]: Motivational, informational, and supportive text messages three times per week | Task-shifting from health care workers to adherence support workers to address inadequate human resources | Adapt existing EHRs toflag clients with poor retention and pending care appointments. Develop automated feed from EHR data to text messaging platform |
Testing, condoms and PrEP | Low motivation and self-efficacy for testing, condoms, and PrEP among young men who have sex with men (MSM) | Keep It Up! (KIU!) [36]: Online, interactive individual-level intervention offered in community-based settings to increase HIV knowledge, motivate and teach safer behaviors, and instill self-efficacy for PrEP, condom use, and other HIV prevention interventions | Use media to spread the word about HIV testing and prevention services; change testing site to increase access to testing | Skills-based training of staff on client recruitment and retention; audit and feedback to monitor and inform midcourse improvements |
HIV testing and care linkage | Latino MSM readiness, stigma, medical mistrust, lack of knowledge of available services | Peer navigation and referral to ancillary services [12] | Develop formal referral and agreement processes between community-based HIV testing organizations and clinical providers | Formal patient navigation program structure, tailored training for patient navigators, integration of patient navigation program into broader clinical/program teams |
Medication for opioid use disorder (OUD) | Adherence to methadone, buprenorphine, and/or naltrexone treatment for OUD | Contingency management [37] — Incentives for recipients to promote achievement of OUD treatment-related goals | Revise standard operating procedures to expedite access to treatment; brief provider training that includes case examples and research data | Didactic training, performance feedback, and external facilitation |
HIV care | People living with HIV who are homeless or unstably housed face particular barriers to achieving and maintaining optimal care | Supportive permanent housing [38]: Provision of affordable, long-term housing with comprehensive supportive services to enhance management of HIV | Client-centered care model, change clinic workflow to facilitate wrap-around services in one visit, change clinical sites of care in community to increase access | Obtain formal commitments between providers of supportive services and network of apartment buildings, create new clinical care and support team to monitor and respond to client’s needs |
PrEP | PrEP medication adherence support | Integrated Next Step Counseling [39]: Participant-centered “check-in” on sexual health protection using motivational interviewing strategies | Alter patient/consumer fees, create new clinical teams that include HIV testing and case management services, develop collaborative practice agreements for pharmacists to prescribe PrEP | Develop training materials and implementation manual, protocol development, dynamic training, continuous quality improvement, train-the-trainer model |
Antihypertensive medication | Medication adherence in hypertensive patients | Collaborative care, medication review, and tailored adherence counseling including motivational interviewing and telephone follow-ups, by a pharmacist [40] | Training in collaborative care between prescribing clinician and pharmacist | Pharmacist training in motivational interviewing, workflow change to administer, score, and review questionnaires about medication adherence, fidelity monitoring |
Antiseizure medications (ASMs) | Medication adherence for children newly diagnosed with epilepsy | Problem-solving counseling intervention to address the family’s individualized adherence barriers delivered by psychologists/trainees [41] | Electronically monitored ASM adherence that is relayed to clinicians | Training by a licensed psychologist who provided monthly supervision (included review of audio sessions and feedback to interventionists, review of treatment manuals, live role plays for clinical content in sessions, and shadowing experiences with more experienced interventionists) |
Cardiovascular disease (CVD) risk assessment and treatment | Help people with rheumatoid arthritis (RA) and CVD risk obtain evidence-based CVD risk assessment and treatment | Peer coaching [42]—an intervention in which a person with RA coaches another person with RA | Training in CVD assessment for patients with RA | Educational materials, peer coach training, group supervision, mock sessions, fidelity rating, and certification of competence |