Behavioral counseling and abstinence-contingent take-home buprenorphine in general practitioners' offices in Malaysia: a randomized, open-label clinical trial.
Behavioral counseling and abstinence-contingent take-home buprenorphine in general practitioners' offices in Malaysia: a randomized, open-label clinical trial.
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马来西亚全科医生办公室的行为咨询和戒酒后带回家的丁丙诺啡：一项随机、开放标签的临床试验。
DOI：
10.1111/add.15399
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Mazlan,Mahmud
中科院分区：
文献类型：
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作者：
Schottenfeld,RichardS;Chawarski,MarekC;Mazlan,Mahmud
背景和目的为了解决阿片类药物使用障碍广泛存在的严重问题，初级保健医生提供的丁丙诺啡-纳洛酮治疗极大地扩大了治疗的可及性;然而，治疗通常只提供最少或不提供行为干预。行为干预是否或哪些行为干预在各种环境中实施并改善治疗效果是可行的，尚未确定。本研究旨在评估两种行为干预措施，以改善丁丙诺啡-纳洛酮治疗。设计一项2 × 2析因、重复测量、开放标签、随机临床试验。设置马来西亚麻坡的综合医疗实践办公室。患者阿片类药物依赖个体（n= 234）。干预参与者被随机分配到四种治疗条件之一，并接受研究干预24周：（1）有或没有行为咨询的医生管理和（2）有或没有戒断-特遣队丁丙诺啡-纳洛酮（ACB）带回家剂量的医生管理。测量主要结果是阿片类药物阴性尿检和HIV风险行为的比例[通过音频计算机辅助艾滋病风险量表评估]结果：治疗24周后，阿片类药物阴性尿检率显著高于未接受行为咨询的患者[68.2%，95%置信区间（CI）= 65-71]。（59.2%，95%CI = 56-62，P< 0.001）和有ACB（71.0%，95%CI = 68-74）的患者比无ACB（56.4%，95%CI = 53-59，P< 0.001）的患者更少，行为干预与时间的交互作用无统计学意义。所有治疗组的ACASI-ARI评分均较基线显著降低（P< 0.001），有无行为咨询无显著差异（P= 0.099）或伴或不伴ACB（P= 0.339）。结论在麻坡提供阿片类药物依赖患者，马来西亚，丁丙诺啡-纳洛酮和医生管理加行为咨询或戒断相关丁丙诺啡-纳洛酮（ACB）与提供丁丙诺啡-纳洛酮和医生管理而不提供行为咨询或ACB相比，
Background and aimTo address the widespread severe problems with opioid use disorder, buprenorphine–naloxone treatment provided by primary care physicians has greatly expanded treatment access; however, treatment is often provided with minimal or no behavioral interventions. Whether or which behavioral interventions are feasible to implement in various settings and improve treatment outcomes has not been established. This study aimed to evaluate two behavioral interventions to improve buprenorphine–naloxone treatment.DesignA 2 × 2 factorial, repeated‐measures, open‐label, randomized clinical trial.SettingsGeneral medical practice offices in Muar, Malaysia.ParticipantsOpioid‐dependent individuals (n= 234).InterventionsParticipants were randomly assigned to one of four treatment conditions and received study interventions for 24 weeks: (1) physician management with or without behavioral counseling and (2) physician management with or without abstinence‐contingent buprenorphine–naloxone (ACB) take‐home doses.MeasurementsThe primary outcomes were proportions of opioid‐negative urine tests and HIV risk behaviors [assessed by audio computer‐assisted AIDS risk inventory (ACASI‐ARI)].FindingsThe rates of opioid‐negative urine tests over 24 weeks of treatment were significantly higher with [68.2%, 95% confidence interval (CI) = 65–71] than without behavioral counseling (59.2%, 95% CI = 56–62,P< 0.001) and with (71.0%, 95% CI = 68–74) than without ACB (56.4%, 95% CI = 53–59,P< 0.001); interaction effects between and among behavioral interventions and time were not statistically significant. Scores on ACASI‐ARI decreased significantly from baseline across all treatment groups (P< 0.001) and did not differ significantly with or without behavioral counseling (P= 0.099) or with or without ACB (P= 0.339).ConclusionsProviding opioid‐dependent patients in Muar, Malaysia with buprenorphine–naloxone and physician management plus behavioral counseling or abstinence‐contingent buprenorphine–naloxone (ACB) resulted in greater reductions of opioid use compared with providing buprenorphine–naloxone and physician management without behavioral counseling or ACB.