Understanding the Impact of COVID-19 on Methadone Treatment Retention and Adherenceàin an Underserved, Minority Population with OUD

项目总结 美国的阿片使用障碍(OUD)危机是一种难以获得护理的流行病，包括药物治疗 阿片类药物使用障碍(Moud)和循证行为干预支持Moud结果。低- 收入、种族/少数民族中有不成比例的乌德人证明穆德的结果很差， 包括不到一半的人通常在六个月后被留在穆德。留住是其中之一 最能预测未来复发、功能和死亡率的因素。实施循证干预措施 改善特别适合低收入、种族/少数民族需要的Moud保留率 有OUD的人是必不可少的。同伴恢复教练(PR)，受过训练的个人与他们自己的生活 有物质使用障碍的经验，可能是唯一适合解决Moud常见障碍的经验 服务不足人群中的滞留，包括耻辱、导航服务的挑战、住房不稳定、 其他结构性和心理社会因素。中国提供的干预措施是一种很有前途的改善战略 低收入、少数族裔OUD患者的MMOD保留，但几乎没有循证干预措施 (EBI)已针对PRC交付进行评估，以促进Moud保留。我们团队的初步工作 提示行为激活(BA)可能是一种可行的、可扩展的基于强化的方法 提高低收入、少数族裔的Moud保留率。拟议的研究建立了 基于我们团队的形成性工作，以适应和评估PRC交付的 BA干预(Peer Activate)，以支持低收入、少数族裔个人在 巴尔的摩市，它是美国服药过量死亡率最高的城市之一，也是OUD负担最大的城市之一 在低收入、种族/少数民族个人中。在第一阶段，我们建议完善和敲定中华人民共和国- 交付的对等激活模型，并使用干预前重点解决第二阶段实施中的障碍 与PRC、工作人员、客户和其他关键利益攸关方组成的小组(n=24)。我们将建立初步的可行性， Peer的可接受性和保真度在开放标签试验(n=30)和试点阶段2研究程序中激活， 包括收集Moud的初步结果(Moud保留和3个月后阿片类药物戒断)。基座 在第一阶段的适应之后，我们将进行随机的、类型1的混合有效性-实施 评估同伴激活与照常治疗(TAU；n=200)的有效性和实施情况的试验 六个月后Moud滞留(主要)、Moud坚持和阿片类药物戒断(尿毒学)，以及 抑郁症状(继发)。将在多个层面上评估实施结果(患者、 提供商、组织)，包括对可行性、可接受性、保真度和采用率的评估，由 普罗科特关于执行成果的概念模型。我们的多学科团队旨在开发一种 循证的PRC提供的治疗模式，可持续提供以改善Moud保留 适用于低收入、少数族裔和儿童。

PROJECT SUMMARY The opioid use disorder (OUD) crisis in the US is an epidemic of poor access to care, including medication for opioid use disorder (MOUD) and evidence-based behavioral interventions to support MOUD outcomes. Low- income, racial/ethnic minority individuals with OUD disproportionately evidence poor MOUD outcomes, including less than half of individuals typically being retained in MOUD at six months. Retention is one of the factors most predictive of future relapse, functioning, and mortality. Implementing evidence-based interventions to improve MOUD retention that are particularly appropriate for the needs of low-income, racial/ethnic minority individuals with OUD is essential. Peer recovery coaches (PRCs), trained individuals with their own lived experience with substance use disorder, may be uniquely suited to address common barriers to MOUD retention among underserved populations, including stigma, challenges navigating services, housing instability, other structural and psychosocial factors. PRC-delivered interventions are a promising strategy for improving MOUD retention for low-income, minority individuals with OUD, yet there are few evidence-based interventions (EBIs) that have been evaluated for PRC delivery to promote MOUD retention. Preliminary work by our team suggests that behavioral activation (BA) may be a feasible, scalable reinforcement-based approach for improving MOUD retention for low-income, minority individuals with OUD by PRCs. The proposed study builds upon our team’s formative work to adapt and evaluate the effectiveness and implementation of a PRC-delivered BA intervention (Peer Activate) to support MOUD retention for low-income, minority individuals initiating MOUD in Baltimore City, which has one of the highest overdose-fatality rates in the US and greatest burdens of OUD among low-income, racial/ethnic minority individuals. In Phase 1, we propose to refine and finalize the PRC- delivered Peer Activate model and address barriers to implementation for Phase 2 using pre-intervention focus groups with PRCs, staff, clients, and other key stakeholders (n=24). We will establish the preliminary feasibility, acceptability and fidelity of Peer Activate in an open-label trial (n=30) and pilot Phase 2 study procedures, including collecting preliminary MOUD outcomes (MOUD retention and opioid abstinence at 3 months). Based upon adaptations in Phase 1, we will then conduct a randomized, Type 1 hybrid effectiveness-implementation trial to evaluate the effectiveness and implementation of Peer Activate vs. treatment as usual (TAU; n=200) on MOUD retention at six months (primary), MOUD adherence and opioid abstinence (urine toxicology), and depressive symptoms (secondary). Implementation outcomes will be assessed at multiple levels (patient, provider, organization), including assessments of feasibility, acceptability, fidelity, and adoption guided by Proctor’s conceptual model of implementation outcomes. Our multidisciplinary team aims to develop an evidence-based PRC-delivered treatment model that can be sustainably delivered to improve MOUD retention for low-income, minority individuals with OUD.