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

项目摘要 美国的阿片类药物使用障碍（OUD）危机是一种难以获得护理的流行病，包括用于 阿片类药物使用障碍（MOUD）和基于证据的行为干预，以支持MOUD的结果。低- 收入，种族/少数民族与OUD的个人不成比例地表现出不良的MOUD结果， 包括通常在发展部保留6个月的人员不到一半。保留是 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MOUD保留，特别适合低收入、种族/少数民族的需求 有OUD的人是必不可少的。同伴恢复教练（PRCs），受过训练的个人与他们自己的生活 物质使用障碍的经验，可能是唯一适合解决MOUD的常见障碍 服务不足人口的滞留问题，包括污名化、服务导航方面的挑战、住房不稳定， 其他结构和心理社会因素。中国提供的干预措施是一个有希望的战略， 低收入、少数OUD患者的MOUD保留，但很少有基于证据的干预措施 （EBI）已被评估为PRC交付，以促进MOUD保留。我们团队的前期工作 表明行为激活（BA）可能是一种可行的、可扩展的基于强化的方法， 改善PRC对低收入、少数群体OUD患者的MOUD保留率。该研究建立了 我们的团队的形成工作，以适应和评估的有效性和实施中国交付 BA干预（Peer Activate），以支持低收入，少数民族个人在以下情况下启动MOUD 巴尔的摩市是美国过量用药致死率最高的城市之一，也是OUD负担最重的城市 低收入、种族/少数民族的人。在第一阶段，我们建议完善和完成《中华人民共和国刑法》- 提供对等激活模型，并使用干预前重点解决第2阶段实施的障碍 与PRC、工作人员、客户和其他关键利益相关者的团体（n=24）。我们将建立初步的可行性， Peer Activate在开放标签试验（n=30）和试验性II期研究程序中的可接受性和保真度， 包括收集初步MOUD结果（3个月时的MOUD保留和阿片类药物戒断）。基于 在第一阶段进行调整之后，我们将进行一次随机的、类型1的混合有效性实施 评价Peer Activate与常规治疗（TAU; n=200）的有效性和实施的试验， 6个月时的MOUD保留（主要），MOUD依从性和阿片类戒断（尿液毒理学），以及 抑郁症状（继发性）。实施结果将在多个层面（患者， 提供者、组织），包括可行性、可接受性、忠诚度和采用的评估， 普罗克特的实施成果概念模型。我们的多学科团队旨在开发一种 循证PRC提供的治疗模式，可持续提供，以提高MOUD保留率 为低收入的少数民族OUD患者提供服务。

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.