Culturally-responsive community-driven substance use recovery for Black and Latinx populations

计划摘要/摘要 2020年，美国有超过8.5万人死于药物过量，布莱克和布莱克的死亡率飙升 考虑到芬太尼(一种人造阿片类药物)的存在，拉丁裔人分别增加了140%和118% 毒品供应。虽然全国媒体关注的是白人中与阿片类药物有关的死亡，但最低限度 与阿片类药物使用障碍(OUD)和酒精有关的不同发病率和死亡率受到了关注 黑人和拉丁裔人群中的使用障碍(AUD)。尽管澳门氏症的总体患病率在不同种族之间相似 和种族群体，或者在某些情况下，比白人少，继续有不成比例的负担 在代表不足的少数民族(URM)人群中经历的疾病，加上缺乏 有文化知识的成瘾治疗选择。此外，在新冠肺炎上，URM的死亡人数继续恶化 这使得研究针对这些人群的文化知情治疗干预措施变得比以往任何时候都更加紧迫。 这种不成比例的疾病负担和缺乏获得成瘾治疗的黄金标准-药物治疗 成瘾治疗(MAT)--与许多障碍有关，基于结构性种族主义，包括 获得技术的机会不足(这一点在当前的新冠肺炎大流行中特别强调)，缺乏 来自URM背景的瘾君子，URM社区中关于MAT的教育有限，以及缺席 在这些社区提供强大的文化信息的减少伤害服务。应对独特的挑战 降低黑人和拉丁裔患者的治疗起始、参与度和对成瘾治疗的依从性 通过SODS，与主要利益相关者合作，我们开发了Imani(在斯瓦希里语中的意思是信仰)突破 2017年，通过以社区为基础的参与进程。伊玛尼突破是一个以信仰为基础的人- 以文化为中心的减少伤害恢复计划，在教堂举行。这 该计划提供了一种创新的方法，使弱势群体参与SUD治疗，通过专注于 健康的8个维度(健康的社会决定因素/SDOH)，公民身份的7个领域，文化知识 SUD教育，并转介到MAT进行FDA批准的任何治疗SUD的药物治疗。主要目标是 目前这项研究的目的是开发和优化方法，以增加获取、吸收和参与的机会 AUD和OUD的垫子，在各种颜色的社区之间。通过多层次的CBPR倡议和严格的RCT 这包含了参与的选择因素，我们将在对MAT感兴趣的参与者中进行审查， 在Imani(Imani+CTM)中增加基于教会的远程医疗垫选项是否会改善Black的结果 与Imani+传统MAT Referral and Linkage(Imani+MAT)相比，患有AUD或OUD的拉丁裔人 R&L)在社区中。不选择参加MAT的个人将继续参加Imani团体计划 像往常一样。我们的CBPR过程包括向教会和更大的社区学习并与其合作，以 增加社区对AUD和OUD的了解，解决垫上的误解，优化Imani 实施，并建立政策建议，以更好地为黑人和拉丁裔提供服务。

Program Summary/Abstract In 2020, over 85,000 people died from drug overdoses in the US, with mortality rates skyrocketing for Black and Latinx people by 140% and 118%, respectively, given the presence of fentanyl (a manufactured opioid) in the drug supply. While the national media has focused on opioid-involved deaths among White people, minimal attention has been given to the disparate morbidity and mortality related to opioid use disorder (OUD) and alcohol use disorder (AUD) among Black and Latinx people. Although overall prevalence of AUD is similar across racial and ethnic groups, or in some cases, fewer than White people, there continues to be a disproportionate burden of illness experienced among under-represented minority (URM) populations, complicated by a dearth of culturally informed addiction treatment options. Further, with COVID-19, deaths continue to worsen for URM with SUDs, making it more urgent than ever to study culturally informed treatment interventions for these populations. This disproportionate illness burden and lack of access to the gold standard in addiction treatment—medication for addiction treatment (MAT)—has been linked to a host of barriers, based in structural racism, including inadequate access to technology (a point particularly underscored in the current COVID-19 pandemic), lack of addiction providers from URM backgrounds, limited education about MAT in URM communities, and an absence of robust culturally informed harm reduction services in these communities. To tackle the unique challenges of decreased treatment initiation, engagement, and adherence to addiction treatment for Black and Latinx people with SUDs, in collaboration with key stakeholders we developed Imani (meaning Faith in Swahili) Breakthrough in 2017 through a community based participatory process. Imani Breakthrough is a faith-based, person- centered, culturally informed harm reduction recovery program that takes place in churches. This program provides an innovative approach to engaging vulnerable groups into SUD treatment, by focusing on the 8 dimensions of wellness (social determinants of health/ SDOH), 7 domains of citizenship, culturally informed SUD education, and referral to MAT for any FDA-approved pharmacotherapy for treating a SUD. The main goal of this current study is to develop and optimize methods for increasing access to, uptake of, and engagement in MAT for AUD and OUD among communities of color. Through a multilevel CBPR initiative and a rigorous RCT that incorporates elements of choice in participation, we will examine, among participants interested in MAT, whether adding a Church-based Telehealth MAT option to Imani (Imani + CTM) will improve outcomes for Black and Latinx people with AUD or OUD compared to Imani + traditional MAT Referral and Linkage (Imani + MAT R&L) in the community. Individuals who do not choose to engage in MAT will continue in the Imani group program as usual. Our CBPR process incorporates learning from and partnering with the church and larger community to increase the community's understanding of AUD and OUD, tackle MAT misconceptions, optimize Imani implementation, and establish policy recommendations to better serve Black and Latinx with SUDs.