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

文化响应型社区驱动的黑人和拉丁裔人群药物使用恢复

• 批准号: 10413500
• 负责人: Chyrell Denise Bellamy
• 金额: $ 166.71万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-23 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10413500
• 关键词: Address; Adherence; Attention; COVID-19 mortality; COVID-19 pandemic; Cessation of life; Church; Collaborations; Color; Communities; Dimensions; Education; Elements; Enrollment; Environment; Ethnic group; FDA approved; Fentanyl; Foundations; Goals; Gold; Harm Reduction; Healthcare; Healthcare Systems; Individual; Intervention; Latinx; Learning; Link; Mediator of activation protein; Methodology; Methods; Minority Groups; Morbidity - disease rate; Opioid; Outcome; Overdose; Participant; Persons; Pharmaceutical Preparations; Pharmacotherapy; Policies; Population; Population Intervention; Prevalence; Process; Provider; Public Health; Race; Randomized Controlled Trials; Recommendation; Recovery; Research; Services; Spirituality; Structural Racism; Substance Use Disorder; Technology; Time; Training; Underrepresented Minority; United States Substance Abuse and Mental Health Services Administration; Vulnerable Populations; addiction; alcohol abuse therapy; alcohol involvement; alcohol use disorder; base; burden of illness; community based participatory research; disparities in morbidity; effective intervention; experience; health disparity; improved outcome; innovation; interest; minority communities; mortality; opioid use disorder; person centered; programs; social health determinants; substance use; telehealth; uptake

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.

项目概要/摘要 2020年，美国有超过85，000人死于药物过量，黑人和黑人的死亡率飙升， 拉丁人分别为140%和118%，因为芬太尼（一种制造的阿片类药物）存在于 毒品供应虽然国家媒体关注的是白色人中与阿片类药物有关的死亡， 阿片类药物使用障碍（OUD）和酒精相关的不同发病率和死亡率已引起关注 使用障碍（AUD）在黑人和拉丁人。尽管不同种族的AUD总体患病率相似， 和种族群体，或在某些情况下，少于白色人，继续有一个不成比例的负担 代表性不足的少数民族（URM）人口中经历的疾病，由于缺乏 文化上知情的戒毒治疗方案。此外，随着COVID-19，URM的死亡人数继续恶化， SUD，使得研究这些人群的文化知情治疗干预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药物的黄金标准 成瘾治疗（MAT）-与一系列基于结构性种族主义的障碍有关，包括 获得技术的途径不足（这一点在当前的COVID-19大流行中特别突出），缺乏 来自URM背景的成瘾提供者，URM社区关于MAT的教育有限， 在这些社区提供强有力的文化上知情的减少伤害服务。为了应对独特的挑战， 减少黑人和拉丁裔人的治疗开始、参与和坚持成瘾治疗 与SUD合作，与主要利益相关者合作，我们开发了Imani（意为斯瓦希里语的信仰）突破 2017年，以社区为基础，以社区为依托。伊玛尼突破是一个基于信仰的人， 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，重点是 健康的8个方面（健康的社会决定因素/ SDOH），公民的7个领域，文化上知情 SUD教育，并转诊到MAT接受任何FDA批准的治疗SUD的药物治疗。主要目标 目前这项研究的目的是开发和优化方法，以增加获得，吸收和参与， MAT为AUD和OUD的颜色社区之间。通过多层次CBPR倡议和严格的RCT 结合参与的选择元素，我们将研究，在MAT感兴趣的参与者中， 在Imani（Imani + CTM）中添加基于教会的远程医疗MAT选项是否会改善黑人的结局 与Imani +传统MAT转诊和联系（Imani + MAT）相比， R&L在社区。不选择从事MAT的个人将继续参加Imani小组计划 和往常一样。我们的CBPR过程包括从教会和更大的社区学习和合作， 增加社区对AUD和OUD的理解，解决MAT误解，优化Imani 实施，并制定政策建议，以更好地为黑人和拉丁裔与SUD。