C-DIAS RP 2: Implementing contingency management for stimulant use in specialty addiction treatment organizations

C-DIAS研究项目2：项目摘要/摘要 这一严格的实验解决了一个关键的公共卫生问题--日益严重的兴奋剂/阿片类药物流行。它 通过对多层次实施战略的评估促进实施科学，并具体说明 结果的背景决定因素。兴奋剂构成了新的致命的第四波阿片类药物 流行病。在阿片类药物使用障碍患者中，兴奋剂的使用与更持久的 阿片类药物的使用；更高的艾滋病毒感染风险；更高的家庭、医疗、法律和职业问题水平；以及 致死过量的风险更高。应急管理(CM)是对兴奋剂最有效的干预 使用，是治疗阿片类药物使用障碍(Moud)的循证辅助药物。然而，CM在中国的吸收 提供Moud的阿片类药物治疗计划(OTP)仍然很低：事实上，获得CM的机会可以说是 成瘾治疗服务领域最大的研究与实践差距。C-DIAS研究的目标 项目2是进行III型混合有效性-实施试验，以评估多层次的 实施战略，科学服务实验室(SSL)，在OTP中安装CM用于兴奋剂。这个 SSL有三个核心组成部分：授课培训、绩效反馈和外部促进。该项目 采用常见的C-DIAS框架、措施和方法来指导SSL评估。利用阶梯式 楔形设计，10个公共部门OTP的地区队列将被随机分配到5个不同的 时间点。每隔六个时间，10个OTP中的每一个都将提供CM上所有可用的患者图表中的数据 分娩和病人结局。每个OTP还将在每个楔子(n=500名患者)招募10名患者来完成 一次基线访谈和3个月的随访。此外，来自每个OTP的工作人员将报告上下文 三个时间点的执行结果的决定因素。这项研究将严格评估一项 由历史最悠久的国家中介机构之一制定的多层次实施战略 组织--SAMHSA技术转移中心，将改进实施和患者 结果。实施成果由RE-AIM指导，包括CM REACH、采用、实施 和可持续性，而患者结果包括CM有效性的衡量标准，如兴奋剂禁欲 和治疗滞留。这项研究将通过打开C-DIAS的黑匣子 实施策略与探索语境对企业发展的中介和调节作用 实施成果。以积极实施阶段为重点，本研究项目利用双 与C-DIAS的定向协同关系。一些但不是所有的例子包括：1)标准化 战略的实施背景、结果和程序细节的措施；2)Pi(Becker)S在以下方面的作用 C-DIAS研究核心；3)关键项目之间密切的合作和指导网络 人员和C-DIAS PI；以及4)可用于C-DIAS Research建模的数据协调 核心专家。

C-DIAS RESEARCH PROJECT 2: PROJECT SUMMARY/ABSTRACT This rigorous experiment addresses a critical public health problem--the rising stimulant/opioid epidemic. It advances implementation science through the evaluation of a multi-level implementation strategy and specifies of contextual determinants of outcomes. Stimulants constitute a new and deadly fourth wave of the opioid epidemic. Among persons with opioid use disorder, stimulant use has been associated with more persistent opioid use; higher risk of HIV infection; higher levels of family, medical, legal, and vocational problems; and higher risk of lethal overdose. Contingency management (CM) is the most effective intervention for stimulant use and is an evidence-based adjunct to medication for opioid use disorder (MOUD). Yet, uptake of CM in opioid treatment programs (OTPs) that provide MOUD remains low: in fact, access to CM is arguably one of the greatest research-to-practice gaps in the addiction treatment services field. The goal of C-DIAS Research Project 2 is to conduct a type III hybrid effectiveness-implementation trial to evaluate a multi-level implementation strategy, the Science to Service Laboratory (SSL), to install CM for stimulant use in OTPs. The SSL has three core components: didactic training; performance feedback; and external facilitation. The project employs common C-DIAS frameworks, measures, and methods to guide SSL evaluation. Utilizing a stepped wedge design, a regional cohort of 10 public sector OTPs will be randomized to receive SSL at five distinct time points. At six intervals, each of the 10 OTPs will provide data from all available patient charts on CM delivery and patient outcomes. Each OTP will also recruit 10 patients per wedge (n = 500 patients) to complete a baseline interview and 3-month follow-up. In addition, staff from each OTP will report on contextual determinants of implementation outcomes at three timepoints. This study will rigorously evaluate whether a multi-level implementation strategy developed by one of the longest-standing national intermediary purveyor organizations--the SAMHSA Technology Transfer Centers, will improve both implementation and patient outcomes. Implementation outcomes are guided by RE-AIM and include CM Reach, Adoption, Implementation and Sustainment, while patient outcomes include measures of CM Effectiveness such as stimulant abstinence and treatment retention. The study will advance the C-DIAS scientific aims by unpacking the black box of implementation strategies and exploring the mediational and moderating influence of context on implementation outcomes. Focused on the active IMPLEMENT phase, this Research Project leverages a bi- directional synergistic relationship with C-DIAS. Some but not all examples of this include: 1) standardized measures of implementation context, outcomes and procedural details of strategies; 2) PI (Becker)’s role on the C-DIAS Research Core; 3) a close network of collaboration and mentoring among the key project personnel and C-DIAS PI; and 4) harmonization of data that can be used for modeling by C-DIAS Research Core experts.