Development of a community-based buprenorphine treatment intervention

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DESCRIPTION (provided by applicant): With rising rates of opioid addiction, inadequate opioid addiction treatment is increasingly problematic. Buprenorphine treatment can address this problem by reducing opioid use and HIV risk behaviors. Marginalized populations at high risk of acquiring and transmitting HIV, like injection drug users (IDUs), have limited access to buprenorphine treatment. Because of minimal regulations, buprenorphine treatment can be integrated into community-based settings where IDUs congregate. There is great potential for strategies that emphasize community-based buprenorphine treatment to reach marginalized populations, like IDUs. Building on our previous work in which we developed community-based strategies to improve access to HIV treatment and developed a buprenorphine induction strategy to overcome induction challenges, we believe that developing a buprenorphine treatment intervention in community-based settings is critical to improving accessible and successful opioid addiction treatment for IDUs. Thus, we propose to develop a buprenorphine treatment intervention in non-medical community-based settings to improve access to opioid addiction treatment, improve health outcomes, and reduce high-risk behaviors among IDUs. We will collaborate with two community-based organizations (CBOs) to develop, test the feasibility of, and preliminarily examine a community-based buprenorphine treatment (CBBT) intervention. We anticipate that the CBBT intervention will consist of: buprenorphine education, facilitated access to physicians, support during buprenorphine induction, and support during buprenorphine maintenance. Additionally, we anticipate that the CBBT intervention will target clients of the CBOs' syringe exchange programs, be implemented by CBOs' outreach workers, and occur in the CBOs' settings. The specific aims are: 1) To develop a community-based buprenorphine treatment intervention. We will conduct focus groups and open-ended individual interviews with two CBOs' staff and clients to guide development of CBBT intervention components, materials, and processes. 2) To test the feasibility of implementing a community-based buprenorphine treatment intervention. We will examine feasibility by: 1) monitoring outreach workers' ability to adhere to the intervention manual; 2) measuring outreach worker and client satisfaction, and 3) tracking clients who engage in the CBBT intervention. 3) To examine treatment outcomes (opioid use, HIV risk behaviors, treatment retention) of a community-based buprenorphine treatment intervention. We will compare change in opioid use and HIV risk behaviors before and 30 days after initiating buprenorphine treatment in clients who received the CBBT intervention with clients who did not. We will also compare 30-day treatment retention. If CBBT is feasible and can improve treatment outcomes, it could positively impact the opioid and HIV epidemics. Pilot data from this project will guide our R01 grant application, to conduct a large-scale rigorous study of the effectiveness of our CBBT intervention.