Buprenorphine group medical visits for drug users at risk for HIV

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 DESCRIPTION (provided by applicant): Group medical visits to intensify buprenorphine treatment in primary care Opioid addiction and opioid overdose deaths have increased rapidly in the United States. Access to opioid addiction treatment has improved through successful implementation of buprenorphine maintenance treatment (BMT) in primary care; however, treatment outcomes, including abstinence from opioids, have yet to be optimized. Our overarching goal is to reduce the consequences of opioid addiction, including HIV transmission, by improving BMT outcomes in primary care. The objective of this study is to develop a manualized theory-guided behavioral intervention based on the model of group medical visits, which will be used in primary care to intensify BMT for patients with ongoing opioid abuse. This proposal aims to: 1.) determine key components of a group-based BMT intervention (G-BMT) that will enhance buprenorphine treatment outcomes within primary care; 2.) develop the G-BMT intervention; and 3.) preliminarily test G-BMT for efficacy, acceptability, and feasibility in primary care. These aims will be achieved by conducting focus groups with eight BMT providers and 40 BMT patients using Social Cognitive Theory as a theoretical framework to determine potential components for the G-BMT intervention that will be acceptable to patients and likely to result in reduced opioid abuse. Based on this formative research, an intervention guide for G-BMT will be developed to provide a novel option for treatment intensification in primary care. In a randomized trial, we will preliminarily test G-BMT (8 sessions over 16 weeks) for feasibility, acceptability, and efficacy, by comparing G-BMT to treatment as usual (TAU) for BMT patients with ongoing opioid abuse while receiving standard office-based BMT. We hypothesize that participants randomized to G- BMT will have higher abstinence rates (primary outcome, efficacy), fewer HIV risk behaviors (efficacy), greater satisfaction with treatment (acceptability) and higher visit adherence (feasibility) than participants randomized to TAU. Following this study, we will use feasibility and acceptability data to further modify the G-BMT intervention, and in a multi-site randomized trial, we will fully examine its effectiveness at improving abstinence, reducing HIV-risk behaviors, and increasing retention in treatment for BMT patients with ongoing opioid abuse.