Expanding Access to Buprenorphine Treatment among Homeless Persons with Opioid Use Disorder

摘要 阿片类药物过量是无家可归者死亡的主要原因。虽然 丁丙诺啡治疗对阿片类药物使用障碍（OUD）有效，无家可归者经历多种 获得这种救命药物的障碍。最近，FDA批准了每月一次的注射剂 用于治疗 OUD 的缓释丁丙诺啡制剂，可能提供舌下含服的替代方案 丁丙诺啡用于难以依从的人群，例如无家可归者。长效制剂 丁丙诺啡治疗有望改善依从性、保留率和临床结果。然而， 关于患有 OUD 的、失去治疗的无家可归者是否愿意接受治疗的信息很少。 可注射的丁丙诺啡制剂。此外，尽管丁丙诺啡治疗可用于多种疾病 在不同的环境中，有限的研究衡量了治疗 OUD 的系统护理模型的准备情况 无家可归者。该项目旨在评估个人、提供者和系统层面的障碍和促进因素 为患有 OUD 的无家可归者提供丁丙诺啡治疗。综合指导下 实施研究框架，我们将使用探索性顺序混合方法设计来 识别实施丁丙诺啡治疗的潜在个人、提供者和系统层面的障碍 在两种服务环境中：无家可归者收容所和注射器获取计划。该项目的具体目标是： (1) 评估扩大丁丙诺啡治疗的组织能力和组织准备情况 无家可归者收容所和注射器获取计划； (2) 用 OUD 评估无家可归者的意愿 接受丁丙诺啡治疗，对不同丁丙诺啡治疗配方的偏好（舌下含服） 与注射），并确定与丁丙诺啡治疗配方偏好相关的因素。至 实现目标 1，我们将与医疗保健提供者进行深入访谈、焦点小组和调查， 项目工作人员以及在无家可归者收容所和注射器获取项目工作的项目主管。在目标 2 中，我们 将从无家可归者收容所、注射器获取计划和无家可归者那里招募 200 名无家可归者 营地；然后进行结构化调查以确定丁丙诺啡治疗的偏好 制剂，并确定不同丁丙诺啡治疗制剂偏好的预测因子。 研究人员可以利用这项研究的结果来指导丁丙诺啡治疗的计划 用 OUD 治疗无家可归者，我们将利用这些结果进行后续可行性研究 舌下含服丁丙诺啡与缓释丁丙诺啡治疗无家可归者 OUD 的可接受性试验 人。

ABSTRACT Opioid overdose is a major cause of death among people experiencing homelessness. Although buprenorphine treatment is effective for opioid use disorder (OUD), homeless persons experience multiple barriers to accessing this life-saving medication. Recently, the FDA approved a once-monthly injectable extended-release buprenorphine formulation for treatment of OUD, which may offer an alternative to sublingual buprenorphine for populations challenged by adherence, such as homeless persons. Long-acting formulations of buprenorphine treatment hold promise for improving adherence, retention, and clinical outcomes. However, little information exists about how amenable out-of-treatment homeless persons with OUD may be to an injectable buprenorphine formulation. Furthermore, although buprenorphine treatment can occur in a variety of settings, limited research has measured readiness of system models of care for the treatment of OUD among homeless persons. This project aims to assess individual, provider and system-level barriers and facilitators to accessing buprenorphine treatment among homeless people with OUD. Guided by the Consolidated Framework for Implementation Research, we will use an exploratory sequential mixed method design to identity potential individual, provider, and system-level barriers to implementation of buprenorphine treatment in two service settings: homeless shelters and syringe access programs. The specific aims of the project are: (1) assess organizational capacity and organizational readiness for the expansion of buprenorphine treatment in homeless shelters and syringe access programs; and (2) assess willingness of homeless people with OUD to receive buprenorphine treatment, preferences for different buprenorphine treatment formulations (sublingual vs. injection), and identify factors associated with preferences for buprenorphine treatment formulations. To achieve Aim 1, we will conduct in-depth interviews, focus groups, and surveys with health care providers, program staff, and program directors working at homeless shelters and syringe access programs. In Aim 2, we will recruit 200 homeless persons from homeless shelters, syringe access programs, and homeless encampments; and then administer structured surveys to identify preferences for buprenorphine treatment formulations, and identify predictors of preferences for different buprenorphine treatment formulations. Researchers can use the results of this study to inform the planning of buprenorphine treatment for out-of- treatment homeless persons with OUD, and we will use these results to conduct a subsequent feasibility and acceptability trial of sublingual buprenorphine vs. extended release buprenorphine to treat OUD in homeless persons.