Evaluation of a peer recovery support program adapted to target retention in clinic-based medication for opioid use disorder treatment

项目摘要 药物过量在美国处于创纪录的水平，主要是由于持续的阿片类药物使用障碍（OUD） 疫情阿片类药物使用障碍（MOUD）的药物已被证明可以安全有效地治疗OUD， 减少过量和过量死亡，并促进长期康复。然而，在MOUD治疗中， 通常福尔斯达不到持续恢复所需的6-12个月时间，并提前终止MOUD 是导致用药过量的危险因素对等恢复支持（PRS;即，由受过培训的“同行”提供支助服务， 成瘾和恢复的生活经验）作为改善保留的策略， MOUD，但几乎没有严格的研究已经进行了其有效性，在这种情况下。总体 拟议项目的目的是让利益相关者参与调整PRS，专门用于门诊MOUD 设置和评估PRS计划在改善多个患者保留方面的有效性 地理位置多样的MOUD诊所。实用、稳健的实施和可持续性模型（PRISM） 一个上下文扩展版本的范围，采用，有效性，实施和维护（RE- AIM）框架将用于项目的两个阶段，以确保最终的PRS计划和 研究结果可以直接转化为实践。在R61阶段，我们提出了一个基于社区的 将减贫战略服务适应门诊MOUD治疗环境的探索性研究方法。我们将 在R61和R33阶段与两个社区委员会聚集并合作，共同开发所有 减贫战略计划的各个方面，同侪恢复专家的培训和监督计划，以及 随后的临床试验。社区委员会将包括：1）有MOUD治疗经验的患者; 以及2）MOUD提供者/工作人员/管理员、同行恢复专家和付款人。接下来，我们将进行混合- 方法试点评估，以测试可行性，并作出完善的PRS计划，同行培训， 监督计划和试行办法。在R33阶段，我们将进行一项随机对照试验， 标准门诊MOUD护理（SC）与SC加适应性PRS计划（SC+PRS）。主 结果是6个月时的治疗保留率和治疗时间长度;次要结果包括12- 月保留，非法阿片类药物使用和患者对达到治疗目标的满意度。探索性分析 检查潜在的主持人（例如，乡村性，成瘾严重性）和介导物（例如，回收资本，内部化 （b）评估SC+PRS的效果，包括参与PRS的程度如何影响有效性。 最后，本项目将使用混合的方法评估PRS计划交付和可持续性的促进者和障碍。 方法方法;该分析的结果将为未来的实施策略提供信息。如果成功，这项研究 将提供有关PRS对MOUD治疗保留的影响的急需证据，并将导致 以患者为中心的PRS计划，可以在地理位置不同的门诊MOUD计划中实施， 包括服务不足的农村地区，这些地区包括OUD的主要健康差距人口。

PROJECT ABSTRACT Drug overdoses are at record levels in the US, driven primarily by the ongoing opioid use disorder (OUD) epidemic. Medications for opioid use disorder (MOUD) have been shown to safely and effectively treat OUD, reduce overdose and overdose death, and facilitate long-term recovery. However, retention in MOUD treatment often falls short of the 6-12-month duration necessary for sustained recovery, and early termination from MOUD is a risk factor for overdose. Peer recovery support (PRS; i.e., support services provided by trained “peers” with lived experience of addiction and recovery) holds substantial promise as a strategy for improving retention in MOUD, yet virtually no rigorous research has been conducted on its effectiveness in this setting. The overarching aim of the proposed project is to engage stakeholders to adapt PRS specifically for use in outpatient MOUD settings and evaluate the effectiveness of the PRS program in improving patient retention across multiple geographically diverse MOUD clinics. The Practical, Robust Implementation and Sustainability Model (PRISM), a contextually expanded version of the Reach, Adoption, Effectiveness, Implementation, and Maintenance (RE- AIM) framework will be used across the two phases of the project to ensure that the resulting PRS program and study findings can be translated directly into practice. In the R61 phase, we propose a Community-Based Participatory Research approach to adapting PRS services for outpatient MOUD treatment settings. We will assemble and collaborate with two community boards throughout the R61 and R33 phases to co-develop all aspects of the PRS program, training and supervision plan for peer recovery specialists, and elements of the subsequent clinical trial. Community boards will include: 1) patients with lived experience with MOUD treatment; and 2) MOUD providers/staff/administers, peer recovery specialists, and payors. Next, we will conduct a mixed- methods pilot evaluation to test feasibility and make refinements to the PRS program, peer training and supervision plan, and trial methods. In the R33 phase, we will conduct a randomized controlled trial comparing standard outpatient MOUD care (SC) versus SC plus the adapted PRS program (SC+PRS). The primary outcomes are treatment retention and length of time in treatment at 6 months; secondary outcomes include 12- month retention, illicit opioid use, and patient satisfaction with meeting treatment goals. Exploratory analyses will examine potential moderators (e.g., rurality, addiction severity) and mediators (e.g., recovery capital, internalized stigma) of the effect of SC+PRS, including how the degree of engagement with PRS impacts effectiveness. Finally, this project will evaluate facilitators and barriers to PRS program delivery and sustainability using a mixed method approach; results of this analysis will inform future implementation strategies. If successful, this study will provide much-needed evidence regarding the impact of PRS on MOUD treatment retention and will result in a patient-centered PRS program that can be implemented in geographically diverse outpatient MOUD programs, including underserved rural areas that encompass a key health disparities population for OUD.