Buprenorphine treatment at syringe exchanges to reduce opioid misuse and HIV risk

注射器交换时丁丙诺啡治疗可减少阿片类药物滥用和艾滋病毒风险

• 批准号: 9411340
• 负责人: Aaron D Fox
• 金额: $ 72.14万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE, INC
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9411340
• 关键词: Accident and Emergency department; Address; American; Attitude; Behavioral Model; Bulla; Buprenorphine; Caring; Cessation of life; Clinic; Communities; Community Health Centers; Data; Data Collection; Drug usage; Economics; Effectiveness; Emergency treatment; Frequencies; Goals; HIV; HIV Infections; HIV risk; Health Personnel; Health Services; Health system; Heroin; Hospitals; Individual; Injecting drug user; Inpatients; Intervention; Jail; Maintenance; Measures; Medical; Modeling; Monitor; Needle-Exchange Programs; Opioid; Outcome; Outcome Study; Overdose; Participant; Patient Self-Report; Pharmaceutical Preparations; Pharmacy facility; Physicians; Pilot Projects; Provider; Public Health; Puerto Rico; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recovery; Recruitment Activity; Regulation; Reporting; Research; Risk; Risk Behaviors; Safety; Sampling; Self Efficacy; Sterility; Surveys; Syringes; Testing; Training; Transportation; Treatment Effectiveness; Treatment outcome; United States; Urine; Vulnerable Populations; Waiting Lists; addiction; arm; base; community setting; cost; cost effective; cost effectiveness; data format; drug testing; experience; follow-up; health care delivery; health service use; high risk; improved; innovation; interest; medication compliance; opioid misuse; opioid use; opioid use disorder; overdose death; patient registry; primary outcome; safety testing; secondary outcome; service utilization; social stigma; transmission process; urban area; waiver

Abstract In the United States, opioid use disorder (OUD) and overdose deaths are increasing; yet 80% of opioid users remain out of treatment. Operating in 33 states, syringe exchange programs (SEPs), which provide sterile syringes and other health services to people who inject drugs, are a key venue to reach out-of-treatment opioid users. SEP participants often request referrals for OUD treatment, but structural barriers to care, such as waiting lists or transportation needs, limit engagement in treatment. Therefore structural interventions in health care delivery are necessary to improve engagement in treatment. Buprenorphine maintenance treatment (BMT) is safe and effective, reducing illicit opioid use, HIV risk behaviors, and opioid overdose, and regulations allow for treatment in diverse settings. Therefore, based on the Behavioral Model for Vulnerable Populations and our formative research, we have developed a model to initiate onsite BMT (O-BMT) at SEPs as an innovative and generalizable way to increase BMT engagement. The objectives of this study are to test the effectiveness and safety of O-BMT. In a 24 week randomized controlled trial based in a large urban area with high rates of OUD and HIV, we will recruit 250 out-of-treatment opioid users who utilize SEPs and randomize 1:1 to O- BMT or enhanced referral. Over two weeks, participants in the O-BMT condition will see a buprenorphine provider twice onsite, receive weekly blister packs of medication, and then their care will be transferred to a community health center (CHC) for maintenance BMT. In the control condition, participants will receive enhanced referral to the CHC for BMT. The primary outcome for this study will be engagement in BMT, defined as receiving BMT at 30 days following randomization (effectiveness), and an important secondary outcome will be reduction in HIV risk behaviors (effectiveness). We will also assess buprenorphine diversion (safety) and collect data on programmatic costs and participants’ service utilization (cost-effectiveness). The specific aims for this proposal are: 1. To test the effectiveness of initiating onsite buprenorphine treatment (O-BMT) at syringe exchange programs; 2. To test the safety of O-BMT by determining the frequency of buprenorphine diversion; and 3. To determine the cost- effectiveness of O-BMT by comparing costs and health service utilization between study arms.

摘要