Adapting the HOPE Online Support Intervention to Increase MAT Uptake Among OUD Patients

在一项随机对照试验中，通过3个月、6个月和1年的随访，本申请旨在评估 使用在线同伴支持社区干预来增加MAT启动的有效性， 在网上招募的阿片类药物使用障碍（OUD）参与者中的维持。 美国平均每天有130人死于阿片类药物过量， 国家最大的公共卫生问题（1，2）。虽然有效的FDA批准的药物辅助治疗 (MAT)可用于阿片类药物使用障碍（OUD）患者，包括丁丙诺啡和注射剂 纳洛酮，只有一小部分受益于这些药物的人使用它们。有 MAT使用率低的一些原因，包括缺乏保险;提供者和 患者; MAT相关的耻辱;和社会规范（例如，如果他们的同龄人更愿意使用MAT， 也使用MAT）。创新方法，特别是涉及多个层面的方法（例如，个人， 文化和社会/社区），以增加MAT在OUD患者中的使用。 在线同伴主导的支持干预措施可能对提高MAT吸收率特别有效，因为 他们可以利用同龄人来广泛、快速地扩大社会规范的变化（例如，有兴趣使用MAT） 在人们的自然的、真实的、虚拟的环境中。例如，利用在线同行 教育（希望）干预，一个在线同伴支持社区干预，旨在减少耻辱和 增加健康行为改变，已被证明是有效地改变健康行为， 被污名化的人群，如艾滋病毒。具体到阿片类药物相关的问题，我们的团队最近发现， 干预是一种可行和可接受的方法，可降低处方阿片类药物滥用的风险， 阿片类药物治疗的慢性疼痛患者。然而，没有研究表明在线支持是否 干预措施，如希望，可能是有效的，在增加MAT的要求，吸收，和维持， OUD患者。因此，评估这些社会规范/行为技术方法至关重要， 降低阿片类药物过量的增长率。 在这项研究中，我们试图探讨是否和如何希望在线支持干预可能会适应 为了增加OUD参与者的MAT启动和维持，评估使用 在网上招募的不使用MAT的OUD参与者中增加MAT使用的干预措施， 一种实施科学方法（基于《综合框架》的结构， 实施研究，CFIR，确定社会网络动态之间的关系（例如，网络 大小）、在线社区讨论的主题以及行为改变。

In a randomized controlled trial, with 3, 6-month and 1-year follow-up, this application seeks to assess the effectiveness of using an online peer support community intervention to increase MAT initiation and sustainment among participants with opioid use disorder (OUD) who are recruited online. On average, 130 people die in the United States each day from opioid overdoses, making the opioid crisis the country's top public health concern (1,2). Although effective FDA-approved medication-assisted therapy (MAT) is available for patients with opioid use disorder (OUD), including buprenorphine and injectable naltrexone, only a small fraction of those who would benefit from these medications use them. There are a number of reasons for low MAT use, including lack of insurance; knowledge, among both providers and patients; MAT-related stigma; and social norms (e.g., people would be more willing to use MAT if their peers were also using MAT). Innovative methods, especially those that address multiple levels (e.g., the individual, culture, and society/community) are needed to increase MAT use among individuals with OUD. Online peer-led support interventions might be particularly effective at increasing MAT uptake because they can leverage peers to widely and rapidly scale changes in social norms (e.g., interest in using MAT) throughout people's natural, real-world, virtual environments. For example, the Harnessing Online Peer Education (HOPE) intervention, an online peer support community intervention designed to reduce stigma and increase health behavior change, has been shown to be effective at changing health behaviors among stigmatized populations, such as for HIV. Specific to opioid-related issues, our team recently found the HOPE intervention to be a feasible and acceptable method of reducing risk for prescription opioid misuse among chronic pain patients on opioid therapy. However, no research has studied whether online support interventions, such as HOPE, might be effective in increasing MAT requests, uptake, and sustainment among OUD patients. It is therefore critical to evaluate these social normative/behavioral technology methods to reduce the increasing rate of opioid overdose. In this study, we seek to explore whether and how the HOPE online support intervention might be adapted to increase MAT initiation and sustainment among participants with OUD, assess the effectiveness of using the intervention to increase MAT use among OUD participants recruited online who are not using MAT, and using an implementation science approach (based on constructs from the Consolidated Framework for Implementation Research, CFIR, determine the relationship between social network dynamics (e.g., network size), topics discussed on the online community, and behavior change.