Expanding Access to Pregnancy Specific Opioid Use Disorder Treatment in Jail: Piloting and Adaptable Implementation Strategy to Advance Equitable and Patient-Centered Care

项目摘要/摘要 每年有近200万名妇女通过美国监狱，其中近8000名孕妇入狱 有阿片类药物使用障碍(OUD)。为这些人提供循证治疗对于 应对阿片类药物流行，优化孕产妇和新生儿结局，并促进孕产妇 健康公平。人们越来越认识到监狱在提供药物治疗方面的关键作用 治疗阿片使用障碍(MOUD)作为遏制阿片类药物流行、减少过量用药的一种手段 死亡，以及促进被系统边缘化的一群人的种族平等。在那里的时候 是越来越多的监狱正在扩大对Moud的访问，这是针对独特的 孕妇的需求不足。此外，许多监狱即使在怀孕期间仍然不提供Moud， 尽管已确立了避免戒断的护理标准和已知的穆德的好处 特别是对怀孕的人。我们的长期目标是确保监狱中患有先天性巨结肠的孕妇 接受适当和及时的护理，以优化他们和他们婴儿的长期福祉。整体而言 目标是开发和试行适用于监狱的实施策略和工具包，以便能够提供 获得专门针对怀孕的OUD护理。理由是监狱在大小、资源和 卫生保健提供系统，并需要他们可以根据自己的环境量身定做的工具。确保监狱提供准入 为穆德，并以量身定做的方式，以独特的医疗、心理健康和社会结构方面 对妊娠合并尿毒症的孕妇的护理对于改善短期和长期妊娠、康复和 代际结果。该项目将吸引多个利益相关者参与，包括直接受影响的人， 设计并试行以病人为中心和监狱可行的实施策略，以促进和加强 监狱对孕妇实施Moud。该战略将包含一系列工具，以帮助监狱 迫切需要为进入监狱的孕妇提供MOD；为怀孕提供量身定制的咨询；以及 以产科、心理社会和结构性需求为中心的其他支持服务和护理联系 在这个人口中。实施战略还将适用于各种类型和地域的 监狱。然后，他们将在四个监狱进行试点，这些监狱具有不同的基线容量和服务，为Moud for 怀孕的人。本R34中建议的步骤对于构建工具、结果衡量标准和 将在未来的R01混合实施/有效性试验中扩展的容量，以提高OUD 这一长期被忽视的群体的治疗机会和母婴健康结果。

Project Summary/Abstract Nearly 2 million women pass through U.S. jails each year, with nearly 8,000 admissions of pregnant people with opioid use disorder (OUD). Providing evidence-based treatment to these individuals is essential to addressing the opioid epidemic, to optimizing maternal and newborn outcomes, and to promoting maternal health equity. There is increasing recognition of the critical role of jails in providing access to medication treatment for opioid use disorder (MOUD) as a means of curbing the opioid epidemic, reducing overdose deaths, and promoting racial equity for a group of individuals who are systematically marginalized. While there is a growing number of jails that are expanding access to MOUD, strategies that are specific to the unique needs of pregnant people are lacking. Moreover, many jails still do not provide MOUD even in pregnancy, despite the well-established standard of care of avoiding withdrawal and the known benefits of MOUD specifically for pregnant individuals. Our long-term goal is to ensure that pregnant people with OUD in jails receive appropriate and timely care to optimize their long-term wellbeing and that of their infants. The overall objective is to develop and pilot an adaptable implementation strategy and toolkit for jails to be able to provide access to pregnancy-specific OUD care. The rationale is that jails vary tremendously in size, resources, and health care delivery systems, and need tools they can tailor to their environment. Ensuring jails provide access to MOUD, and in ways that are tailored to the distinctive medical, mental health and social structural aspects of care for pregnant people with OUD is essential for improving short and long-term pregnancy, recovery, and intergenerational outcomes. This project will engage multiple stakeholders, including directly impacted people, to design then pilot a patient-centered and jail-feasible implementation strategy that will facilitate and enhance jails’ implementation of MOUD for pregnant people. The strategy will contain a menu of tools to assist jails with immediate needs to provide MOUD to pregnant people entering jails; with pregnancy-tailored counseling; and with other support services and linkages to care that center the obstetrical, psychosocial, and structural needs of this population. The implementation strategy will also be adaptable to a variety of types and geographies of jails. They will then be piloted at four jails with different baseline capacities and services for MOUD for pregnant people. The steps proposed in this R34 are necessary for building the tools, outcome measures, and capacity that will be scaled-up in a future R01 hybrid implementation/effectiveness trial to improve OUD treatment access and maternal and infant health outcomes for this long-overlooked group.