Peer-Delivered Behavioral Activation Intervention to Improve Adherence to MAT Among Low-Income, Minority Individuals With OUD

项目总结 美国的阿片使用障碍(OUD)危机是一种难以获得包括药物在内的护理的流行病 辅助治疗(MAT)和循证行为干预以支持MAT结果。低- 收入、种族/少数族裔有不成比例的乌德人证明MAT结果不佳，包括 不到一半的个体通常在六个月后被保留在垫子上。留存是最重要的因素之一 预测未来的复发、功能和死亡率。实施循证干预措施，以改善 特别适合低收入、种族/少数民族个人需要的垫子保留 与OUD是必不可少的。同伴恢复教练(PR)，受过培训的人员具有自己的亲身经历 物质使用障碍，可能是唯一适合于解决以下方面的共同障碍 服务不足的人口，包括耻辱、导航服务的挑战、住房不稳定、其他结构性问题 以及心理社会因素。中国提供的干预措施是改善垫子固位率的一个有前景的策略 低收入的少数族裔OUD患者，但很少有循证干预(EBI) 对PRC交付进行了评估，以促进垫子的保留。我们团队的初步工作表明， 行为激活(BA)可能是改进MAT的一种可行的、可扩展的基于强化的方法 保留低收入、少数族裔个人的权利和权利，并由区域中心负责。这项拟议的研究建立在我们团队的 适应和评估中华人民共和国提供的BA干预的有效性和实施情况的形成性工作 (Peer Activate)支持低收入少数族裔个人在巴尔的摩市启动MAT保留， 它是美国服药过量致死率最高的城市之一，也是OUD负担最大的城市之一 收入、种族/少数民族个人。在第1阶段，我们建议完善和最终确定PRC交付的Peer 使用干预前焦点小组激活模型并解决实施第二阶段的障碍 PRC、工作人员、客户和其他关键利益攸关方(n=24)。我们将建立初步的可行性， Peer的可接受性和保真度在开放标签试验(n=30)和试点阶段2研究程序中激活， 包括收集初步的MAT结果(MAT滞留和3个月后阿片类药物戒断)。基座 在第一阶段的适应之后，我们将进行随机的、类型1的混合有效性-实施 评估同伴激活与照常治疗(TAU；n=200)的有效性和实施情况的试验 六个月后垫子滞留(主要)、垫子坚持和阿片类药物戒断(尿毒学)，以及 抑郁症状(继发)。将在多个层面上评估实施结果(患者、 提供商、组织)，包括对可行性、可接受性、保真度和采用率的评估，由 普罗科特关于执行成果的概念模型。我们的多学科团队旨在开发一种 循证的PRC提供的治疗模式，可持续提供以改善垫子固位力 适用于低收入、少数族裔和儿童。

PROJECT SUMMARY The opioid use disorder (OUD) crisis in the US is an epidemic of poor access to care, including medication assisted treatment (MAT) and evidence-based behavioral interventions to support MAT outcomes. Low- income, racial/ethnic minority individuals with OUD disproportionately evidence poor MAT outcomes, including less than half of individuals typically being retained in MAT at six months. Retention is one of the factors most predictive of future relapse, functioning, and mortality. Implementing evidence-based interventions to improve MAT retention that are particularly appropriate for the needs of low-income, racial/ethnic minority individuals with OUD is essential. Peer recovery coaches (PRCs), trained individuals with their own lived experience with substance use disorder, may be uniquely suited to address common barriers to MAT retention among underserved populations, including stigma, challenges navigating services, housing instability, other structural and psychosocial factors. PRC-delivered interventions are a promising strategy for improving MAT retention for low-income, minority individuals with OUD, yet there are few evidence-based interventions (EBIs) that have been evaluated for PRC delivery to promote MAT retention. Preliminary work by our team suggests that behavioral activation (BA) may be a feasible, scalable reinforcement-based approach for improving MAT retention for low-income, minority individuals with OUD by PRCs. The proposed study builds upon our team’s formative work to adapt and evaluate the effectiveness and implementation of a PRC-delivered BA intervention (Peer Activate) to support MAT retention for low-income, minority individuals initiating MAT in Baltimore City, which has one of the highest overdose-fatality rates in the US and greatest burdens of OUD among low- income, racial/ethnic minority individuals. In Phase 1, we propose to refine and finalize the PRC-delivered Peer Activate model and address barriers to implementation for Phase 2 using pre-intervention focus groups with PRCs, staff, clients, and other key stakeholders (n=24). We will establish the preliminary feasibility, acceptability and fidelity of Peer Activate in an open-label trial (n=30) and pilot Phase 2 study procedures, including collecting preliminary MAT outcomes (MAT retention and opioid abstinence at 3 months). Based upon adaptations in Phase 1, we will then conduct a randomized, Type 1 hybrid effectiveness-implementation trial to evaluate the effectiveness and implementation of Peer Activate vs. treatment as usual (TAU; n=200) on MAT retention at six months (primary), MAT adherence and opioid abstinence (urine toxicology), and depressive symptoms (secondary). Implementation outcomes will be assessed at multiple levels (patient, provider, organization), including assessments of feasibility, acceptability, fidelity, and adoption guided by Proctor’s conceptual model of implementation outcomes. Our multidisciplinary team aims to develop an evidence-based PRC-delivered treatment model that can be sustainably delivered to improve MAT retention for low-income, minority individuals with OUD.