Improving access to opioid use disorder treatment among marginalized patients with a tailored telehealth intervention

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PROJECT SUMMARY/ABSTRACT: The goal of this K23 award is to give the PI the skills and preliminary data needed to improve access to opioid use disorder (OUD) treatment with buprenorphine among marginalized individuals via telehealth care. Dr. Aronowitz is proposing a research and career development plan that will prepare her to become an independent investigator focused on expanding access to OUD treatment and harm reduction services via innovative care delivery models. OUD continues to be a leading cause of morbidity and mortality in the United States. Substantial evidence supports the use of medications for OUD (MOUD) like buprenorphine; however, 80% of people with OUD receive no treatment; of those who receive treatment, only a third receive MOUD. Preliminary evidence suggests that a COVID-era policy change allowing for buprenorphine induction and management via telehealth expanded access. There is little evidence, however, about how to tailor telehealth models to promote equitable and effective OUD care. Providers may hesitate to offer MOUD via telehealth to patients they deem “unstable,” even if these patients lack other treatment options. Given the dearth of accessible treatment options for many individuals, the decision not to offer telehealth may result in a patient receiving no OUD treatment. Therefore, clinicians need evidence to guide how and to whom they deliver telehealth OUD treatment. Dr. Aronowitz will develop and test a telehealth model in partnership with Prevention Point Philadelphia, a harm reduction organization providing MOUD and other services to the most marginalized people with OUD in the city. The specific aims are to: 1) identify components of an effective telehealth intervention and barriers to implementation, 2) partner with an advisory board of OUD treatment stakeholders from different settings to develop a telehealth intervention for OUD treatment with buprenorphine, and 3) conduct a pilot trial of the telehealth intervention for OUD treatment. The mentorship team brings together experts in health services research, human-centered design, intervention development, and evidence- based OUD treatment, and key stakeholder advisors from diverse community settings. This K23 extends Dr. Aronowitz's experience as a clinician scientist with four training goals: 1) build skills in contextual inquiry and human-centered design to support effective intervention development; 2) develop expertise in intervention mapping, community-partnered research with Black and Latino communities, and stakeholder engagement to inform intervention development, implementation and sustainment; 3) learn how to conduct field trials ethically and effectively with marginalized populations; and 4) enhance grant-writing skills for transition to independence. With successful completion of this project and training Dr. Aronowitz will be well-prepared to lead an independent research agenda dedicated to improving access to care for people who use drugs. This project is well-aligned with the strategic objectives of NIDA to leverage technology and innovation, reduce health disparities, and develop models that address the real-world complexities of substance use.