Buprenorphine group medical visits for drug users at risk for HIV

丁丙诺啡对有艾滋病毒风险的吸毒者进行团体医疗就诊

• 批准号: 8922622
• 负责人: Aaron D Fox
• 金额: $ 6.96万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-15 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8922622
• 关键词: Abstinence; Address; Adherence; Agonist; Behavior Therapy; Behavioral; Buprenorphine; Caring; Cessation of life; Chronic; Counseling; Data; Development; Diabetes Mellitus; Disease; Drug user; Education; Effectiveness; Effectiveness of Interventions; Epidemic; Focus Groups; Frequencies; Goals; Grant; HIV; HIV risk; Habits; Health Personnel; Health system; Home environment; Individual; Instruction; Intervention; Maintenance; Manuals; Medical; Mental Depression; Modeling; Opiate Addiction; Opioid; Outcome; Overdose; Participant; Patients; Physicians; Primary Health Care; Provider; Public Health; Publishing; Randomized; Recommendation; Recruitment Activity; Research; Risk; Risk Behaviors; Self Management; Site; Specialist; Structure; Testing; Time; Treatment Efficacy; Treatment outcome; United States; Visit; addiction; base; comparative efficacy; craving; experience; group intervention; improved; interest; member; methadone maintenance; novel; opioid abuse; overdose death; patient oriented; peer; pressure; primary outcome; psychosocial; public health relevance; randomized trial; satisfaction; skills; social cognitive theory; social stigma; theories; therapy development; transmission process; treatment as usual

 DESCRIPTION (provided by applicant): Group medical visits to intensify buprenorphine treatment in primary care Opioid addiction and opioid overdose deaths have increased rapidly in the United States. Access to opioid addiction treatment has improved through successful implementation of buprenorphine maintenance treatment (BMT) in primary care; however, treatment outcomes, including abstinence from opioids, have yet to be optimized. Our overarching goal is to reduce the consequences of opioid addiction, including HIV transmission, by improving BMT outcomes in primary care. The objective of this study is to develop a manualized theory-guided behavioral intervention based on the model of group medical visits, which will be used in primary care to intensify BMT for patients with ongoing opioid abuse. This proposal aims to: 1.) determine key components of a group-based BMT intervention (G-BMT) that will enhance buprenorphine treatment outcomes within primary care; 2.) develop the G-BMT intervention; and 3.) preliminarily test G-BMT for efficacy, acceptability, and feasibility in primary care. These aims will be achieved by conducting focus groups with eight BMT providers and 40 BMT patients using Social Cognitive Theory as a theoretical framework to determine potential components for the G-BMT intervention that will be acceptable to patients and likely to result in reduced opioid abuse. Based on this formative research, an intervention guide for G-BMT will be developed to provide a novel option for treatment intensification in primary care. In a randomized trial, we will preliminarily test G-BMT (8 sessions over 16 weeks) for feasibility, acceptability, and efficacy, by comparing G-BMT to treatment as usual (TAU) for BMT patients with ongoing opioid abuse while receiving standard office-based BMT. We hypothesize that participants randomized to G- BMT will have higher abstinence rates (primary outcome, efficacy), fewer HIV risk behaviors (efficacy), greater satisfaction with treatment (acceptability) and higher visit adherence (feasibility) than participants randomized to TAU. Following this study, we will use feasibility and acceptability data to further modify the G-BMT intervention, and in a multi-site randomized trial, we will fully examine its effectiveness at improving abstinence, reducing HIV-risk behaviors, and increasing retention in treatment for BMT patients with ongoing opioid abuse.

 描述（由申请人提供）：在美国，加强初级保健中丁丙诺啡治疗的团体医疗访问阿片类药物成瘾和阿片类药物过量死亡人数迅速增加。通过在初级保健中成功实施丁丙诺啡维持治疗，获得阿片类成瘾治疗的机会有所改善;然而，治疗结果，包括戒断阿片类药物，尚未得到优化。我们的总体目标是通过改善初级保健中的BMT结果来减少阿片类药物成瘾的后果，包括艾滋病毒传播。本研究的目的是开发一种基于小组医疗访问模型的手动理论指导的行为干预，该干预将用于初级保健，以加强持续阿片类药物滥用患者的BMT。本建议旨在：1.）确定基于组的BMT干预（G-BMT）的关键组成部分，该干预将增强初级保健中的丁丙诺啡治疗结果; 2.）开发G-BMT干预措施; 3.）初步测试G-BMT在初级保健中的有效性、可接受性和可行性。这些目标将通过与8名BMT提供者和40名BMT患者进行焦点小组来实现，使用社会认知理论作为理论框架，以确定患者可接受并可能导致减少阿片类药物滥用的G-BMT干预的潜在组成部分。基于这一形成性研究，将制定G-BMT的干预指南，为初级保健中的强化治疗提供一种新的选择。在一项随机试验中，我们将初步测试G-BMT（16周内8次）的可行性、可接受性和疗效，方法是将G-BMT与常规治疗（TAU）进行比较，以治疗持续滥用阿片类药物的BMT患者，同时接受标准的基于办公室的BMT。我们假设随机分配到G-BMT组的受试者与随机分配到TAU组的受试者相比，禁欲率（主要结局，疗效）更高，HIV风险行为（疗效）更少，对治疗的满意度（可接受性）更高，访视依从性（可行性）更高。在这项研究之后，我们将使用可行性和可接受性数据来进一步修改G-BMT干预， 在一项多中心随机试验中，我们将全面检查其在改善戒断、减少HIV风险行为和增加持续阿片类药物滥用的BMT患者治疗保留率方面的有效性。