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

基本信息

批准号：
9050663
负责人：
Aaron D Fox
金额：
$ 28.93万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE, INC
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-04-15 至 2018-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9050663
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 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 improved outcome interest member methadone maintenance novel opioid abuse overdose death patient oriented peer support pressure primary outcome psychosocial public health relevance randomized trial satisfaction skills social cognitive theory social stigma theories therapy development transmission process treatment as usual treatment group

项目摘要

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（由适用提供）：在美国，初级保健阿片类成瘾和阿片类药物过量死亡中加强丁丙诺啡治疗的小组医疗就诊在美国迅速增加。通过成功实施初级保健中丁丙诺啡维护治疗（BMT），获得阿片类药物成瘾治疗的机会得到了改善。但是，包括阿片类药物的禁欲在内的治疗结果尚待优化。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，包括艾滋病毒的传播。这项研究的目的是根据小组医疗就诊模型开发手动理论指导的行为干预措施，该模型将用于初级保健，以增强持续的阿片类药物滥用患者的BMT。该提案的目的是：1。）确定基于组的BMT干预（G-BMT）的关键组成部分，该组件将增强初级保健内的丁丙诺啡治疗结果； 2.）开发G-BMT干预； 3.）初步测试G-BMT的初级保健效率，可接受性和可行性。这些目标将通过使用社会认知理论作为一个理论框架来确定患者可以接受的G-BMT干预措施的潜在成分，并可能导致卵虫类滥用减少，从而实现了八个BMT提供者和40名BMT患者的焦点小组。基于这项形成性研究，将开发针对G-BMT的干预指南，以提供新颖的初级保健治疗加强选择。在一项随机试验中，我们将通过将G-BMT与往常的治疗（TAU）进行比较，以便在接受标准办公室BMT的同时将G-BMT与治疗（TAU）进行比较，以便在接受G-BMT与治疗（TAU）中进行初步测试（16周内），以实现可行性，可接受性和有效性。我们假设将参与者随机分配给G-BMT将具有更高的禁欲率（主要结果，有效性），较少的HIV风险行为（疗效），对治疗（可接受性）的满意度更高（可接受性）和更高的访问依从性（可行性），而不是随机地将参与者随机地放在TAU上。在这项研究之后，我们将使用可行性和可接受性数据进一步修改G-BMT干预措施，并在一项多站点随机试验中，我们将充分研究其在改善戒酒，减少艾滋病毒风险行为以及增加持续滥用阿片类药物的BMT患者治疗方面的有效性。