Understanding How Peers Can Shift Stigma to Retain Low-Income, Minority Individuals in Opioid Treatment

项目总结 迫切需要制定和评估创新战略，以减少药物使用耻辱和改善阿片类药物使用障碍(OUD)的治疗结果。特别是在新冠肺炎严重的健康差距的背景下，我们还必须考虑其他与健康和种族有关的污名如何进一步助长患有OUD的低收入少数族裔个人在护理方面的不良保留。减少多重交叉污名和提高对低收入少数群体的护理参与度的最有希望的战略之一是通过使用同伴康复教练(PRCs)。与其他卫生工作者相比，PRC，即自己经历过康复过程的个人，在聘用和留住低收入、种族/少数民族患者方面被证明更容易接受。一种占主导地位的理论是，中国人共享的生活经历和背景可能会减少耻辱，这随后可以转化为改善患者护理。然而，令人惊讶的是，很少有研究正式评估原癌药物对药物使用耻辱的影响，也没有正式评估PRC干预措施如何减少耻辱可能导致改善治疗结果。我们的家长奖(R61AT010799)正在评估一项由中华人民共和国提供的行为干预措施，以改善巴尔的摩市低收入、种族/少数民族个人在美沙酮治疗中的保留情况。拟议增补的总体目标是测试PRC模式是否以及如何可以减少多个交叉的耻辱，以及耻辱的变化是否转化为美沙酮治疗保留的改善。首先，通过对关键利益相关者(患者、PRC和工作人员；n=24)的深入个别访谈，我们将探索PRC如何改变患有OUD的种族/民族少数人之间的交叉耻辱，以提高护理的保留率，以及如何量身定做PRC干预措施，以减少这些交叉耻辱及其对OUD结果的影响。接下来，我们将评估在家长奖中正在评估的PRC干预措施对3个月内内化和预期的物质使用污名(主要)、美沙酮污名(次要)和其他交叉污名(由目标1指导)的影响，在低收入、少数族裔个人中开始使用美沙酮或表现出挑战保留(n=30)。作为最后的探索目标，我们将研究物质使用和美沙酮污名的变化作为美沙酮在六个月内滞留的预测因素。本补充资料回应了NOT-OD-20-101的高度优先领域，因为：(1)我们将分析减少内化和预期的物质使用和美沙酮污名的战略，以改善低收入少数族裔患者的治疗机会、有效性和康复；(2)我们将利用现有的心理测量学验证工具和理论来评估污名，这些污名利用我们团队与其他与健康相关的污名的工作(即，在全球艾滋病毒护理中)。这是多组分方法的第一阶段开发，可以扩展和实施大型项目(即R33阶段)，并可能在全国范围内推广，以减少耻辱并支持低收入的少数族裔OUD患者。

PROJECT SUMMARY There is an urgent need to develop and evaluate innovative strategies to reduce substance use stigma and improve opioid use disorder (OUD) treatment outcomes. Particularly in the context of the devastating health disparities of COVID-19, we must also consider how other health- and race-related stigmas further contribute to poor retention in care among low-income, minority individuals with OUD. One of the most promising strategies to reduce multiple intersecting stigmas and improve engagement in care for low-income, minority individuals is through the use of peer recovery coaches (PRCs). PRCs, individuals who have gone through the recovery process themselves, have been shown to be more acceptable for engaging and retaining low-income, racial/ethnic minority patients compared to other health workers. A predominant theory is that a PRC’s shared lived experience and background may decrease stigma, which can then translate into improved patient care. However, surprisingly little research has formally evaluated the effects of PRCs on substance use stigma, nor how PRC interventions reducing stigma may result in improved treatment outcomes. Our parent award (R61AT010799) is evaluating a PRC-delivered behavioral intervention to improve retention in methadone treatment among low-income, racial/ethnic minority individuals in Baltimore City. The overall aim of the proposed supplement is to test whether and how a PRC model can reduce multiple intersecting stigmas, and whether changes in stigma translate into improvements in methadone treatment retention. First, using in-depth, individual interviews with key stakeholders (patients, PRCs, and staff; n=24), we will explore how PRCs can shift intersecting stigmas among racial/ethnic minority individuals with OUD to improve retention in care, and how to tailor a PRC intervention to reduce these intersecting stigmas and their impact on OUD outcomes. Next, we will evaluate the effects of a PRC intervention being evaluated in the parent award on internalized and anticipated substance use stigma over 3 months (primary), methadone stigma (secondary), and other intersecting stigmas (guided by Aim 1), among low-income, minority individuals initiating methadone or demonstrating challenges with retention (n=30). As a final exploratory aim, we will examine changes in substance use and methadone stigma as predictors of methadone retention over six months. This supplement is responsive to high priority areas of NOT-OD-20-101 in that: (1) we will analyze strategies to reduce internalized and anticipated substance use and methadone stigma to improve treatment access, effectiveness, and recovery for low-income, minority patients; and (2) we will utilize existing psychometrically validated tools and theories to assess stigma that leverages our team’s work with other health-related stigma (i.e., in HIV care globally). This is the first stage development of a multicomponent approach that could be expanded and implemented for large-scale projects (i.e., in the R33 phase) and potentially scaled nationally to reduce stigma and support low-income, minority patients with OUD.