Improving Treatment Engagement and Adherence to Optimize Outcomes for Opioid-Exposed Mother-Infant Dyads

项目总结： 处方类阿片类药物、海洛因和芬太尼的非医疗使用激增是一个关键的公共卫生问题 影响育龄妇女及其家人的紧急情况。怀孕是一段激动人心的时期 患有阿片类药物使用障碍(OUD)的妇女接受治疗、药物治疗(使用美沙酮或 丁丙诺啡)和心理治疗是推荐的一线治疗方法。药物治疗的依从性 与产科、婴儿和产妇分娩时物质使用结果的改善有关。还没有 产后停药的发生率很高，增加了复发和 服药过量。然而，到目前为止，支持孕妇坚持药物治疗的干预措施 与妇产科疾病的研究结果喜忧参半，很少有针对产后妇女和 家人。因此，这项混合方法研究的中心目标是量化药物治疗的效果。 利用对产后母婴结局的影响及影响治疗因素的定性探讨 坚持开展药物治疗促进干预以改善阿片类药物的健康- 暴露的母婴二元体。该项目包括三个主要目标：(1)分析一个相互关联的、纵向的、 来自马萨诸塞州公共卫生部的行政数据集，以检查持续时间 药物治疗参与度和药物治疗类型对母婴结局有影响； (2)与不同的利益攸关方接触，包括患有阿片类药物使用障碍的产后妇女和 他们的家人定性地确定信仰和态度，并划定人际和结构性障碍 和促进者对治疗的参与度和依从性，制定药物治疗促进干预措施； 以及(3)对药物治疗干预措施进行试点，以提高孕妇和 产后妇女用OUD评估干预的可行性和可接受性。调查结果来自 这一系列项目将填补NIDA内一个高优先级研究领域的现有空白，该领域将向 孕妇和产后妇女的护理。私家侦探希夫博士是职业生涯早期的临床医生调查员， 儿科医生和成瘾药物医生，她将利用这个职业发展奖来提升她 定量研究技能，包括对复杂的公共卫生数据集的纵向分析，定性 针对弱势人群的研究、干预开发和临床试验设计。在整个过程中 在获奖期间，希夫博士将与一个拥有专业知识的多学科指导和咨询团队密切合作 在母婴健康、成瘾精神病学、围产期流行病学、生物统计学、定性分析、 干预发展和临床试验设计，以实现她声明的职业目标和具体目标。

PROJECT SUMMARY: The surge in the non-medical use of prescription opioids, heroin, and fentanyl is a critical public health emergency affecting women of child bearing age and their families. Pregnancy can be a motivating time for women with opioid use disorder (OUD) to engage in treatment, with pharmacotherapy (with methadone or buprenorphine) and psychotherapy the recommended first line treatment. Pharmacotherapy adherence has been associated with improved obstetric, infant, and maternal substance use outcomes at delivery. Yet medication discontinuation in the postpartum period occurs at high rates, increasing the risk of relapse and overdose. To date, however, interventions to support pharmacotherapy adherence among pregnant women with OUD have shown mixed results, and few interventions have been aimed at postpartum women and families. Therefore, the central objective of this mixed-methods study is to quantify how OUD pharmacotherapy utilization impacts postpartum maternal-infant outcomes and qualitatively explore factors impacting treatment adherence in order to develop a pharmacotherapy promotion intervention to improve the health of the opioid- exposed mother-infant dyad. This project includes three main aims: (1) To analyze a linked, longitudinal, administrative dataset from Massachusetts Department of Public Health to examine how duration of pharmacotherapy engagement and type of pharmacotherapy received impact maternal and infant outcomes; (2) To engage with a diverse group of stakeholders including postpartum women with opioid use disorder and their families to qualitatively identify beliefs and attitudes and delineate interpersonal and structural barriers and facilitators to treatment engagement and adherence to develop a pharmacotherapy promotion intervention; and (3) Pilot test the pharmacotherapy intervention to improve treatment adherence among pregnant and postpartum women with OUD assessing the feasibility and acceptability of the intervention. The findings from this series of projects will fill an existing gap in a high priority research area within NIDA that will inform the care of pregnant and postpartum women with OUD. The PI, Dr. Schiff, is an early-career clinician investigator, pediatrician, and addiction medicine physician who will use this career development award to enhance her skills in quantitative research including longitudinal analyses of complex public health datasets, qualitative research with vulnerable populations, intervention development, and clinical trials design. Throughout the award period, Dr. Schiff will work closely with a multidisciplinary mentorship and advisory team with expertise in maternal-child health, addiction psychiatry, perinatal epidemiology, biostatistics, qualitative analysis, intervention development, and clinical trials design to carry out her stated career objectives and specific aims.