"Bupe by the Book:" Developing and Testing a Tele-Buprenorphine Intervention in Public Libraries with Unstably Housed Persons with Opioid Use Disorder

书本上的BUPE：开发和测试远程丁丙诺啡公共干预 居住不稳定的阿片类药物使用障碍者的图书馆 摘要 全国的公共图书馆正在经历一场内部阿片类药物过量的危机。丁丙诺啡 “BUPE”是一种非常有效的治疗方法，但许多住房不稳定的人在 由于结构障碍，图书馆无法访问BUPE。《Bupe by the Book》(BBB)，与 我们已建立的当地合作伙伴，圣地亚哥公共图书馆和乔神父村健康中心(FJV)， 将创新地将FJV已经成功的当天免费低障碍远程治疗调整为 库设置。通过测试图书馆对电视内容的吸收和保留，这项研究将告诉我们 个人可以通过创新的低门槛方式接受丰胸护理，潜在地改变景观 从根本上实现了BUPE。我们的三个目标是： 1)在技术接受模型中开发和提炼“BUPE by the Book”(BBB) ()：通过焦点小组和干预图谱技术，我们将：a)评估人们的看法 利益相关者，如使用图书馆的有孩子的当地居民、图书馆工作人员、电话广播 供应商和了解BBB潜力的人员；b)制定有利益相关者意见的计划；c) 确定实施的可修改障碍。 2)确定血脑屏障的可行性并测量治疗摄取和依从性：我们将 进行为期12周的先导性双臂随机对照试验(RCT)(n=40)。学习人员将招聘图书馆 并随机安排他们每周在图书馆或亲临诊所控制手臂进行电视直播。一个健康的身体 然后，供应商将筛选参与者是否有资格参加当天的BUPE培训。血脑屏障对BUPE的影响 诱导和遵守规定剂量将基于自我报告的措施1-，2-，4-，8-，12- 每周与研究人员进行随访，每周进行尿液药物筛查和处方提取。我们 假设图书馆中的电视剧与对照组相比将有更高的摄取率和更长的时间 坚持治疗。该试点项目将为设计 更大规模的干预效果试验。 3)评估BBB的可接受性，并确定可以改进的计划组件 以提高依从性和患者满意度。我们将对BBB进行系统的采访 患者、卫生服务提供者和图书馆工作人员深入了解患者的BBB经历 与以面对面诊所为基础的BUPE治疗相比。 通过利用多个图书馆站点，我们将使远程图书馆可供全国其他图书馆复制 面对阿片类药物过量，并为在随后的R01中进行更大的RCT奠定基础，以评估 利用公共环境治疗药物使用障碍和减少阿片类药物相关死亡的有效性。

Bupe by the Book: Developing and Testing a Tele-buprenorphine Intervention in Public Libraries with Unstably Housed Persons with Opioid Use Disorder Abstract Public libraries nationwide are experiencing an on-premise opioid overdose crisis. Buprenorphine “bupe” is a highly effective medical treatment for OUD, but many unstably housed persons at libraries lack access to bupe due to structural barriers. “Bupe by the Book” (BBB), in collaboration with our established local partners, San Diego Public Libraries and Father Joe's Village Health Center (FJV), would innovatively adapt FJV's already successful same-day, free low barrier tele-bupe treatment to library settings. By testing tele-bupe uptake and retention in libraries, this study will inform how individuals can receive bupe care in innovative low-barrier ways, potentially changing the landscape radically for implementing bupe. Our three aims are: 1) Develop and refine “Bupe by the Book” (BBB) within the Technology Acceptance Model (TAM): Through focus groups and intervention mapping techniques, we will: a) assess the perceptions of stakeholders such as local residents with children who use the library, library staff, tele-bupe providers, and persons with OUD about BBB's potential, b) develop a plan with stakeholder input, and c) identify modifiable barriers to implementation. 2) Determine the feasibility of BBB and measure treatment uptake and adherence: We will conduct a 12-week pilot 2-arm randomized controlled trial (RCT) (n=40). Study staff will recruit library patrons and randomize them to weekly tele-bupe at the library or in-person clinic control arms. A health provider will then screen participants for eligibility for same-day bupe induction. BBB's effects on bupe induction and adherence to prescribed doses will be based on self-reported measures at 1-,2-,4-,8-,12- week follow-ups with study staff, and weekly urinary drug screenings and prescription pickups. We hypothesize that tele-bupe in the library vs. the control group will have higher uptake and longer adherence to treatment. This pilot will provide estimates of uptake and adherence for the design of a larger trial of the intervention's efficacy. 3) Evaluate the acceptability of BBB and identify program components that could be improved to enhance adherence and patient satisfaction. We will conduct structured interviews with BBB patients, health providers, and library staff to gain insight into the patients' experiences with BBB compared to in-person clinic-based bupe treatment. By utilizing multiple library sites, we will render tele-bupe reproducible for other libraries nationwide facing opioid overdoses and pave the foundation for a larger RCT in a subsequent R01 to evaluate the efficacy of utilizing public settings to treat substance use disorders and reduce opioid-related deaths.