Development of a community-based buprenorphine treatment intervention

描述(申请人提供)：随着阿片成瘾率的上升，阿片成瘾治疗不足的问题越来越多。丁丙诺啡治疗可以通过减少阿片类药物的使用和艾滋病毒危险行为来解决这个问题。注射吸毒者等感染和传播艾滋病毒风险较高的边缘化人群获得丁丙诺啡治疗的机会有限。由于最低限度的规定，丁丙诺啡治疗可以纳入注射成瘾者聚集的社区环境中。强调以社区为基础的丁丙诺啡治疗的战略有很大的潜力，以接触到诸如注射吸毒者等边缘人群。在我们以前工作的基础上，我们制定了以社区为基础的战略，以改善获得艾滋病毒治疗的机会，并制定了丁丙诺啡诱导战略，以克服诱导挑战，我们认为，在以社区为基础的环境中制定丁丙诺啡治疗干预措施，对于改善注射吸毒者获得和成功的阿片成瘾治疗至关重要。因此，我们建议在非医疗社区环境中开发丁丙诺啡治疗干预措施，以改善获得阿片成瘾治疗的机会，改善健康结局，并减少注射吸毒者的高危行为。我们将与两个社区组织(CBO)合作，开发、测试和初步研究社区丁丙诺啡治疗(CBBT)干预的可行性。我们预计CBBT干预措施将包括：丁丙诺啡教育，促进医生的接触，丁丙诺啡诱导期间的支持，以及丁丙诺啡维持期间的支持。此外，我们预计CBBT干预将针对社区组织的注射器交换项目的客户，由社区组织的外展工作人员实施，并发生在社区组织的环境中。具体目标是：1)开展以社区为基础的丁丙诺啡治疗干预。我们将对两个CBO的工作人员和客户进行焦点小组和开放式个人访谈，以指导CBBT干预组件、材料和流程的开发。2)探讨丁丙诺啡社区治疗干预的可行性。我们将通过以下方式检查可行性：1)监测外展工作人员遵守干预手册的能力；2)衡量外展工作人员和服务对象的满意度；3)跟踪参与CBBT干预服务的服务对象。3)检查以社区为基础的丁丙诺啡治疗干预的治疗结果(阿片类药物使用、艾滋病毒危险行为、治疗保留)。我们将比较接受CBBT干预的患者与未接受干预的患者在开始丁丙诺啡治疗前和30天后阿片类药物使用和艾滋病毒危险行为的变化。我们还将比较30天的治疗保留时间。如果CBBT是可行的，并可以改善治疗结果，它可能会对阿片类药物和艾滋病毒流行产生积极影响。该项目的试点数据将指导我们的R01赠款申请，对我们CBBT干预的有效性进行大规模的严格研究。 公共卫生相关性：随着阿片成瘾率的增加，我们的创新项目将开发、测试和初步检查基于社区的丁丙诺啡治疗干预的治疗结果。归根结底，这种干预措施有可能改善丁丙诺啡治疗阿片成瘾的机会，并改善丁丙诺啡治疗结果(减少阿片类药物的使用，减少艾滋病毒危险行为，并改善丁丙诺啡治疗的存留率)。这项研究的结果将用于指导我们以社区为基础的丁丙诺啡治疗干预的大规模研究。

DESCRIPTION (provided by applicant): With rising rates of opioid addiction, inadequate opioid addiction treatment is increasingly problematic. Buprenorphine treatment can address this problem by reducing opioid use and HIV risk behaviors. Marginalized populations at high risk of acquiring and transmitting HIV, like injection drug users (IDUs), have limited access to buprenorphine treatment. Because of minimal regulations, buprenorphine treatment can be integrated into community-based settings where IDUs congregate. There is great potential for strategies that emphasize community-based buprenorphine treatment to reach marginalized populations, like IDUs. Building on our previous work in which we developed community-based strategies to improve access to HIV treatment and developed a buprenorphine induction strategy to overcome induction challenges, we believe that developing a buprenorphine treatment intervention in community-based settings is critical to improving accessible and successful opioid addiction treatment for IDUs. Thus, we propose to develop a buprenorphine treatment intervention in non-medical community-based settings to improve access to opioid addiction treatment, improve health outcomes, and reduce high-risk behaviors among IDUs. We will collaborate with two community-based organizations (CBOs) to develop, test the feasibility of, and preliminarily examine a community-based buprenorphine treatment (CBBT) intervention. We anticipate that the CBBT intervention will consist of: buprenorphine education, facilitated access to physicians, support during buprenorphine induction, and support during buprenorphine maintenance. Additionally, we anticipate that the CBBT intervention will target clients of the CBOs' syringe exchange programs, be implemented by CBOs' outreach workers, and occur in the CBOs' settings. The specific aims are: 1) To develop a community-based buprenorphine treatment intervention. We will conduct focus groups and open-ended individual interviews with two CBOs' staff and clients to guide development of CBBT intervention components, materials, and processes. 2) To test the feasibility of implementing a community-based buprenorphine treatment intervention. We will examine feasibility by: 1) monitoring outreach workers' ability to adhere to the intervention manual; 2) measuring outreach worker and client satisfaction, and 3) tracking clients who engage in the CBBT intervention. 3) To examine treatment outcomes (opioid use, HIV risk behaviors, treatment retention) of a community-based buprenorphine treatment intervention. We will compare change in opioid use and HIV risk behaviors before and 30 days after initiating buprenorphine treatment in clients who received the CBBT intervention with clients who did not. We will also compare 30-day treatment retention. If CBBT is feasible and can improve treatment outcomes, it could positively impact the opioid and HIV epidemics. Pilot data from this project will guide our R01 grant application, to conduct a large-scale rigorous study of the effectiveness of our CBBT intervention. PUBLIC HEALTH RELEVANCE: With increasing rates of opioid addiction, our innovative project will develop, test the feasibility of, and preliminarily examine treatment outcomes of a community-based buprenorphine treatment intervention. Ultimately, this intervention has the potential to improve access to opioid addiction treatment with buprenorphine and improve buprenorphine treatment outcomes (reduce opioid use, reduce HIV risk behaviors, and improve retention in buprenorphine treatment). This study's findings will be used to guide a large-scale study of our community-based buprenorphine treatment intervention.