Buprenorphine Facilitated Access and Supportive Treatment in Former Inmates

描述(由申请人提供)：亚伦·福克斯博士以成为一名独立调查员为职业目标，描述了一个有指导的研究项目和具体的职业发展计划，这将为他研究改善监禁后阿片依赖治疗的干预措施做好准备。在从教养机构释放后，依赖阿片类药物的前囚犯再次吸毒、艾滋病毒感染和与过量服药有关的死亡的风险很高。丁丙诺啡治疗阿片依赖是有效的，但没有得到充分利用，这使得鼓励治疗的行为干预至关重要。该提案旨在：1)确定监狱服刑后开始丁丙诺啡治疗的障碍和促进者 对于依赖阿片类药物的前囚犯，2)利用同伴指导，制定干预措施，为前囚犯提供丁丙诺啡便利准入和支持性治疗(BUP-FAST)，以及3)试点测试BUP-FAST在增加丁丙诺啡治疗的主动性方面的可行性和有效性。在一个多学科专家导师团队的指导下，福克斯博士将以社会认知理论为理论框架，对阿片类药物依赖的前囚犯进行半结构化访谈，以了解丁丙诺啡治疗的障碍和促进者。基于这些发现，他将量身定做一种先前开发的干预措施，通过使用同伴导师和针对前囚犯来鼓励丁丙诺啡治疗的启动。由此产生的干预，BUP-FAST，将有特定的组成部分，通过将社会认知理论应用于我们的发现来确定，但我们预计同伴导师将提供：丁丙诺啡教育，促进丁丙诺啡治疗，伴随预约，以及支持性咨询。为了测试BUP-FAST的可行性和有效性，我们将进行一项BUP-FAST的试点随机试验(与简单转介丁丙诺啡治疗相比)，收集有关过程措施的数据以测试可行性，并研究启动丁丙诺啡治疗以试点测试有效性。我们假设，与简单的转介参与者相比，随机服用BUP-FAST的患者更有可能开始丁丙诺啡治疗。随后，我们将提交一份R01拨款申请，在一项多地点随机对照试验中，全面检验BUP-FAST在改善丁丙诺啡治疗结果、减少艾滋病毒危险行为、阿片类药物使用和再次监禁方面的有效性。在获奖期间，福克斯博士将继续接受高级定性方法、行为干预设计、分层建模(用于分析集群数据)方面的培训，并将在入狱后获得医疗保健联系方面的经验。随着这些活动的完成，以及密集的指导，福克斯博士将为全面测试BUP-FAST和成为一名独立调查员的职业目标做好充分准备。

DESCRIPTION (provided by applicant): With the career goal of becoming an independent investigator, Dr. Aaron Fox describes a mentored research project and specific career development plan, which will prepare him to study interventions that improve treatment of opioid dependence post-incarceration. Following release from correctional facilities, opioid-dependent former inmates are at high risk of relapse to drug use, HIV-infection, and overdose-related death. Buprenorphine treatment for opioid dependence is effective, but underutilized, which makes behavioral interventions that encourage treatment critical. This proposal aims to: 1) determine the barriers to and facilitators of initiating buprenorphine treatment post-incarceration for opioid-dependent former inmates, 2) to tailor an intervention, using peer mentorship, to provide BUPrenorphine Facilitated Access and Supportive Treatment (BUP-FAST) to former inmates, and 3) to pilot test the feasibility and effectiveness of BUP-FAST at increasing initiatio of buprenorphine treatment. With guidance from a multidisciplinary team of expert mentors, Dr. Fox will conduct semi-structured interviews with opioid-dependent former inmates using Social Cognitive Theory as a theoretical framework to understand barriers to and facilitators of buprenorphine treatment. Based on these findings, he will tailor a previously developed intervention to encourage initiation of buprenorphine treatment by using peer mentors and targeting former inmates. The resulting intervention, BUP-FAST, will have specific components that are determined by applying Social Cognitive Theory to our findings, but we anticipate that peer mentors will provide: buprenorphine education, facilitated access to buprenorphine treatment, accompaniment to appointments, and supportive counseling. To pilot test BUP-FAST for feasibility and effectiveness, we will conduct a pilot randomized trial of BUP-FAST (vs. simple referral to buprenorphine treatment) collecting data on process measures to test feasibility and examining initiation of buprenorphine treatment to pilot test effectiveness. We hypothesize that compared to simple referral participants randomized to BUP-FAST will be more likely to initiate buprenorphine treatment. Subsequently, we will submit an R01 grant application to fully examine the effectiveness of BUP-FAST at improving buprenorphine treatment outcomes and reducing HIV-risk behaviors, opioid use, and re-incarceration in a multi-site randomized controlled trial. During the award period, Dr. Fox will pursue training in advanced qualitative methods, design of behavioral interventions, hierarchical modeling (for analysis of clustered data), and will gain experience in health care linkage following incarceration. With completion of these activities, along with intensive mentorship, Dr. Fox will be well prepared to fully test BUP-FAST and for his career goal of becoming an independent investigator.