Buprenorphine Facilitated Access and Supportive Treatment in Former Inmates

Aaron Fox描述了一个指导研究项目和具体的职业发展计划，这将使他准备研究改善监禁后阿片类药物依赖治疗的干预措施。从惩教设施释放后，依赖阿片类药物的前囚犯面临着重新吸毒、感染艾滋病毒和过量死亡的高风险。丁丙诺啡治疗阿片类药物依赖是有效的，但未得到充分利用，这使得鼓励治疗的行为干预至关重要。该提案旨在：1）确定监禁后开始丁丙诺啡治疗的障碍和促进因素 2）使用同伴指导，量身定制干预措施，为前囚犯提供丁丙诺啡便利获取和支持性治疗（BUP-FAST），以及3）试点测试BUP-FAST在增加丁丙诺啡治疗初始化方面的可行性和有效性。在多学科专家导师团队的指导下，福克斯博士将使用社会认知理论作为理论框架，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因素。基于这些发现，他将调整先前开发的干预措施，以鼓励通过使用同伴导师和针对前囚犯开始丁丙诺啡治疗。由此产生的干预，BUP-FAST，将有特定的组件，通过应用社会认知理论来确定我们的研究结果，但我们预计，同伴导师将提供：丁丙诺啡教育，促进获得丁丙诺啡治疗，陪同约会，和支持性咨询。为了初步测试BUP-FAST的可行性和有效性，我们将进行一项BUP-FAST（与简单的丁丙诺啡治疗转诊）的初步随机试验，收集有关过程措施的数据，以测试可行性，并检查丁丙诺啡治疗的启动以初步测试有效性。我们假设，与简单转诊相比，随机分配至BUP-FAST的受试者更有可能开始丁丙诺啡治疗。随后，我们将提交R 01拨款申请，以全面检查BUP-FAST在多中心随机对照试验中改善丁丙诺啡治疗结果和减少艾滋病毒风险行为，阿片类药物使用和重新监禁的有效性。在奖励期间，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（用于聚类数据分析）的培训，并将获得监禁后医疗保健联系的经验。随着这些活动的完成，沿着密集的指导，Fox博士将为全面测试BUP-FAST和成为独立研究者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.