Peer-Delivered Behavioral Activation Intervention to Improve Adherence to MAT Among Low-Income, Minority Individuals With OUD

项目摘要 美国的阿片类药物使用障碍（OUD）危机是一种难以获得护理的流行病，包括药物治疗 辅助治疗（MAT）和循证行为干预，以支持MAT的结果。低- 收入、种族/少数民族的OUD患者不成比例地证明MAT结果较差，包括 不到一半的人通常在六个月内留在MAT。保留是最重要的因素之一 预测未来的复发、功能和死亡率。实施循证干预措施， MAT保留，特别适合低收入，种族/少数民族个人的需要 OUD是必不可少的。同伴恢复教练（PRC），受过训练的个人，他们自己的生活经验， 物质使用障碍，可能是唯一适合解决常见的障碍，以MAT保留之间 得不到充分服务的人口，包括污名化、获得服务的挑战、住房不稳定、其他结构性问题 和心理社会因素。中国提供的干预措施是改善MAT保留率的一项有前途的战略， 低收入，少数人与OUD，但很少有基于证据的干预措施（EBI）， 评估PRC交付以促进MAT保留。我们团队的初步工作表明， 行为激活（BA）可能是一种可行的，可扩展的基于认知的方法，用于改善MAT 保留低收入，少数民族的个人与OUD由PRC。这项研究建立在我们团队的基础上， 适应和评估中国提供的BA干预措施的有效性和实施的形成性工作 (Peer激活），以支持MAT保留低收入，少数民族个人开始MAT在巴尔的摩市， 其中有一个最高的过量死亡率在美国和最大的负担OUD之间的低- 收入，种族/少数民族个人。在第1阶段，我们建议完善并最终确定PRC交付的Peer 利用干预前焦点小组激活模式并解决第2阶段实施的障碍， PRC、工作人员、客户和其他关键利益相关者（n=24）。我们将建立初步的可行性， Peer Activate在开放标签试验（n=30）和试验性II期研究程序中的可接受性和保真度， 包括收集初步MAT结果（3个月时的MAT保留和阿片类药物戒断）。基于 在第一阶段进行调整之后，我们将进行一次随机的、类型1的混合有效性实施 评价Peer Activate与常规治疗（TAU; n=200）的有效性和实施的试验， 6个月时的MAT保留（主要）、MAT依从性和阿片类戒断（尿液毒理学），以及 抑郁症状（继发性）。实施结果将在多个层面（患者， 提供者、组织），包括可行性、可接受性、忠诚度和采用的评估， 普罗克特的实施结果概念模型。我们的多学科团队旨在开发一个 基于循证的PRC提供的治疗模式，可持续提供，以改善MAT保留 为低收入的少数民族OUD患者提供服务。

PROJECT SUMMARY The opioid use disorder (OUD) crisis in the US is an epidemic of poor access to care, including medication assisted treatment (MAT) and evidence-based behavioral interventions to support MAT outcomes. Low- income, racial/ethnic minority individuals with OUD disproportionately evidence poor MAT outcomes, including less than half of individuals typically being retained in MAT at six months. Retention is one of the factors most predictive of future relapse, functioning, and mortality. Implementing evidence-based interventions to improve MAT retention that are particularly appropriate for the needs of low-income, racial/ethnic minority individuals with OUD is essential. Peer recovery coaches (PRCs), trained individuals with their own lived experience with substance use disorder, may be uniquely suited to address common barriers to MAT retention among underserved populations, including stigma, challenges navigating services, housing instability, other structural and psychosocial factors. PRC-delivered interventions are a promising strategy for improving MAT retention for low-income, minority individuals with OUD, yet there are few evidence-based interventions (EBIs) that have been evaluated for PRC delivery to promote MAT retention. Preliminary work by our team suggests that behavioral activation (BA) may be a feasible, scalable reinforcement-based approach for improving MAT retention for low-income, minority individuals with OUD by PRCs. The proposed study builds upon our team’s formative work to adapt and evaluate the effectiveness and implementation of a PRC-delivered BA intervention (Peer Activate) to support MAT retention for low-income, minority individuals initiating MAT in Baltimore City, which has one of the highest overdose-fatality rates in the US and greatest burdens of OUD among low- income, racial/ethnic minority individuals. In Phase 1, we propose to refine and finalize the PRC-delivered Peer Activate model and address barriers to implementation for Phase 2 using pre-intervention focus groups with PRCs, staff, clients, and other key stakeholders (n=24). We will establish the preliminary feasibility, acceptability and fidelity of Peer Activate in an open-label trial (n=30) and pilot Phase 2 study procedures, including collecting preliminary MAT outcomes (MAT retention and opioid abstinence at 3 months). Based upon adaptations in Phase 1, we will then conduct a randomized, Type 1 hybrid effectiveness-implementation trial to evaluate the effectiveness and implementation of Peer Activate vs. treatment as usual (TAU; n=200) on MAT retention at six months (primary), MAT adherence and opioid abstinence (urine toxicology), and depressive symptoms (secondary). Implementation outcomes will be assessed at multiple levels (patient, provider, organization), including assessments of feasibility, acceptability, fidelity, and adoption guided by Proctor’s conceptual model of implementation outcomes. Our multidisciplinary team aims to develop an evidence-based PRC-delivered treatment model that can be sustainably delivered to improve MAT retention for low-income, minority individuals with OUD.