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

被书包围：在公共场合开发和测试远程丁丙诺啡干预 有阿片类药物使用障碍的不稳定居住者的图书馆 摘要 全国的公共图书馆正在经历一场阿片类药物过量的危机。丁丙 “bupe”是一种非常有效的治疗OUD的药物，但许多居住不稳定的人， 由于结构性障碍，图书馆无法获得bupe。《读书人》（BBB），与 我们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）， 将创新地调整FJV已经成功的当天，免费低障碍远程bupe治疗， 库设置。通过测试图书馆对电话咨询的接受和保留，本研究将告知如何 个人可以通过创新的低障碍方式接受bupe护理，这可能会改变景观 从根本上实施bupe。我们的三个目标是： 1)在技术接受模型中开发和完善“按书执行”（BBB） (TAM)：通过焦点小组和干预绘图技术，我们将：a）评估 利益相关者，如使用图书馆的当地居民，图书馆工作人员， 提供者和有OUD的人对BB B的潜力，B）制定一个计划与利益相关者的投入，和c） 确定可改变的执行障碍。 2)确定BBB的可行性并测量治疗吸收和依从性：我们将 进行为期12周的初步2组随机对照试验（RCT）（n=40）。研究人员将招募图书馆 顾客和随机他们每周电话bupe在图书馆或在人的诊所控制武器。健康 然后，提供者将筛选参与者是否有资格参加当天的bupe诱导。血脑屏障对脑出血的影响 诱导和对处方剂量的依从性将基于1-、2-、4-、8-、12- 研究人员每周随访，每周进行尿液药物筛查和处方取药。我们 假设库中Tele-Bupe与对照组相比将具有更高的摄取和更长的 坚持治疗。这一试点将为设计一个 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。我们将与BBB进行结构化面试 患者、医疗服务提供者和图书馆工作人员，以深入了解患者的BBB经历 与基于临床的BUP治疗相比。 通过利用多个图书馆网站，我们将使tele-bupe可复制的其他图书馆全国 面临阿片类药物过量，并为随后的R 01中更大的RCT奠定基础，以评估 利用公共场所治疗药物使用障碍和减少类阿片相关死亡的有效性。

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.