Adapting the HOPE Online Support Intervention to Increase MAT Uptake Among OUD Patients

在一项随机对照试验中，有3个月、6个月和1年的随访，该应用程序试图评估 使用在线同伴支持社区干预增加MAT发起和 在网上招募的阿片使用障碍(OUD)参与者中的维持。 美国平均每天有130人死于阿片类药物过量，造成阿片类药物危机 该国最大的公共卫生问题(1，2)。尽管FDA批准的药物辅助治疗有效 (MAT)适用于阿片类药物使用障碍(OUD)患者，包括丁丙诺啡和注射剂 纳曲酮，只有一小部分受益于这些药物的人使用它们。有一种 垫子使用率低的一些原因，包括缺乏保险；供应商和 患者；与MAT相关的耻辱；以及社会规范(例如，如果他们的同龄人更愿意使用MAT 也在使用垫子)。创新方法，特别是那些涉及多个层次的方法(例如，个人， 文化和社会/社区)，以增加个人对垫的使用。 在线同行主导的支持干预在增加MAT摄入量方面可能特别有效，因为 他们可以利用同行来广泛和快速地调整社会规范的变化(例如，对使用MAT的兴趣) 在人们的自然、现实世界和虚拟环境中。例如，利用在线Peer 教育(希望)干预，一种旨在减少耻辱和 增加健康行为的改变，已被证明在改变健康行为方面是有效的 被污名化的人群，例如艾滋病毒。具体到与阿片类药物相关的问题，我们的团队最近发现了希望 干预是降低处方阿片类药物滥用风险的可行和可接受的方法 接受阿片类药物治疗的慢性疼痛患者。然而，还没有研究表明在线支持 干预措施，如希望，可能有效地增加MAT的需求、吸收和维持 我们的病人。因此，评估这些社会规范/行为技术方法对于 降低阿片类药物过量的递增率。 在这项研究中，我们试图探索是否以及如何调整希望在线支持干预 为加强对有OUD的参与者的MAT发起和支持，评估使用 在网上招募的不使用MAT的在线参与者中增加MAT使用的干预措施，并使用 实施科学方法(基于综合框架中的构造 实施研究，CFIR，确定社交网络动态(例如，网络)之间的关系 大小)、在线社区上讨论的话题以及行为改变。

In a randomized controlled trial, with 3, 6-month and 1-year follow-up, this application seeks to assess the effectiveness of using an online peer support community intervention to increase MAT initiation and sustainment among participants with opioid use disorder (OUD) who are recruited online. On average, 130 people die in the United States each day from opioid overdoses, making the opioid crisis the country's top public health concern (1,2). Although effective FDA-approved medication-assisted therapy (MAT) is available for patients with opioid use disorder (OUD), including buprenorphine and injectable naltrexone, only a small fraction of those who would benefit from these medications use them. There are a number of reasons for low MAT use, including lack of insurance; knowledge, among both providers and patients; MAT-related stigma; and social norms (e.g., people would be more willing to use MAT if their peers were also using MAT). Innovative methods, especially those that address multiple levels (e.g., the individual, culture, and society/community) are needed to increase MAT use among individuals with OUD. Online peer-led support interventions might be particularly effective at increasing MAT uptake because they can leverage peers to widely and rapidly scale changes in social norms (e.g., interest in using MAT) throughout people's natural, real-world, virtual environments. For example, the Harnessing Online Peer Education (HOPE) intervention, an online peer support community intervention designed to reduce stigma and increase health behavior change, has been shown to be effective at changing health behaviors among stigmatized populations, such as for HIV. Specific to opioid-related issues, our team recently found the HOPE intervention to be a feasible and acceptable method of reducing risk for prescription opioid misuse among chronic pain patients on opioid therapy. However, no research has studied whether online support interventions, such as HOPE, might be effective in increasing MAT requests, uptake, and sustainment among OUD patients. It is therefore critical to evaluate these social normative/behavioral technology methods to reduce the increasing rate of opioid overdose. In this study, we seek to explore whether and how the HOPE online support intervention might be adapted to increase MAT initiation and sustainment among participants with OUD, assess the effectiveness of using the intervention to increase MAT use among OUD participants recruited online who are not using MAT, and using an implementation science approach (based on constructs from the Consolidated Framework for Implementation Research, CFIR, determine the relationship between social network dynamics (e.g., network size), topics discussed on the online community, and behavior change.