Understanding the Impact of COVID-19 on Methadone Treatment Retention and Adherenceàin an Underserved, Minority Population with OUD

了解 COVID-19 对使用 OUD 的服务不足的少数族群中美沙酮治疗保留和依从性的影响

• 批准号: 10169836
• 负责人: Jessica F Magidson
• 金额: $ 12.94万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10169836
• 关键词: Abstinence; Acute; Address; Adherence; Administrative Supplement; Adoption; African American; Age; Award; Baltimore; Behavior Therapy; Behavioral; COVID-19; Caring; Cessation of life; Cities; Client; Clinic; Communities; Counseling; Data; Diagnosis; Dose; Drug Rehabilitation Centers; Electronic Health Record; Emergency Situation; Ensure; Epidemic; Evidence based intervention; Face; Fatality rate; Focus Groups; Funding; Future; Goals; Health; Health Services Accessibility; Home environment; Homelessness; Individual; Infrastructure; Intervention; Interview; Low income; Maryland; Measures; Minority; Modeling; National Institute of Drug Abuse; Opioid; Outcome; Outpatients; Overdose; Parents; Patients; Perception; Pharmaceutical Preparations; Phase; Population; Procedures; Provider; Psychological reinforcement; Psychosocial Factor; Race; Randomized; Recovery; Regulation; Relapse; Research; Resources; Services; Structure; Substance Use Disorder; System; Technology; Time; Toxicology; Training; Treatment outcome; Underserved Population; United States Substance Abuse and Mental Health Services Administration; Universities; Urine; Work; base; cohort; coronavirus disease; depressive symptoms; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; ethnic minority population; evidence base; experience; health disparity; housing instability; improved; low socioeconomic status; methadone clinic/center; methadone treatment; minority communities; mortality; multidisciplinary; novel; open label; opioid treatment program; opioid use disorder; pandemic disease; parent grant; patient population; peer; phase 2 study; prescription opioid; programs; racial and ethnic; recruit; response; sex; social stigma; telehealth; treatment as usual; treatment program; underserved minority; virtual

PROJECT SUMMARY The opioid use disorder (OUD) crisis in the US is an epidemic of poor access to care, including medication for opioid use disorder (MOUD) and evidence-based behavioral interventions to support MOUD outcomes. Low- income, racial/ethnic minority individuals with OUD disproportionately evidence poor MOUD outcomes, including less than half of individuals typically being retained in MOUD at six months. Retention is one of the factors most predictive of future relapse, functioning, and mortality. Implementing evidence-based interventions to improve MOUD 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 MOUD 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 MOUD 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 MOUD retention. Preliminary work by our team suggests that behavioral activation (BA) may be a feasible, scalable reinforcement-based approach for improving MOUD 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 MOUD retention for low-income, minority individuals initiating MOUD 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 MOUD outcomes (MOUD 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 MOUD retention at six months (primary), MOUD 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 MOUD retention for low-income, minority individuals with OUD.

项目摘要 美国的阿片类药物使用障碍（OUD）危机是一种无法获得护理的流行病，包括药物 OOPIOED使用障碍（MOUD）和基于证据的行为干预措施，以支持MOUD结果。低的- 收入，种族/族裔少数民族个人，穆德的结果不成比例， 包括不到一半的个体通常在六个月时保留在穆德中。保留是 最可预测未来救济，功能和死亡率的因素。实施基于证据的干预措施 改善穆德保留率特别适合低收入，种族/族裔少数民族的需求 患有OUD的人是必不可少的。同行恢复教练（PRC），训练有素的人 具有药物使用障碍的经验，可能非常适合解决MOUD的常见障碍 服务不足的人口（包括污名）的保留质疑导航服务，住房不稳定， 其他结构和社会心理因素。统治干预措施是改善的有前途的策略 低收入，少数族裔OUD的穆德保留率，但很少有循证干预措施 （EBIS）已评估PRC交付以促进MOUD保留。我们团队的初步工作 表明行为激活（BA）可能是一种基于可行的，可扩展的强化方法 改善PRC的低收入，少数族裔个人的MOUD保留。拟议的研究建造 根据我们团队的形成性工作，以适应和评估中国延期的有效性和实施 BA干预（同伴激活）以支持低收入的少数族裔的穆德保留率 巴尔的摩市，它是美国最高的过量疗法率之一，也是Oud的最大伯伦斯 在低收入，种族/族裔少数民族中。在第1阶段，我们建议完善和最终确定PRC- 交付同行激活模型和解决第2阶段实施的障碍，使用干预前重点 与中国，员工，客户和其他主要利益相关者的小组（n = 24）。我们将建立初步可行性， 在开放标签试验（n = 30）和Pilot 2阶段研究程序中，同伴的可接受性和忠诚度激活 包括收集初步的MOUD结果（在3个月时保留和戒酒）。基于 在第1阶段进行适应后，我们将进行随机的1型混合有效性实现 试验以评估同伴的有效性和实施，如往常（tau; n = 200） 在六个月（初级），MOUD依从性和阿片类药物禁欲（尿液毒理学）和 抑郁症状（次要）。实施结果将在多个级别上进行评估（患者， 提供者，组织），包括对可行性，可接受性，忠诚度和采用的评估 Proctor的实施成果概念模型。我们的多学科团队旨在发展 基于证据的PRC提供的治疗模型，可以可持续交付以改善MOUD保留 对于低收入的少数族裔，有Oud。