Development of a community-based buprenorphine treatment intervention

开发基于社区的丁丙诺啡治疗干预措施

• 批准号: 8071920
• 负责人: Chinazo Cunningham
• 金额: $ 22.34万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-15 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8071920
• 关键词: Address; Adoption; Agonist; American; Applications Grants; Behavior Therapy; Buprenorphine; Client; Client satisfaction; Communities; Community Developments; Data; Development; Education; Effectiveness; Epidemic; Focus Groups; Fright; HIV; Health; Improve Access; Individual; Injecting drug user; Intervention; Interview; Maintenance; Manuals; Measures; Methadone; Monitor; Needle-Exchange Programs; New York City; Opiate Addiction; Opioid; Opioid Analgesics; Outcome; Patients; Pharmaceutical Preparations; Physicians; Population; Process; Psychosocial Assessment and Care; Public Health; Regulation; Risk Behaviors; Testing; Time; Treatment outcome; Work; base; chronic care model; group support; high risk; high risk behavior; improved; innovation; opioid abuse; opioid withdrawal; outreach; prescription opioid; treatment duration; waiver

DESCRIPTION (provided by applicant): With rising rates of opioid addiction, inadequate opioid addiction treatment is increasingly problematic. Buprenorphine treatment can address this problem by reducing opioid use and HIV risk behaviors. Marginalized populations at high risk of acquiring and transmitting HIV, like injection drug users (IDUs), have limited access to buprenorphine treatment. Because of minimal regulations, buprenorphine treatment can be integrated into community-based settings where IDUs congregate. There is great potential for strategies that emphasize community-based buprenorphine treatment to reach marginalized populations, like IDUs. Building on our previous work in which we developed community-based strategies to improve access to HIV treatment and developed a buprenorphine induction strategy to overcome induction challenges, we believe that developing a buprenorphine treatment intervention in community-based settings is critical to improving accessible and successful opioid addiction treatment for IDUs. Thus, we propose to develop a buprenorphine treatment intervention in non-medical community-based settings to improve access to opioid addiction treatment, improve health outcomes, and reduce high-risk behaviors among IDUs. We will collaborate with two community-based organizations (CBOs) to develop, test the feasibility of, and preliminarily examine a community-based buprenorphine treatment (CBBT) intervention. We anticipate that the CBBT intervention will consist of: buprenorphine education, facilitated access to physicians, support during buprenorphine induction, and support during buprenorphine maintenance. Additionally, we anticipate that the CBBT intervention will target clients of the CBOs' syringe exchange programs, be implemented by CBOs' outreach workers, and occur in the CBOs' settings. The specific aims are: 1) To develop a community-based buprenorphine treatment intervention. We will conduct focus groups and open-ended individual interviews with two CBOs' staff and clients to guide development of CBBT intervention components, materials, and processes. 2) To test the feasibility of implementing a community-based buprenorphine treatment intervention. We will examine feasibility by: 1) monitoring outreach workers' ability to adhere to the intervention manual; 2) measuring outreach worker and client satisfaction, and 3) tracking clients who engage in the CBBT intervention. 3) To examine treatment outcomes (opioid use, HIV risk behaviors, treatment retention) of a community-based buprenorphine treatment intervention. We will compare change in opioid use and HIV risk behaviors before and 30 days after initiating buprenorphine treatment in clients who received the CBBT intervention with clients who did not. We will also compare 30-day treatment retention. If CBBT is feasible and can improve treatment outcomes, it could positively impact the opioid and HIV epidemics. Pilot data from this project will guide our R01 grant application, to conduct a large-scale rigorous study of the effectiveness of our CBBT intervention. PUBLIC HEALTH RELEVANCE: With increasing rates of opioid addiction, our innovative project will develop, test the feasibility of, and preliminarily examine treatment outcomes of a community-based buprenorphine treatment intervention. Ultimately, this intervention has the potential to improve access to opioid addiction treatment with buprenorphine and improve buprenorphine treatment outcomes (reduce opioid use, reduce HIV risk behaviors, and improve retention in buprenorphine treatment). This study's findings will be used to guide a large-scale study of our community-based buprenorphine treatment intervention.

描述（由申请人提供）：随着阿片类药物成瘾率的上升，阿片类药物成瘾治疗不足越来越有问题。丁丙诺啡治疗可以通过减少阿片类药物使用和HIV风险行为来解决此问题。以高度获取和传播艾滋病毒的高风险的边缘化人群，例如注射吸毒者（IDU），可以使用丁丙诺啡治疗。由于法规最少，可以将丁丙诺啡治疗纳入IDU聚集的基于社区的环境中。强调以社区为基础的丁丙诺啡治疗来达到边缘化人群（如IDU）的策略有很大的潜力。 在我们以前的工作的基础上，我们制定了基于社区的策略来改善艾滋病毒治疗的机会，并制定了丁丙诺啡诱导策略来克服归纳挑战，我们认为在基于社区的环境中开发丁丙诺啡治疗干预措施对于改善iDUS的可访问和成功的阿片类药物成瘾治疗至关重要。因此，我们建议在非医疗社区的环境中开发丁丙诺啡治疗干预措施，以改善接受阿片类药物成瘾治疗的机会，改善健康结果并减少IDU之间的高风险行为。 我们将与两个基于社区的组织（CBO）合作开发，测试可行性并初步检查基于社区的丁丙诺啡治疗（CBBT）干预措施。我们预计CBBT干预措施将包括：丁丙诺啡教育，促进医师的机会，丁丙诺啡诱导期间的支持以及丁丙诺啡维持期间的支持。此外，我们预计CBBT干预将针对CBO的注射器交换计划的客户，由CBOS的外展工人实施，并发生在CBOS的设置中。具体目的是：1）开发基于社区的丁丙诺啡治疗干预措施。我们将与两名CBO的员工和客户进行焦点小组和开放式个人访谈，以指导CBBT干预组件，材料和流程的开发。 2）测试实施基于社区的丁丙诺啡治疗干预措施的可行性。我们将通过以下方式检查可行性：1）监视外展工人遵守干预手册的能力； 2）测量外展工作者和客户满意度，3）跟踪参与CBBT干预的客户。 3）检查基于社区的丁丙诺啡治疗干预措施的治疗结果（阿片类药物使用，HIV风险行为，治疗保留）。我们将在接受CBBT干预的客户启动丁丙诺啡治疗之前和30天后比较阿片类药物使用和艾滋病毒风险行为的变化。我们还将比较30天的治疗保留率。 如果CBBT是可行的，并且可以改善治疗结果，则可能会对阿片类药物和HIV流行病产生积极影响。该项目的试点数据将指导我们的R01赠款应用程序，以对CBBT干预的有效性进行大规模的严格研究。 公共卫生相关性：随着阿片类药物成瘾率的提高，我们的创新项目将开发，测试可行性并初步检查基于社区的丁丙诺啡治疗干预措施的治疗结果。最终，这种干预措施有可能改善丁丙诺啡治疗阿片类成瘾治疗并改善丁丙诺啡治疗结果（减少阿片类药物的使用，减少HIV风险行为并改善丁丙诺啡治疗中的保留率）。这项研究的发现将用于指导我们基于社区的丁丙诺啡治疗干预措施的大规模研究。