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

同伴提供的行为激活干预可提高低收入少数族裔 OUD 患者对 MAT 的依从性

• 批准号: 10662567
• 负责人: Jessica F Magidson
• 金额: $ 84.73万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662567
• 关键词: Abstinence; Address; Adherence; Adoption; Affect; African American population; Agreement; Baltimore; Behavior; Behavior Therapy; Behavioral; Caring; Cities; Client; Clinic; Counseling; Disparity; Enrollment; Epidemic; Evidence based intervention; Face; Fatality rate; Feedback; Focus Groups; Future; HIV; Health Services Accessibility; Hybrids; Individual; Intervention; Location; Low income; Manuals; Medically Underserved Area; Mental Depression; Methods; Minority; Minority Groups; Modeling; Opioid; Outcome; Outpatients; Patient Self-Report; Patients; Phase; Positive Reinforcements; Procedures; Proctor framework; Professional counselor; Provider; Psychological reinforcement; Psychosocial Factor; Quality of life; Randomized; Relapse; Research; Services; Substance Use Disorder; Testing; Toxicology; Training; Treatment outcome; Underserved Population; Urine; Work; addiction; combat; community setting; contingency management; cost; cost effective; depressive symptoms; design; effectiveness evaluation; effectiveness/implementation study; effectiveness/implementation trial; efficacious treatment; ethnic minority; ethnic minority population; evidence base; experience; flexibility; housing instability; implementation barriers; implementation facilitators; implementation outcomes; improved; improved outcome; innovation; medically underserved; medication compliance; medication-assisted treatment; mortality; multidisciplinary; open label; opioid treatment program; opioid use disorder; overdose death; peer; peer recovery; phase 2 study; prevent; provider-level barriers; psychosocial; racial minority; social stigma; structural determinants; treatment adherence; treatment as usual; treatment program; underserved community

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.

项目概要 美国的阿片类药物使用障碍 (OUD) 危机是一种难以获得医疗服务（包括药物治疗）的流行病 辅助治疗 (MAT) 和基于证据的行为干预支持 MAT 结果。 收入、种族/族裔少数群体的 OUD 不成比例地证明 MAT 结果不佳，包括 通常只有不到一半的人会在六个月后保留 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，实施基于证据的干预措施以改善。 特别适合低收入、少数种族/族裔个人需求的 MAT 保留 同伴恢复教练 (PRC) 是必不可少的，他们是经过培训并拥有自己生活经验的人。 物质使用障碍，可能特别适合解决 MAT 保留的常见障碍 服务不足的人群，包括耻辱、导航服务挑战、住房不稳定、其他结构性问题 PRC 提供的干预措施是提高 MAT 保留率的一个有前途的策略。 低收入、少数族裔个体患有 OUD，但很少有基于证据的干预措施 (EBI) 我们团队对 PRC 交付以促进 MAT 保留进行了评估。 行为激活 (BA) 可能是一种可行的、可扩展的基于强化的方法，用于改善 MAT 拟议的研究以我们团队的研究为基础。 调整和评估中国提供的 BA 干预措施的有效性和实施情况的形成性工作 (Peer Activate) 支持在巴尔的摩市发起 MAT 的低收入少数族裔个人保留 MAT， 它是美国服药过量死亡率最高的国家之一，也是低收入群体中 OUD 负担最大的国家之一。 在第一阶段，我们建议完善并最终确定 PRC 交付的 Peer。 使用预干预焦点小组激活模型并解决第二阶段实施的障碍 PRC、员工、客户和其他主要利益相关者 (n=24) 我们将建立初步可行性， Peer Activate 在开放标签试验 (n=30) 和试点第 2 阶段研究程序中的可接受性和保真度， 包括收集初步 MAT 结果（基于 MAT 保留和 3 个月阿片类药物戒断）。 在第一阶段进行调整后，我们将进行随机的 1 类混合有效性实施 评估 Peer Activate 与照常治疗（TAU；n=200）的有效性和实施情况的试验 六个月 MAT 保留（主要）、MAT 依从性和阿片类药物戒断（尿液毒理学），以及 抑郁症状（次要）。实施结果将在多个层面进行评估（患者、 提供商、组织），包括对可行性、可接受性、保真度和采用的评估 Proctor 的实施结果概念模型。我们的多学科团队旨在开发一个 基于证据的 PRC 提供的治疗模型，可以持续提供以提高 MAT 保留率 适用于具有 OUD 的低收入、少数族裔个人。