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: 10588504
• 负责人: Jessica F Magidson
• 金额: $ 84.92万
• 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/10588504
• 关键词: Abstinence; Address; Adherence; Adoption; Affect; African American population; Baltimore; Behavior; Behavior Therapy; Behavioral; Caring; Cities; Client; Clinic; Counseling; Enrollment; Epidemic; Evidence based intervention; Face; Fatality rate; Feedback; Focus Groups; Future; HIV; Health Services Accessibility; Hybrids; Individual; Intervention; Lead; 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; Recovery; Relapse; Research; Services; Substance Use Disorder; Testing; Toxicology; Training; Treatment outcome; Underserved Population; Urine; Work; addiction; base; 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; phase 2 study; prevent; provider-level barriers; psychosocial; racial and ethnic; social stigma; treatment adherence; treatment as usual; treatment program; underserved community; underserved minority

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 辅助治疗（MAT）和基于证据的行为干预措施以支持MAT结果。低的- 收入，种族/族裔少数民族的人，越来越不成比例地证明了不良的垫子结果，包括 不到一半的个体通常在六个月后将其保留在MAT中。保留是最大的因素之一 预测未来的救济，功能和死亡率。实施基于证据的干预措施以改进 保留量特别适合低收入，种族/族裔少数民族的需求 使用OUD是必不可少的。同行恢复教练（PRC），训练有素的人，拥有自己的现场经验 药物使用障碍，可能非常适合解决与垫子保留率的共同障碍 服务不足的人口，包括污名，挑战导航服务，住房不稳定性，其他结构性 和社会心理因素。 PRC分配干预措施是改善MAT保留率的承诺策略 低收入，少数族裔的人，但是很少有循证干预措施（EBIS） 对我们进行了PRC的评估，以促进MAT保留。我们团队的初步工作表明 行为激活（BA）可能是一种可行的，可扩展的增强方法，用于改善垫子 为低收入的少数族裔个人保留。拟议的研究基于我们团队的 形成性工作，以适应和评估PRC授予的BA干预的有效性和实施 （同行激活）支持低收入的少数民族个人在巴尔的摩市发射垫子的垫子保留率， 在美国，它是美国的过量效率最高的率之一，在低 - 收入，种族/族裔少数民族个人。在第1阶段，我们建议完善和最终确定PRC分配的同伴 使用带有干预前的焦点小组激活模型并解决第2阶段实施障碍 中国，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， 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 包括收集初步的垫子结果（3个月时保留和阿片类药物的禁欲）。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（主要），MAT依从性和阿片类药物戒酒（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 可以可持续交付以改善垫子保留率的基于证据的PRC提供的治疗模型 对于低收入的少数族裔，有Oud。