Culturally-responsive community-driven substance use recovery for Black and Latinx populations

文化响应型社区驱动的黑人和拉丁裔人群药物使用恢复

• 批准号: 10592799
• 负责人: Chyrell Denise Bellamy
• 金额: $ 14.86万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-30 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10592799
• 关键词: Adherence; Attention; Black Populations; Black race; COVID-19 mortality; COVID-19 pandemic; Cessation of life; Church; Collaborations; Color; Communities; Dimensions; Education; Elements; Ethnic group; FDA approved; Fentanyl; Goals; Gold; Harm Reduction; Individual; Latinx; Latinx population; Learning; Link; Methodology; Methods; Minority Groups; Opioid; Overdose; Participant; Persons; Pharmaceutical Preparations; Pharmacotherapy; Population Intervention; Prevalence; Process; Provider; Race; Randomized Controlled Trials; Recovery; Services; Structural Racism; Technology; Underrepresented Minority; Vulnerable Populations; addiction; alcohol abuse therapy; alcohol use disorder; base; burden of illness; disparities in morbidity; experience; improved outcome; innovation; interest; minority communities; mortality; opioid use disorder; person centered; policy recommendation; programs; social health determinants; substance use; telehealth; uptake

Program Summary/Abstract In 2020, over 85,000 people died from drug overdoses in the US, with mortality rates skyrocketing for Black and Latinx people by 140% and 118%, respectively, given the presence of fentanyl (a manufactured opioid) in the drug supply. While the national media has focused on opioid-involved deaths among White people, minimal attention has been given to the disparate morbidity and mortality related to opioid use disorder (OUD) and alcohol use disorder (AUD) among Black and Latinx people. Although overall prevalence of AUD is similar across racial and ethnic groups, or in some cases, fewer than White people, there continues to be a disproportionate burden of illness experienced among under-represented minority (URM) populations, complicated by a dearth of culturally informed addiction treatment options. Further, with COVID-19, deaths continue to worsen for URM with SUDs, making it more urgent than ever to study culturally informed treatment interventions for these populations. This disproportionate illness burden and lack of access to the gold standard in addiction treatment—medication for addiction treatment (MAT)—has been linked to a host of barriers, based in structural racism, including inadequate access to technology (a point particularly underscored in the current COVID-19 pandemic), lack of addiction providers from URM backgrounds, limited education about MAT in URM communities, and an absence of robust culturally informed harm reduction services in these communities. To tackle the unique challenges of decreased treatment initiation, engagement, and adherence to addiction treatment for Black and Latinx people with SUDs, in collaboration with key stakeholders we developed Imani (meaning Faith in Swahili) Breakthrough in 2017 through a community based participatory process. Imani Breakthrough is a faith-based, person- centered, culturally informed harm reduction recovery program that takes place in churches. This program provides an innovative approach to engaging vulnerable groups into SUD treatment, by focusing on the 8 dimensions of wellness (social determinants of health/ SDOH), 7 domains of citizenship, culturally informed SUD education, and referral to MAT for any FDA-approved pharmacotherapy for treating a SUD. The main goal of this current study is to develop and optimize methods for increasing access to, uptake of, and engagement in MAT for AUD and OUD among communities of color. Through a multilevel CBPR initiative and a rigorous RCT that incorporates elements of choice in participation, we will examine, among participants interested in MAT, whether adding a Church-based Telehealth MAT option to Imani (Imani + CTM) will improve outcomes for Black and Latinx people with AUD or OUD compared to Imani + traditional MAT Referral and Linkage (Imani + MAT R&L) in the community. Individuals who do not choose to engage in MAT will continue in the Imani group program as usual. Our CBPR process incorporates learning from and partnering with the church and larger community to increase the community's understanding of AUD and OUD, tackle MAT misconceptions, optimize Imani implementation, and establish policy recommendations to better serve Black and Latinx with SUDs.

计划摘要/摘要 2020 年，美国有超过 85,000 人死于吸毒过量，其中黑人和黑人的死亡率飙升 鉴于芬太尼（一种人造阿片类药物）的存在，拉丁裔人群的死亡率分别下降了 140% 和 118%。 尽管全国媒体一直关注白人因阿片类药物导致的死亡，但这一数字极小。 与阿片类药物使用障碍（OUD）和酒精相关的不同发病率和死亡率受到关注 尽管 AUD 的总体患病率在不同种族中相似，但黑人和拉丁裔人群中使用障碍 (AUD) 的比例相似。 和种族群体，或者在某些情况下，少于白人，仍然存在不成比例的负担 代表性不足的少数民族 (URM) 人群中经历的疾病，由于缺乏 此外，随着 COVID-19 的出现，URM 的死亡人数继续恶化。 SUD，使得研究针对这些人群的文化知情治疗干预措施比以往任何时候都更加紧迫。 这种不成比例的疾病负担和缺乏成瘾治疗的黄金标准——药物治疗 成瘾治疗（MAT）——与一系列基于结构性种族主义的障碍有关，包括 获得技术的机会不足（当前的 COVID-19 大流行特别强调了这一点）、缺乏 来自 URM 背景的成瘾提供者、URM 社区中关于 MAT 的教育有限以及缺席 在这些社区提供强有力的文化信息减少伤害服务，以应对独特的挑战。 黑人和拉丁裔人士的治疗开始、参与和坚持成瘾治疗 我们与 SUD 和主要利益相关者合作，开发了 Imani（斯瓦希里语中的信仰）突破 2017 年，通过基于社区的参与过程，Imani Breakthrough 是一项基于信仰的、以人为本的活动。 在教堂中进行的以文化为中心的减少伤害恢复计划。 计划提供了一种创新方法，让弱势群体参与 SUD 治疗，重点关注 健康的 8 个维度（健康的社会决定因素/SDOH）、公民的 7 个领域、文化背景 SUD 教育，以及转诊 MAT 接受 FDA 批准的治疗 SUD 的药物疗法。 当前研究的目的是开发和优化方法，以增加对这些内容的获取、吸收和参与 通过多层次的 CBPR 倡议和严格的 RCT，为有色人种社区提供 AUD 和 OUD 的 MAT。 其中包含参与选择的要素，我们将在对 MAT 感兴趣的参与者中进行审查， 在 Imani (Imani + CTM) 中添加基于教会的远程医疗 MAT 选项是否会改善黑人的治疗结果 与使用 AUD 或 OUD 的拉丁裔人士相比，Imani + 传统 MAT 推荐和链接（Imani + MAT 社区中不选择参加 MAT 的个人将继续参加 Imani 团体计划。 像往常一样，我们的 CBPR 流程包括向教会和更大的社区学习并与之合作。 增加社区对 AUD 和 OUD 的理解，解决 MAT 误解，优化 Imani 实施，并制定政策建议，以通过 SUD 更好地为黑人和拉丁裔服务。