Community-Based Opioid Treatment (CBOT): Development and testing of a novel nurse-led model to deliver opioid use disorder treatment and HIV prevention and care in the community setting.

University Of Washington, Seattle WA

Investigators

Abstract

PROJECT SUMMARY People who use opioids (PWUO) are at increased risk of drug overdose as well as HIV infection or worse HIV outcomes. Retention in opioid use disorder treatment and HIV prevention or treatment (hereafter referred to as HIV care) for PWUO remains suboptimal. Medications for opioid use disorder are gold standard treatments for opioid use disorder (OUD). This includes buprenorphine which has a strong evidence base in reducing the risk of overdose, reductions in drug use, soft-tissue infections, and hospitalizations. Additionally, buprenorphine treatment been shown to improve HIV care outcomes by engaging in PWUO in health care services to reduce infection risk as well as promoting HIV viral load suppression for PWUO living with HIV. While there are successful clinic-based implementation strategies to improve buprenorphine and HIV care access, long-term retention, particularly at 1 year, remains elusive. Achieving this long-term retention goal requires innovations in delivery of these services. Community-based care is a means of service delivery which prioritizes individuals at high risk of falling out of care and/or poor HIV care outcomes with care services delivered directly to them. The propose of this study is to develop the Community-Based Opioid Treatment (CBOT) implementation strategy to deliver buprenorphine and HIV care services to PWUO by nurse care-managers and community outreach workers and then conduct an implementation trial comparing the implementation and clinical effectiveness outcomes of CBOT compared to evidence-based, clinic delivery of opioid treatment. Part 1 of the study will consist of interviewing patients, providers, nurses, and other stakeholders to inform development of CBOT and the blueprint needed to implement this care delivery strategy. Part 1 will conclude with a 3-month pilot of CBOT with n=10 participants, and any needed refinement of the CBOT implementations strategy. Part 2 of the study will be a type-3 hybrid implementation trial. Participants (n=140) will be randomized (1:1) to receive the CBOT implementation strategy for opioid use disorder treatment and HIV care services delivered by a nurse care- manager and community outreach workers or office-based opioid treatment, with opioid use disorder treatment delivered by a nurse care-manager in the clinic setting. Primary implementation outcomes include the feasibility, acceptability, and maintenance of the CBOT implementation strategy. Secondary clinical outcomes are buprenorphine retention and HIV care outcomes (HIV viral load or uptake of HIV testing). Finally, costing measures will be continuously collected to conduct micro-costing analysis. CBOT can be the next tool that clinics and health systems utilize to successfully reach PWUO at risk for or living with HIV who are at high risk of falling out of care and prioritizing them for enhanced services. In summary, this study addresses a pressing need to determine the most effective approach to retention in opioid use disorder treatment and HIV care for a priority population of individuals at high risk of a drug overdose and falling out of established care.