This application seeks five years for a physician-scientist to emerge as an independent patient-centered decision science researcher in the intersection of substance use disorders and infectious diseases, especially within criminal justice populations. The application proposes a combination of carefully timed coursework and related research projects that will be supervised by leading experts in decision science and patient preferences, addiction medicine, criminal justice, biostatistics and HIV prevention. The candidate has chosen to focus on an incredibly vulnerable time for people with or at risk for HIV ? the transitional period after release from incarceration. This is especially timely given the volatile opioid epidemic that has fueled excessive opioid- related overdoses and transmission of HIV and HCV. The risk for complications from opioid use disorder are especially heightened during the transition from prisons and jails; 52% of all overdose mortality in Connecticut occurred in recently released prisoners. Treating opioid use disorder in prisoners and maintaining after release from prison is one of the most effective strategies to address the negative consequences of the opioid epidemic. For prisoners with opioid use disorder, however, they are often overly-optimistic that they no longer need treatment or have insufficient information to guide their selection of available treatments. Decision aids are evidence-based strategies to more effectively engage patients (and providers) in their treatment. Decision aids for other conditions and settings have been shown to improve knowledge and opting for choices that better comport with patient values and preferences, thus increasing likelihood of initiation and retention in evidence-based care. The candidate plans to adapt a decision aid that she developed for community treatment settings to the transitional period from incarceration. This aid is designed to improve both patient and provider knowledge and attitudes, to overcome misinformation and negative feelings about treatment. To adapt the current decision aid for opioid use disorder (OUD) treatment, the candidate proposes to conduct mixed- methods assessments of both incarcerated individuals with OUD and multidisciplinary justice system staff, regarding shared decision making for OUD treatment and medication initiation prior to release. Informed by these results, she will adapt (using a systematic framework) an existing tablet-based decision aid for OUD treatment with usability/field testing. This finalized and new decision aid for incarcerated individuals anticipating release will be piloted to assess feasibility and acceptability among the incarcerated individuals and staff, as well as for feasibility of the trial and preliminary effectiveness for increasing medication initiation compared to counseling as usual. These proposed aims will be supported with a plan of mentorship and training, all of which will support the candidate?s ultimate development into an independent researcher with an eventual R01 submission in patient-centered research in substance use and infectious disease.
The North American opioid epidemic is especially concentrated among incarcerated individual, who often relapse upon release and experience disproportionately high risk of overdose death, Hepatitis C, and HIV, during that chaotic transition to the community. While medication treatment is a key intervention for opioid use disorder that can reduce these risks, initiation and retention in treatment is low, even when available, due to individual- and provider-level barriers including misinformation, lack of information, and negative attitudes. In order to increase entry and continuation in opioid use disorder treatment, we propose to (1) conduct a needs assessment of both incarcerated individuals with opioid use disorder and corrections staff; and (2) systematically adapt an existing decision aid for shared decision making for opioid use disorder treatment in the justice system, then pilot this tool to assess feasibility, acceptability, and preliminary effectiveness.
