Gittins Rosalind, Teck Joseph Tay Wee, Knowles Rebecca, Clarke Nicole, Baldacchino Alexander
Via, London, United Kingdom.
Forward Leeds and Humankind Charity, Durham, United Kingdom.
Front Psychiatry. 2023 Jul 20;14:1224376. doi: 10.3389/fpsyt.2023.1224376. eCollection 2023.
Access to prescribed interventions and retention in treatment services are associated with improved health outcomes and reduced premature mortality rates for people living with opioid use disorder (OUD). In Leeds, transactional sex-workers frequently cycled in and out of treatment for OUD such that they never reached a level of engagement that permitted opportunities to meet their healthcare or housing needs. Barriers to accessing care provision include an itinerant lifestyle, difficulties with travel at unpredictable hours, impacting upon adherence to medication regimens including daily supervised consumption.
To use a co-produced, "health at the margins" approach, to reach the sex-working population in Leeds, and support informed choices about the potential to receive buprenorphine prolonged-release injection (BPRI) as a treatment option for OUD.
BPRI was introduced using a theory of change model and improvements in sex-worker care delivery was reviewed. Strategies included buprenorphine micro-induction, shared decision-making, collaborative multi-agency working and supporting a strengths-based and trauma-informed approach.
Benefits of BPRI included removal of the need for daily pharmacy visits, reducing the risk of diversion, improved medication adherence, stability and engagement with treatment and supportive services.
BPRI may offer an additional option for pharmacological interventions for people with OUD where there may be increased barriers to accessing treatment for example due to sex-working. Strategies for effective BPRI include micro-induction, shared decision-making, collaborative multi-agency working and supporting a strengths-based approach.
获得规定的干预措施并持续接受治疗服务，与改善阿片类药物使用障碍（OUD）患者的健康状况及降低过早死亡率相关。在利兹，从事交易性性工作的人员频繁进出OUD治疗项目，以至于他们从未达到能够满足其医疗保健或住房需求的参与程度。获得护理服务的障碍包括流动的生活方式、在不可预测的时间出行困难，这影响了对包括每日监督服药在内的药物治疗方案的依从性。
采用共同制定的“边缘健康”方法，接触利兹的性工作人群，并支持他们就是否有可能接受丁丙诺啡长效注射剂（BPRI）作为OUD的一种治疗选择做出明智选择。
采用变革理论模型引入BPRI，并对性工作者护理服务的改善情况进行了评估。策略包括丁丙诺啡微诱导、共同决策、多机构协作以及支持基于优势和创伤知情的方法。
BPRI的益处包括无需每日去药房，降低了药物被挪用的风险，提高了药物依从性、稳定性以及对治疗和支持性服务的参与度。
对于因从事性工作等原因而在获得治疗方面可能存在更多障碍的OUD患者，BPRI可能为药物干预提供另一种选择。有效的BPRI策略包括微诱导、共同决策、多机构协作以及支持基于优势的方法。
