Project Summary/Abstract:
Rural counties, particularly in Appalachia, are battling fast-growing outbreaks of HIV and have been
labeled by the CDC as vulnerable to growing transmission rates due to widespread injection drug use. One of
the most promising mechanisms for reducing HIV transmission in these communities is the use of
buprenorphine, which treats opioid use disorder and also reduces behaviors that increase HIV risk. Despite the
potential benefit of buprenorphine, health care professionals (HCPs) in rural areas of the United States are
much less likely to have received the training and federal waiver necessary to prescribe this medication.
Stigma toward patients who use drugs is an accepted barrier to substance use treatment, but it also impacts
health care professionals, especially rural primary care prescribers such as physicians, nurse practitioners, and
physicians assistants who are on the front lines of the opioid crisis. We have shown in previous studies that
stigma is a primary reason why fewer rural health care professionals are willing to work with patients with OUD.
Stigma and negative attitudes toward patients with OUD, fortunately, are modifiable but require training
interventions that are both effective and feasible to implement in rural practice settings. Previous interventions
have been used with health care professionals successfully to reduce stigma, but they have not been tailored
for medications for opioid use, such as buprenorphine, or for the rural primary care setting. We propose to
adapt an existing brief stigma-reduction training intervention to the rural primary care setting to increase
buprenorphine prescribing and implement a randomized, pilot study to assess feasibility and acceptability
among rural primary care providers. Our specific aims are to: 1) Examine HCP knowledge and attitudes about
OUD to understand their reluctance to prescribe MOUD and manage patients with OUD. 2) Develop a
prototype narrative-based stigma reduction intervention and tailor it to the rural primary care setting using HCP
feedback and 3) Assess the feasibility and acceptability of a stigma-reduction intervention in a pilot study in a
diverse group of rural HCPs across 6 primary care clinics. The primary pilot trial outcomes are feasibility,
acceptability, appropriateness, and adoption, measured among a cohort of HCPs who do not currently
prescribe buprenorphine at full capacity. We will also measure additional stigma outcomes such as attitudes
towards patients with OUD and harm reduction. We will use in-depth interviews to further assess perceptions
of the intervention and finalize it for use in a follow-up cluster randomized controlled trial. This developmental
trial will produce a brief stigma reduction training intervention that is acceptable and feasible to implement in
rural primary care clinics. The long-term goal is to establish a brief stigma-reduction training intervention that is
modifiable for different practice settings and effective at increasing buprenorphine prescribing in underserved
communities.
