title: The effect of bundling medication-assisted treatment for opioid addiction with mHealth: study protocol for a randomized clinical trial.
abstract: Opioid dependence has devastating and increasingly widespread consequences and costs, and the most common outcome of treatment is early relapse. People who inject opioids are also at disproportionate risk for contracting the human immunodeficiency virus (HIV) and hepatitis C virus (HCV). This study tests an approach that has been shown to improve recovery rates: medication along with other supportive services (medication-assisted treatment, or MAT) against MAT combined with a smartphone innovation called A-CHESS (MAT + A-CHESS).
  
  
  
  This unblinded study will randomly assign 440 patients to receive MAT + A-CHESS or MAT alone. Eligible patients will meet criteria for having an opioid use disorder of at least moderate severity and will be taking methadone, injectable naltrexone, or buprenorphine. Patients with A-CHESS will have smartphones for 16 months; all patients will be followed for 24 months. The primary outcome is the difference between patients in the two arms in percentage of days using illicit opioids during the 24-month intervention. Secondary outcomes are differences between patients receiving MAT + A-CHESS versus MAT in other substance use, quality of life, retention in treatment, health service use, and, related to HIV and HCV, screening and testing rates, medication adherence, risk behaviors, and links to care. We will also examine mediators and moderators of the effects of MAT + A-CHESS. We will measure variables at baseline and months 4, 8, 12, 16, 20, and 24. At each point, patients will respond to a 20- to 30-min phone survey; urine screens will be collected at baseline and up to twice a month thereafter. We will use mixed-effects to evaluate the primary and secondary outcomes, with baseline scores functioning as covariates, treatment condition as a between-subject factor, and the outcomes reflecting scores for a given assessment at the six time points. Separate analyses will be conducted for each outcome.
  
  
  
  A-CHESS has been shown to improve recovery for people with alcohol dependence. It offers an adaptive and extensive menu of services and can attend to patients nearly as constantly as addiction does. This suggests the possibility of increasing both the effectiveness of, and access to, treatment for opioid dependence.
  
  
  
  ClinicalTrials.gov, NCT02712034 . Registered on 14 March 2016.
authors.affiliation: Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Gustafson
authors.affiliation: Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Landucci
authors.affiliation: Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA.
authors.forename: Fiona
authors.initials: F
authors.lastname: McTavish
authors.affiliation: Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA.|School of Journalism and Mass Communication, University of Wisconsin-Madison, Madison, WI, 53706, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Kornfield
authors.affiliation: Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA. bobbie.johnson@wisc.edu.
authors.forename: Roberta A
authors.initials: RA
authors.lastname: Johnson
authors.affiliation: Communication Arts Department, University of Wisconsin-Madison, Madison, WI, 53706, USA.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Mares
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53705, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Westergaard
authors.affiliation: Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Quanbeck
authors.affiliation: Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA.
authors.forename: Esra
authors.initials: E
authors.lastname: Alagoz
authors.affiliation: Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA.
authors.forename: Klaren
authors.initials: K
authors.lastname: Pe-Romashko
authors.affiliation: Access Community Health Centers, Madison, WI 53715, USA.
authors.forename: Chantelle
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Mass Communication Research Center, School of Journalism and Mass Communication, University of Wisconsin-Madison, Madison, WI, 53706, USA.
authors.forename: Dhavan
authors.initials: D
authors.lastname: Shah
mesh_terms: D000223:Adaptation, Psychological; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D002047:Buprenorphine / Q000008:administration & dosage* / Q000009:adverse effects; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D055030:Drug Users / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D008691:Methadone / Q000008:administration & dosage* / Q000009:adverse effects; D063731:Mobile Applications; D009271:Naltrexone / Q000008:administration & dosage* / Q000009:adverse effects; D058850:Opiate Substitution Treatment / Q000009:adverse effects / Q000379:methods*; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012008:Recurrence; D012107:Research Design; D000068997:Smartphone; D017216:Telemedicine / Q000295:instrumentation* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014922:Wisconsin
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D009271:Naltrexone; D008691:Methadone
keywords: Addiction; HCV; HIV; Medication-assisted treatment; Opioids; Smartphone; Technology; mHealth