# Peer-Delivered Behavioral Activation Intervention to Improve Adherence to MAT Among Low-Income, Minority Individuals With OUD

> **NIH NIH R33** · UNIV OF MARYLAND, COLLEGE PARK · 2024 · $842,519

## Abstract

PROJECT SUMMARY
The opioid use disorder (OUD) crisis in the US is an epidemic of poor access to care, including medication
assisted treatment (MAT) and evidence-based behavioral interventions to support MAT outcomes. Low-
income, racial/ethnic minority individuals with OUD disproportionately evidence poor MAT outcomes, including
less than half of individuals typically being retained in MAT at six months. Retention is one of the factors most
predictive of future relapse, functioning, and mortality. Implementing evidence-based interventions to improve
MAT retention that are particularly appropriate for the needs of low-income, racial/ethnic minority individuals
with OUD is essential. Peer recovery coaches (PRCs), trained individuals with their own lived experience with
substance use disorder, may be uniquely suited to address common barriers to MAT retention among
underserved populations, including stigma, challenges navigating services, housing instability, other structural
and psychosocial factors. PRC-delivered interventions are a promising strategy for improving MAT retention for
low-income, minority individuals with OUD, yet there are few evidence-based interventions (EBIs) that have
been evaluated for PRC delivery to promote MAT retention. Preliminary work by our team suggests that
behavioral activation (BA) may be a feasible, scalable reinforcement-based approach for improving MAT
retention for low-income, minority individuals with OUD by PRCs. The proposed study builds upon our team’s
formative work to adapt and evaluate the effectiveness and implementation of a PRC-delivered BA intervention
(Peer Activate) to support MAT retention for low-income, minority individuals initiating MAT in Baltimore City,
which has one of the highest overdose-fatality rates in the US and greatest burdens of OUD among low-
income, racial/ethnic minority individuals. In Phase 1, we propose to refine and finalize the PRC-delivered Peer
Activate model and address barriers to implementation for Phase 2 using pre-intervention focus groups with
PRCs, staff, clients, and other key stakeholders (n=24). We will establish the preliminary feasibility,
acceptability and fidelity of Peer Activate in an open-label trial (n=30) and pilot Phase 2 study procedures,
including collecting preliminary MAT outcomes (MAT retention and opioid abstinence at 3 months). Based
upon adaptations in Phase 1, we will then conduct a randomized, Type 1 hybrid effectiveness-implementation
trial to evaluate the effectiveness and implementation of Peer Activate vs. treatment as usual (TAU; n=200) on
MAT retention at six months (primary), MAT adherence and opioid abstinence (urine toxicology), and
depressive symptoms (secondary). Implementation outcomes will be assessed at multiple levels (patient,
provider, organization), including assessments of feasibility, acceptability, fidelity, and adoption guided by
Proctor’s conceptual model of implementation outcomes. Our multidisciplinary team aims to dev...

## Key facts

- **NIH application ID:** 10893370
- **Project number:** 5R33DA057747-04
- **Recipient organization:** UNIV OF MARYLAND, COLLEGE PARK
- **Principal Investigator:** Jessica F Magidson
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $842,519
- **Award type:** 5
- **Project period:** 2022-09-01 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10893370

## Citation

> US National Institutes of Health, RePORTER application 10893370, Peer-Delivered Behavioral Activation Intervention to Improve Adherence to MAT Among Low-Income, Minority Individuals With OUD (5R33DA057747-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10893370. Licensed CC0.

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