PROJECT SUMMARY Black and Latinx people who use opioids (PWUO) bear a disproportionate burden of opioid-related overdose deaths. Racial disparities among PWUO are exacerbated by persistent socioeconomic and structural barriers (e.g., stigma, lack of social support, housing instability) which may be partially addressed using scalable open- source solutions (e.g., peer recovery coaches, mobile health, telemedicine). With NIH support, we have validated a theory-based, AI-driven texting using natural language processing in a publicly-funded health system to provide real-time responses to patient queries combined with automated texts to enhance identification and address participant unmet SDH needs (e.g., access to peer support, healthcare), and linkages and retention in buprenorphine treatment per the medical management model (e.g., patient education, self-management). We have also refined an evidence-supported Cultural Structural Humility (CSH) training for peer recovery coaches (PRCs) that goes beyond a social determinants of health (SDH) framework to also include stigma reduction, health habitus, and patient navigation to improve clinical outcomes and social services use among PWUO. This proposal aims to adapt the evidence-supported CSH training to interactive video modules for peer recovery coaches (PRCs), and refine an artificial intelligence (AI)-driven texting tool to reinforce core CSH principles. The 3-month pilot RCT will test AI-driven CSH-enhanced texting tool + CSH-trained PRC providing telephone-based services coordination (multimodal intervention arm-1) vs. AI-driven CSH-enhanced texting tool (intervention arm-2) vs. treatment as usual / informational pamphlets only (control arm) among emergency department- enrolled Black / Latinx PWUO (N=150) to estimate rates of PRC-PWUO contact, AI-driven texting use among PWUO, assess potential for pre-/post-intervention impact on reduction of felt and/or anticipated stigma, clinical outcomes (i.e., time to initial receipt of buprenorphine), and social services use at 1- and 3-months to obtain intervention effect sizes, and estimate the associated cost of implementing and sustaining the multimodal intervention (e.g., cost-per OUD treatment days). The RE-AIM framework will inform implementation of this multimodal intervention that has high public health impact on complementing the HHS Overdose Prevention Strategy (i.e., harm reduction, OUD treatment, and recovery support) in a manner that is scalable, sustainable, and equitable using open-source solutions. Our team is uniquely positioned to obtain data that will inform a subsequent large-scale efficacy trial evaluating our proposed multimodal intervention to increase access to buprenorphine and social services among Black / Latinx PWUO.

PROJECT NARRATIVE Black and Latinx people who use opioids (PWUO) bear a disproportionate burden of opioid-related overdose deaths. This proposal aims to adapt an evidence-supported Cultural Structural Humility (CSH) training to interactive video modules for peer recovery coaches (PRCs) that goes beyond a social determinants of health (SDH) framework to also include stigma reduction, health habitus, and patient navigation, and refine an artificial intelligence (AI)-driven texting tool to reinforce core CSH principles. The pilot RCT involves PRC completion of interactive video modules to facilitate telephone-based care coordination combined with AI- driven CSH-enhanced texting to deliver social services information addressing SDH to enhance receipt of buprenorphine among emergency department-recruited Black and Latinx PWUO.