"Bupe by the book": A study protocol for a pilot randomized controlled trial of library-facilitated telehealth to increase buprenorphine treatment among individuals experiencing homelessness.

Background: Accessing opioid use disorder (OUD) treatment is difficult for individuals with unstable housing. This population often uses public libraries for computer and internet access, which could provide telehealth access to OUD treatment. Therefore, we developed a novel 12-week library-facilitated telehealth intervention study called "Bupe by the Book" (BBB) that uses library resources to facilitate initiation and retention in OUD treatment with buprenorphine.

Methods: The study is a partnership between the San Diego Public Library and a federally qualified healthcare center attached to a homeless shelter (Father Joe's Villages (FJV) Village Health Center). We co-designed a pilot randomized controlled trial to assess the feasibility and acceptability of a library-facilitated telehealth intervention in San Diego, California. The intervention is being evaluated for its feasibility and acceptability (library tele-buprenorphine uptake) by obtaining an estimate of the effect of the library telehealth arm of the intervention on buprenorphine treatment outcomes (primary outcome: buprenorphine uptake, i.e., a pharmacy pickup and taking the prescription 1 + times) and adherence (i.e., > 1 buprenorphine positive screens, ideally for 8 + weeks), compared to the control (standard care at the clinic) intervention. Individuals reporting homelessness and OUD (with or without other substance use) are eligible. Forty library patrons will be recruited via flyers, screened for eligibility, and referred to FJV Health Center for in-person initial buprenorphine treatment intake visits. Participants who complete intake are enrolled and randomized to the library-facilitated telehealth condition, which involves using library internet and computer resources for follow-up buprenorphine treatment appointments with the medical provider via library telehealth. In the control condition, participants do not use library telehealth for their buprenorphine care follow up appointments, but rather they go in-person to the clinic or per usual standard care protocols. Feasibility and acceptability of the library telehealth intervention and conduct of the randomized controlled trial are determined by the participants' use of the library telehealth intervention for buprenorphine treatment, and quantitative and qualitative measures assessing their perceptions of the library telehealth intervention, collected over a 12-week period.

Discussion: The design of this pilot study may support the adoption of library-facilitated telehealth treatment as a feasible and acceptable strategy to engage and retain people experiencing homelessness with OUD in buprenorphine treatment.

Trial registration: This trial was registered prospectively at ClinicalTrials.gov (registration number NCT05872386) on May 24, 2023.