Retention and Re-Engagement in Treatment for Addiction following Serious Injection Related Infections (RETAIN)

严重注射相关感染后保留和重新参与成瘾治疗（RETAIN）

• 批准号: 10428651
• 负责人: Simeon Kimmel
• 金额: $ 18.94万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-15 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10428651
• 关键词: Acute suppurative arthritis due to bacteria; Address; Advisory Committees; Antibiotics; Area; Bacteremia; Biometry; Boston; Buprenorphine; Caring; Cessation of life; Clinical Trials; Clinical Trials Design; Communicable Diseases; Complex; Continuity of Patient Care; Data; Data Set; Development; Drug usage; Endocarditis; Enrollment; Epidural Abscess; Event; Evidence based intervention; Face; Future; Goals; Health care facility; Healthcare Systems; Home; Hospitalization; Hospitals; Imprisonment; Individual; Infection; Infective endocarditis; Injectable; Injections; Inpatients; Intervention; Interview; Intravenous; K-Series Research Career Programs; Lead; Link; Massachusetts; Medical; Medical center; Medicine; Mentorship; Methadone; Modeling; Morbidity - disease rate; Naltrexone; National Institute of Drug Abuse; Osteomyelitis; Outpatients; Overdose; Participant; Persons; Pharmaceutical Preparations; Population; Positioning Attribute; Primary Health Care; Public Health; Qualitative Methods; Randomized Controlled Trials; Records; Recovery; Recurrence; Research; Research Personnel; Research Training; Specialist; Structure; Testing; Work; acceptability and feasibility; acute care; addiction; base; care outcomes; career; checkup examination; cost; design; effectiveness trial; evidence base; experience; high risk; hospital readmission; improved; insight; large datasets; mortality; motivational enhancement therapy; novel; opioid epidemic; opioid injection; opioid overdose; opioid use; opioid use disorder; outreach; peer; prevent; programs; randomized trial; response; skills; substance use treatment; success; therapy development; trial design

PROJECT SUMMARY Serious injection-related infections (SIRIs), including infective endocarditis, bacteremia, osteomyelitis, epidural abscess, and septic arthritis have more than doubled since 2002 due to the opioid epidemic, causing morbidity, mortality, and costing more than $700 million annually. Growing evidence suggests that medications for opioid use disorder (MOUD) which include methadone, buprenorphine, and extended-release naltrexone reduce readmission and death following SIRIs. In response to this emerging data, programs and studies seek to optimize MOUD initiation in hospitals. However, the benefits of MOUD have not been fully realized due to limited retention in treatment with MOUD after hospitalization. To date, there has been a paucity of research focused on MOUD retention, the crucial next step of the opioid use disorder (OUD) care continuum. Further, evidence-based MOUD retention interventions have not been adapted for individuals with SIRIs who have riskier injection practices, greater medical complexity, mortality, and costs than others with OUD. The Recovery Management Checkups model is a proactive, peer-delivered, motivational interviewing-based MOUD retention intervention that increased retention by 50% in outpatient addition treatment and following incarceration. It has been piloted in multiple settings, making it a promising intervention for individuals with SIRIs who face unique challenges following their infections. Therefore, the central objective of this proposal is to determine individual and group factors associated with MOUD treatment along the OUD care continuum in the critical 12 month period after a SIRI and to use these insights to adapt and test Recovery Management Checkups for this new population. This proposal includes three aims: 1) Examine MOUD treatment along the OUD care continuum in the 12 months after SIRIs; 2) Informed by the findings from Aim 1, adapt the Recovery Management Checkups MOUD retention model for individuals with SIRIs; 3) Conduct a pilot randomized controlled trial of the adapted intervention to promote MOUD retention and re-engagement for individuals with SIRIs. The findings from these Aims address a gap in current research and will inform care for individuals with SIRIs, a priority area for the National Institute on Drug Abuse. Dr. Kimmel, an early-career investigator is the PI and will use this Career Development Award to develop skills in modeling approaches to address recurrent events (e.g. multiple treatment episodes) and group membership (e.g. latent classes) in treatment retention data, qualitative methods, intervention adaptation and development, and clinical trials design. Developing these skills will position him to lead impactful research that will improve the care and outcomes for very high- risk individuals who use drugs. Dr. Kimmel will work closely with a mentorship and advisory team with experience in addiction medicine, infectious diseases, biostatistics, qualitative methods, intervention adaptation and development and clinical trials to accomplish his research and training Aims.

项目摘要 严重注射相关感染（SIRI），包括感染性心内膜炎、菌血症、骨髓炎、硬膜外 自2002年以来，由于阿片类药物的流行，脓肿和脓毒性关节炎增加了一倍以上，导致发病率， 死亡率，每年花费超过7亿美元。越来越多的证据表明， 使用障碍（MOUD），包括美沙酮，丁丙诺啡和缓释纳洛酮， SIRI后再入院和死亡针对这些新出现的数据，方案和研究力求 优化MOUD在医院的启动。然而，由于以下原因，MOUD的好处尚未充分实现： 住院后MOUD治疗的保留有限。迄今为止， 专注于MOUD保留，这是阿片类药物使用障碍（OUD）护理连续体的关键下一步。此外，本发明还 基于证据的MOUD保留干预措施尚未适用于患有SIRI的个体， 与其他OUD患者相比，风险更高的注射实践，更大的医疗复杂性，死亡率和成本。的 恢复管理检查模型是一种主动、对等交付、基于激励性访谈的MOUD 在门诊附加治疗和随访中，保留干预使保留增加50% 监禁。它已在多个环境中进行了试点，使其成为对患有糖尿病的个人的有希望的干预措施。 SIRI在感染后面临独特的挑战。因此，本建议的中心目标是 确定与MOUD治疗沿着OUD护理连续体相关的个体和群体因素， SIRI后的关键12个月，并利用这些见解来调整和测试恢复管理 为新来的人做体检。该建议包括三个目标：1）检查MOUD处理沿着 SIRI后12个月的OUD护理连续性; 2）根据目标1的发现，调整恢复 管理层检查SIRI患者的MOUD保留模型; 3）进行随机试点 适应性干预的对照试验，以促进MOUD的保留和个人的重新参与， SIRI。这些目标的发现解决了当前研究中的一个空白，并将为患有以下疾病的个人提供信息： SIRI是国家药物滥用研究所的优先领域。Kimmel博士是一名早期职业调查员， 并将利用这一职业发展奖，以发展技能的建模方法，以解决经常性的 治疗保留中的事件（例如多个治疗事件）和组成员（例如潜在类别） 数据，定性方法，干预措施的适应和发展，以及临床试验设计。发展中 这些技能将使他能够领导有影响力的研究，这将改善非常高的护理和结果- 吸毒的高危人群。Kimmel博士将与一个指导和咨询团队密切合作， 成瘾医学经验，传染病，生物统计学，定性方法，干预适应 和开发和临床试验，以实现他的研究和培训目标。