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

项目总结 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，脓肿和感染性关节炎增加了一倍以上，导致发病率， 死亡率，每年造成超过7亿美元的损失。越来越多的证据表明，阿片类药物 使用障碍(Moud)，包括美沙酮、丁丙诺啡和缓释纳曲酮减少 在Siris之后重新入院和死亡。作为对这些新兴数据的回应，项目和研究试图 优化医院的Moud启动。然而，Moud的好处并未完全实现，原因是 入院后使用Moud治疗时的有限滞留。到目前为止，这方面的研究还很少 重点放在Moud保留上，这是阿片使用障碍(OUD)护理连续体的关键下一步。此外， 基于证据的Moud保留干预措施尚未适用于患有Siri的患者 风险更高的注射实践，更大的医疗复杂性，死亡率和成本比其他使用OUD的人。这个 恢复管理检查模式是一种主动、同行交付、基于激励性访谈的模式 保留干预使门诊附加治疗和后续治疗中的保留增加50% 监禁。它已经在多种环境中进行了试点，使其成为一种有希望的干预措施，适用于患有 在感染后面临独特挑战的Siri人。因此，这项提议的中心目标是 确定与Moud治疗相关的个人和群体因素 Siri之后的关键12个月期间，并使用这些见解来适应和测试恢复管理 为这一新人口做体检。这项建议包括三个目的：1)检查沿线的霉菌处理 在Siris后12个月内持续护理；2)根据目标1的调查结果，适应康复 管理体检：Siris个体的Moud保持模型；3)进行随机试点 改编干预的对照试验，以促进患有MUD的患者保持和重新参与 西里斯。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 国家药物滥用问题研究所的优先领域。坎摩尔博士是一名职业生涯早期的调查员 并将利用这一职业发展奖来培养建模方法的技能，以应对经常性的 治疗保留中的事件(例如多个治疗事件)和小组成员(例如潜伏期) 数据、定性方法、干预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，改善非常高- 给吸毒的人带来风险。基梅尔博士将与一个指导和咨询团队密切合作， 成瘾医学、传染病、生物统计学、定性方法、干预适应经验 以及开发和临床试验，以实现他的研究和培训目标。

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.