Preventing Bacterial and Viral Infections among Injection Drug Users

描述（由申请人提供）：注射吸毒者 (IDU) 面临一系列医疗并发症的风险，包括血源性病毒（例如，艾滋病毒、丙型肝炎）和细菌（例如，皮肤脓肿、心内膜炎）感染。虽然先前的研究已经检验了预防艾滋病毒和丙型肝炎的风险降低策略的有效性，但很少关注预防吸毒者中的细菌感染，尽管这些感染非常常见，与昂贵的急诊科就诊和住院治疗相关，并导致相当大的发病率和死亡率。我们最近开发并试点测试了一种有希望的简短的、两次疗程的风险降低干预措施，旨在减少细菌和病毒感染（皮肤和针头卫生干预或“皮肤”）。 Skin R21 的六个月结果证明了可行性和有希望的试点结果，包括出色的疗程和随访率、对皮肤和针头清洁技能的持续干预效果以及干预参与者中较低的细菌感染风险。目前的提案是一项皮肤干预的随机对照试验 (RCT)，与仅评估条件（两组均接受快速 HIV 检测、检测结果审查和简短的 HIV 预防咨询）在 350 名住院注射吸毒者中进行比较。在综合医院环境中，注射吸毒的流行率很高，本来可能不会寻求治疗的患者是可以接触到的，并且药物相关疾病的存在可以为患者更容易接受干预奠定基础。我们假设皮肤干预将产生比仅评估更好的结果，如干预后 1、3、6、9 和 12 个月收集的数据所示。主要结果包括 1) 细菌感染，2) 参与细菌感染的高风险注射实践（皮下或肌肉注射，注射前未清洁皮肤）和病毒感染 感染（共用注射设备），以及 3) 卫生服务的使用。我们还将检查皮肤卫生和注射技术的变化是否可能介导皮肤干预对细菌感染的影响。皮肤干预如果有效，将 减少注射吸毒者中细菌和病毒感染的发生，改善该人群的健康状况并节省医疗保健成本。在医院环境中招募注射吸毒者扩大了广泛采用这种新颖干预措施的可能性，增强了公共卫生影响。

DESCRIPTION (provided by applicant): Injection drug users (IDU) are at risk for a host of medical complications including blood-borne viral (e.g., HIV, Hepatitis C) and bacterial (e.g., skin abscesses, endocarditis) infections. While prior studies have examined the effectiveness of risk reduction strategies to prevent HIV and Hepatitis C, there has been little focus on preventing bacterial infections among IDUs, despite the fact that these infections are very common, associated with costly emergency department visits and hospitalization, and lead to considerable morbidity and mortality. We recently developed and pilot-tested a promising brief, two-session risk reduction intervention aimed at reducing both bacterial and viral infections (Skin and Needle Hygiene Intervention or "Skin"). Six- month outcomes from the Skin R21 demonstrated feasibility and promising pilot results including excellent session and follow-up rates, sustained intervention effects on skin and needle cleaning skills, and lower bacterial infection risk among intervention participants. The current proposal is a randomized controlled trial (RCT) of the Skin intervention, compared to an assessment-only condition (both groups receive rapid HIV testing, a review of testing results, and brief HIV prevention counseling) among 350 hospitalized IDUs. In the general hospital setting, the prevalence of injection drug use is high, patients who otherwise might not seek care are accessible, and the presence of a drug-related illness can set the stage for patients to be more receptive to interventions. We hypothesize that the Skin intervention will produce better outcomes than assessment-only as shown by data collected at 1-, 3-, 6-, 9-, and 12-month(s) post-intervention. Primary outcomes include 1) bacterial infections, 2) participation in high-risk injection practices for bacterial infections (subcutaneous or intramuscular injection, no skin cleaning prior to injection) and viral infections (sharing injection equipment), and 3) health services use. We will also examine whether changes in skin hygiene and injection technique may be mediating the effect of the Skin intervention on acquisition of bacterial infections. The Skin intervention, if effective, will reduce the acquisition of bacterial and viral infections among IDUs, improving health outcomes for this population and producing health care cost savings. Recruitment of IDUs in the hospital setting broadens the possibility of widespread adoption of this novel intervention heightens the public health impact.