Preventing Bacterial and Viral Infections among Injection Drug Users

描述（由申请人提供）：注射吸毒者（IDU）有许多医疗并发症的风险，包括血液传播的病毒（如艾滋病毒、丙型肝炎）和细菌（如皮肤脓肿、心内膜炎）感染。虽然先前的研究已经检查了预防艾滋病毒和丙型肝炎的降低风险战略的有效性，但很少关注预防注射吸毒者中的细菌感染，尽管这些感染非常常见，与昂贵的急诊就诊和住院有关，并导致相当高的发病率和死亡率。我们最近开发并试点测试了一种很有前景的旨在减少细菌和病毒感染的短期、两期风险降低干预（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，包括良好的会话和随访率，持续的干预对皮肤和针头清洁技能的影响，以及干预参与者中较低的细菌感染风险。目前的建议是在350名住院注射吸毒者中进行一项随机对照试验（RCT），将皮肤干预与仅评估条件（两组均接受快速艾滋病毒检测，检查检测结果并进行简短的艾滋病毒预防咨询）进行比较。在一般医院环境中，注射吸毒的流行率很高，否则可能不会寻求治疗的患者可以获得治疗，并且与药物有关的疾病的存在可以为患者更容易接受干预措施创造条件。根据干预后1个月、3个月、6个月、9个月和12个月收集的数据，我们假设Skin干预会产生比单纯评估更好的结果。主要结局包括1)细菌感染，2)参与高风险的细菌感染（皮下或肌肉注射，注射前不清洗皮肤）和病毒注射

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.