Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE)

新英格兰北部农村地区的药物注射监测和护理加强 (DISCERNNE)

• 批准号: 9760225
• 负责人: Peter D Friedmann
• 金额: $ 137.8万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9760225
• 关键词: Acute suppurative arthritis due to bacteria; Adoption; Bacterial Infections; Caring; Clinic; Communicable Diseases; Communities; Comorbidity; County; Development; Disease; Disease Outbreaks; Effectiveness; Elements; Environment; Epidemic; Epidemiology; Epidural Abscess; Evaluation; Fentanyl; Geographic Locations; Gonorrhea; HIV; HIV/HCV; Health Services Accessibility; Healthcare; Hepatitis; Hepatitis B Vaccination; Hepatitis B Virus; Hepatitis C Therapy; Hepatitis C Transmission; Hepatitis C virus; Hybrids; Improve Access; Indiana; Individual; Infective endocarditis; Infrastructure; Injecting drug user; Injections; Intake; Intervention; Investigation; Laboratories; Laboratory Research; Learning; Maine; Methods; Modeling; Molecular; Morbidity - disease rate; Naloxone; Needle-Exchange Programs; New England; New Hampshire; Osteomyelitis; Overdose; Pharmaceutical Preparations; Phase; Policies; Population; Prevalence; Preventive service; Primary Health Care; Process; Public Health; Research; Research Methodology; Research Project Grants; Respondent; Risk; Risk Behaviors; Rural; Rural Community; Sampling; Service delivery model; Services; Sexually Transmitted Diseases; Site; Social Network; Specimen; Syphilis; Teleconsultations; Telemedicine; Testing; Time; Transportation; Triage; United States; Vermont; Visit; care coordination; care systems; design; high risk; injection drug use; insight; intervention program; laboratory equipment; medical specialties; mortality; multidisciplinary; novel strategies; opioid epidemic; opioid overdose; opioid use disorder; overdose death; overdose prevention; pre-exposure prophylaxis; prescription opioid; prevent; primary outcome; recruit; response; rural area; rural counties; secondary outcome; service delivery; symposium; treatment services; virtual

PROJECT SUMMARY/ABSTRACT In New England’s rural northern states, the epidemic of opioid use disorder (OUD) and its related sequelae ? overdose, HIV, hepatitis C virus (HCV), sexually transmitted infections (STIs) and other infectious comorbidities ? present the most substantial challenges to public health and health care in decades. This two- stage, mixed-methods study will examine the epidemiology of IDU, its infectious consequences, and service accessibility among young persons who inject drugs (PWID) (UG3 phase) in 15 rural counties in Maine, New Hampshire and Vermont, and then implement an integrated telemedicine approach to treat OUD and reduce HIV, HCV, STIs, major bacterial infections (e.g. infective endocarditis, septic arthritis, osteomyelitis, epidural abscess) and overdose (UH3 phase). The UG3 phase will employ qualitative, quantitative, social network, geospatial, and laboratory methods to characterize the risk environment and epidemiology of OUD, its infectious complications, opioid overdose, risk behaviors, service use and needs in a respondent-driven sample (n=360) of young PWID in these rural counties. An environmental assessment of policy and infrastructure will examine available services, needs and gaps. This phase will also build capacity to collect and deliver specimens for centralized HCV transmission investigation and molecular epidemiologic analysis. In the UH3 phase, a Hybrid Type 1 implementation study will evaluate the effectiveness of a regionalized, integrated model of expanded service delivery for rural PWID. Using a stepped wedge design, the UH3 study will roll-out expanded services into primary care clinics and practices (PCCP) in these 15 rural northern New England counties using regional real-time tele-consultation, assessment and triage for HIV, hepatitis and OUD; and virtual, expert-facilitated bi-weekly case conferences around key topics (e.g., overdose prevention and HIV pre-exposure prophylaxis [PrEP]). PWID recruited during the UG3 phase in intervention counties will be recontacted and referred to these PCCP sites. Primary outcomes will be the proportion of PWID: (1) with an initial assessment at a PCCP site ("intake"); (2) with an initial visit who initiated any treatment service within 30 days ("initiation”); (3) who initiated then received 3 more services within 180 days of initiation ("engagement”); and (4) discussed and followed via telemedicine (“retention”). Process evaluation will assess barriers, facilitators,implementationproblemsandnecessaryadaptations.Secondaryoutcomesincludetheproportion of PWID who receive: HAV/HBV vaccination and STI testing; naloxone rescue kits; and OUD, HIV and HCV treatment, including HIV suppression and sustained HCV response (SVR) among those who receive services. This project is uniquely responsive to RFA-DA-17-014 in that it will provide in-depth understanding of high- risk rural PWID, inform community response strategies, and implement a comprehensive, integrated approach to treat OUD, reduce overdose and infectious complications among PWID in the rural US.

项目总结/摘要 在新英格兰的农村北方州，阿片类药物使用障碍（OUD）及其相关后遗症的流行 ?过量、艾滋病毒、丙型肝炎病毒（HCV）、性传播感染（STI）和其他传染性疾病 合并症？这是几十年来公共卫生和医疗保健面临的最大挑战。这两个- 一个阶段，混合方法的研究将审查IDU的流行病学，其传染后果，和服务 在缅因州的15个农村县，新的注射毒品的年轻人（PWID）（UG3阶段）的可及性 汉普郡和佛蒙特州，然后实施综合远程医疗方法来治疗OUD， HIV、HCV、STI、重大细菌感染（例如感染性心内膜炎、脓毒性关节炎、骨髓炎、硬膜外 脓肿）和用药过量（UH3期）。UG3阶段将采用定性，定量，社会网络， 地理空间和实验室方法来表征OUD的风险环境和流行病学， 感染性并发症、阿片类药物过量、风险行为、服务使用和需求， 样本（n = 360）的青年PWID在这些农村县。政策和环境评估 基础设施将审查现有服务、需求和差距。这一阶段还将建设收集 并运送标本用于HCV传播集中调查和分子流行病学分析。 在UH3阶段，混合1型实施研究将评估区域化、 为农村残疾人提供扩大服务的综合模式。使用阶梯式楔形设计，UH3研究 在这15个北方新农村地区， 英格兰各县使用区域实时远程咨询，评估和分类艾滋病毒，肝炎和OUD; 以及围绕关键主题（例如，过量预防和艾滋病毒 暴露前预防[PrEP]）。在UG3阶段在干预县招募的PWID将 重新联系并转介到这些PCCP站点。主要结果将是PWID的比例：（1） 在PCCP站点进行的初始评估（"摄入量"）;（2）在30天内开始任何治疗服务的初始访视 （3）发起者在发起后180天内接受了3次以上的服务（"参与"）; 和（4）通过远程医疗讨论和跟踪（"保留"）。过程评价将评估障碍， 促进者、实施问题和必要的调整。次要结果包括 接受：HAV/HBV疫苗接种和STI检测;纳洛酮急救包; OUD、HIV和HCV 治疗，包括在接受服务的人中抑制艾滋病毒和持续的HCV反应（SVR）。 本项目是对RFA-DA-17 - 014的唯一响应，因为它将提供对高 风险农村PWID，告知社区应对策略，并实施全面的综合方法 治疗OUD，减少美国农村PWID中的药物过量和感染并发症。