Teaching harm reduction in vulnerable environments (THRIVE): a peer-led intervention bridging acute care settings and the discharge to the community

摘要 有急性医疗问题的药物使用者（PWUD）随后的死亡率很高， 与药物使用有关的发病率，有明显的种族差异。虽然减少危害服务可以减少 药物过量和注射相关并发症在历史上在卫生保健环境之外发生， 将减少伤害纳入急性护理临床环境可以改善这些结果。存在一个临界 如何在卫生系统中最好地实施减少伤害服务，从而导致有效的行为 改变和解决公平差距。我们的研究建议发展一个可接受的，可行的，有效的同行领导的 减少伤害的服务。我们的总体目标是量身定制THRIVE（教学减少伤害 在脆弱环境中）干预，并确定其在改变行为和减少 PWUD的健康风险。THRIVE干预是由我们的团队沿着与患有以下疾病的人一起概念化的 生活经验，并告知COM-B模型的行为改变和理论领域 框架. THRIVE捆绑了基于证据的减少危害策略（例如，更安全的注射教育，采取 家用纳洛酮和芬太尼测试条）。它包括每周一次的短信推动的面对面会议， 电子内容。内容在12周内交付。我们的研究团队拥有广泛的专业知识， 社区合作研究、定性方法、行为健康干预设计和临床 为成功实现拟议目标，需要进行审判管理。我们将采用以人为本的设计 一种方法来定制THRIVE模型，并解决患者、提供者和系统级障碍， 在医院和急诊室环境中实施。这包括一个“设计冲刺”， PWUD将绘制问题（通过与患者和医疗保健提供者的定性访谈进行指导）， 实现元素，选择要开发的关键方面，并构建模型组件。这些 THRIVE模型的实施方法将在8周内对20名患者进行用户测试 期然后，我们将研究THRIVE干预在降低累积发病率方面的有效性。 基线至6个月期间自我报告的非致死性药物过量或皮肤和软组织感染， 混合1型随机对照试验中的PWUD。我们将进行随机对照试验， 三分之一的阿片类药物使用障碍住院或急诊的患者（n=390） 医院的我们还将分析实施的障碍和促进因素的繁荣模式使用的健康 公平执行框架，以确定为实现公平所需的任何执行支助 实施.

ABSTRACT People who use drugs (PWUD) with acute medical problems have high rates of subsequent mortality and morbidity related to substance use, with notable racial disparities. While harm reduction services to reduce overdose and injection-related complications have historically functioned outside of health care settings, integrating harm reduction into acute care clinical settings could improve these outcomes. There is a critical gap in how best to implement harm reduction services in the health system that will lead to effective behavioral change and address equity gaps. Our study proposes to develop an acceptable, feasible, and effective peer-led bundle of harm reduction services. Our overall objectives are to tailor the THRIVE (Teaching Harm Reduction In Vulnerable Environments) intervention and determine its efficacy in changing behaviors and reducing health risks among PWUD. The THRIVE intervention was conceptualized by our team along with people with lived experience and informed by the COM-B model for Behavior Change and the Theoretical Domains Framework. THRIVE bundles evidence-based harm reduction strategies (e.g. safer injection education, take home naloxone, and fentanyl test strips). It includes a face-to-face session boosted by weekly text messages and electronic content. Content is delivered over 12 weeks. Our research team has the extensive expertise in community-partnered research, qualitative methodology, behavioral health intervention design, and clinical trial management needed to successfully complete the proposed aims. We will use a human-centered design approach to tailor the THRIVE model and address the patient, provider, and systems-level barriers to implementation in hospital and emergency-department settings. This includes a “Design Sprint” in which PWUD will map the problem (guided by qualitative interviews with patients and healthcare providers), sketch implementation elements, choose the key aspects to develop, and build model components. These implementation methods for the THRIVE model will then be user-tested with 20 patients over an 8-week period. We will then examine the efficacy of the THRIVE intervention in reducing the cumulative incidence of self-reported non-fatal overdose or skin and soft tissue infection between baseline and 6-months among PWUD in a hybrid type 1 randomized controlled trial. We will conduct a randomized controlled trial recruiting patients (n=390) admitted to the hospital or Emergency Department with opioid use disorder in one of three hospitals. We will also analyze implementation barriers and facilitators of the THRIVE model using the health equity implementation framework to identify any needed implementation supports for widescale implementation.