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

摘要 使用药物(PWUD)并有急性医疗问题的人随后的死亡率和 与药物使用有关的发病率，有明显的种族差异。在减少危害服务的同时减少 服药过量和与注射相关的并发症历来在医疗保健环境之外发挥作用， 将减少危害纳入急性护理临床环境可以改善这些结果。有一个关键的问题 在如何最好地在卫生系统中实施减少危害服务方面的差距将导致有效的行为 改变和解决股权差距。我们的研究建议发展一种可接受的、可行的、有效的同行领导 减少危害服务捆绑包。我们的总体目标是量身定做Thrive(减少伤害教学 在脆弱环境中)干预并确定其在改变行为和减少 残障人士的健康风险。Thrive干预是由我们的团队与 生活体验和受COM-B模型影响的行为改变及其理论领域 框架。Thrive捆绑以证据为基础的减少伤害战略(例如，更安全的注射教育，采取 国产纳洛酮和芬太尼试纸)。它包括面对面的会议，由每周的短信和 电子内容。内容交付时间为12周。我们的研究团队拥有丰富的专业知识 社区合作研究、定性方法、行为健康干预设计和临床 试验管理需要成功地完成拟议的目标。我们将采用以人为中心的设计 定制Thrive模型并解决患者、提供商和系统级障碍的方法 在医院和急诊科环境中实施。其中包括《设计冲刺》，在这个节目中 PWUD将绘制问题图(通过对患者和医疗保健提供者的定性访谈进行指导)、草图 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周内与20名患者进行用户测试 句号。然后，我们将研究Thrive干预措施在降低心绞痛累积发病率方面的有效性 在基线和6个月之间自我报告的非致命性服药过量或皮肤和软组织感染 PWUD是一项混合型1型随机对照试验。我们将进行随机对照试验招募 住院或急诊科阿片类药物使用障碍患者(n=390) 医院。我们还将使用Health分析Thrive模式的实施障碍和推动者 公平实施框架，以确定任何需要的大规模实施支持 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.